Shock séptico: complicación atípica de duplicación del tracto alimentario / Septic shock: an atypical complication of alimentary tract duplication

Las duplicaciones del tracto alimentario son un conjunto heterogéneo de anomalías congénitas del tubo digestivo. Su forma de presentación es variada, y pueden desarrollar distintas complicaciones libradas a su evolución natural. La infección es una complicación poco frecuente, pero que no puede desconocerse por la gravedad que implica. Se presenta el caso de una paciente de 2 años de edad, previamente sana, con una complicación atípica de una duplicación del tracto alimentario: un shock séptico. Consultó inicialmente por distensión y dolor abdominal asociado a una masa abdominal palpable. Los estudios imagenológicos evidenciaron una formación líquida parcialmente tabicada en el hemiabdomen derecho. Durante la internación, se presentó una infección intratumoral, que evolucionó al shock séptico. Respondió favorablemente al tratamiento médico del shock, y se realizó la exéresis quirúrgica posteriormente. La anatomía patológica confirmó la duplicación del tracto alimentario.

Alimentary tract duplications are heterogenous congenital anomalies of the digestive tract. Their form of presentation is varied, and they may lead to different complications, depending on their natural course. Infection is a rare complication, but it cannot be ignored because of its severity. Here we describe the case of an otherwise healthy 2-year-old girl with an atypical complication of alimentary tract duplication: septic shock. She initially consulted due to abdominal distension and pain associated with a palpable abdominal mass. The imaging studies showed a partial fluid septation in the right side of the abdomen. During hospitalization, an intratumoral infection developed, which progressed to septic shock. The patient responded favorably to medical treatment for shock, and surgical resection was subsequently performed. The pathology report confirmed the presence of alimentary tract duplication.

Colangitis aguda secundaria a hidatidosis biliar resuelta por colangiopancreatografía retrógrada endoscópica. Reporte de un caso / Acute cholangitis secondary to biliary hydatidosis resolved by endoscopic retrograde cholangiopancreatography. Reporte of a case

Introducción. La hidatidosis biliar es la complicación más frecuente de la hidatidosis hepática. La colangiopancreatografía retrógrada endoscópica desempeña un papel clave en el tratamiento. Caso clínico. Femenina de 57 años acude por dolor abdominal, vómito, diarrea, leucocitosis, hiperbilirrubinemia, en colangioresonancia magnética presenta vía biliar dilatada, defecto de señal en tercio proximal y distal. La colangiopancreatografía retrógrada endoscópica evidencia presencia de cuerpo extraño de aspecto de membranas, vía biliar dilatada, se extrae quistes de aspecto parasitario. Conclusión. El tratamiento de elección es quirúrgico y farmacológico, la colangiopancreatografía retrógrada endoscópica antes de la cirugía, asegura la extracción del material hidatídico y trata la obstrucción biliar, identifica el trayecto fistuloso y facilita su cierre mediante colocación de prótesis y esfinterotomía, por lo que constituye un tratamiento no quirúrgico efectivo y con margen amplio de seguridad.

Introduction: Biliary hydatid disease is the most common complication of hepatic hydatid disease. Endoscopic retrograde cholangiopancreatography plays a key role in treatment. Clinical case: A 57-year-old female presented with abdominal pain, vomiting, diarrhea, leukocytosis, mixed hyperbilirubinemia, and magnetic resonance cholangiography showed a dilated bile duct and a signal defect in the proximal and distal third. Endoscopic retrograde cholangiopancreatography shows the presence of a foreign body with a membrane appearance, a dilated bile duct, and cysts with a parasitic appearance. Conclusion: The treatment of choice is surgical and pharmacological, endoscopic retrograde cholangiopancreatography before surgery ensures the extraction of hydatid material and treats biliary obstruction, identifies the fistulous tract and facilitates its closure by placing a prosthesis and sphincterotomy, which is why it constitutes a Effective non-surgical treatment with a wide margin of safety.

Factores asociados al desenlace en niños con mal rotación intestinal manejados en el Hospital Infantil de San Vicente Fundación, Medellín, Colombia / Factors associated with outcome in children with intestinal malrotation managed at the Hospital Infantil of San Vicente Fundación, Medellín, Colombia

Introducción. El intestino primitivo rota durante la vida embrionaria. Cuando ocurre de forma inadecuada aparece la malrotación intestinal que puede llevar a la obstrucción o al vólvulo del intestino medio. La incidencia disminuye con el aumento de la edad. La malrotación intestinal es una de las principales causas de complicaciones del tracto gastrointestinal en la edad pediátrica. Métodos. Estudio retrospectivo, observacional, transversal y analítico, de la experiencia durante 10 años en pacientes menores de 15 años con diagnóstico de malrotación intestinal, tratados en el Hospital Infantil de San Vicente Fundación, en Medellín, Colombia. Se buscó la asociación entre variables demográficas, clínicas e imagenológicas con los desenlaces. Resultados. Se obtuvieron 58 pacientes con malrotación intestinal, 65 % menores de 1 año. En 29,3 % de los pacientes se hizo el diagnóstico con la presentación clínica; los síntomas predominantes fueron distensión abdominal y emesis. En el 24,1 % se confirmó el diagnóstico con imágenes. Las variables con una diferencia estadísticamente significativa a favor de encontrar una malrotación complicada fueron choque séptico (OR=11,7), síndrome de respuesta inflamatoria sistémica (OR=8,4) y deshidratación (OR=5,18). Conclusiones. La malrotación intestinal tiene complicaciones como perforación, peritonitis, vólvulo e intestino corto. El vólvulo se acompaña de shock y sepsis, con mortalidad hasta del 50 %. Las imágenes diagnósticas son una ayuda, pero no se puede basar la conducta médica en estas porque ninguna imagen garantiza el diagnóstico definitivo. Los signos de alarma son poco específicos. En menores de un año con emesis, distensión y dolor abdominal se debe sospechar malrotación intestinal.

Introduction. The primitive intestine rotates during embryonic life. When it occurs inappropriately, intestinal malrotation appears, which can lead to obstruction or midgut volvulus. The incidence decreases when age increases. Intestinal malrotation is one of the main causes of complications of the gastrointestinal tract in pediatric age. Method. Retrospective, observational, cross-sectional and analytical study of the experience over 10 years in patients under 15 years of age with a diagnosis of intestinal malrotation, treated at Hospital Infantil of San Vicente Fundación, in Medellín, Colombia. The association between demographic, clinical and imaging variables with the outcomes was sought. Results. There were 58 patients with intestinal malrotation, 65% under one year of age. In 29.3% of patients, intestinal malrotation was diagnosed clinically. The predominant symptoms were abdominal distension and emesis. In 24.1% the diagnosis was confirmed with imaging. The variables with a statistically significant difference in favor of finding a complicated malrotation were septic shock (OR=11.7), systemic inflammatory response syndrome (OR-8.4), and dehydration (OR=5.18). Conclusions. Malrotation has complications such as perforation, peritonitis, volvulus, and short bowel. Volvulus is accompanied by shock and sepsis, with mortality of up to 50%. Diagnostic images are helpful, but medical conduct cannot be based on them because no image guarantees a definitive diagnosis. The warning signs are not very specific. In children under one year of age with emesis, distension and abdominal pain, intestinal malrotation should be suspected.

Tumor neuroectodérmico maligno del tracto gastrointestinal: a propósito de un caso / Malignant neuroectodermal tumor of the gastrointestinal tract: case report

El tumor neuroectodérmico maligno del tracto gastrointestinal es una neoplasia rara con pocos casos reportados en la literatura, especialmente en América Latina. Descrito por primera vez en 2003, se trata de una entidad sin tratamiento estandarizado y de pobre pronóstico. Se presenta el caso de una paciente de 22 años de edad que acude a la consulta por dolor abdominal, anemia y masa abdominal palpable. Luego de estudios pertinentes se decide la conducta resectiva y el posterior tratamiento oncológico. (AU)

Malignant gastrointestinal neuroectodermal tumor (GNET), formerly known as clear cell sarcoma of the gastrointestinal tract, is an extremely rare tumor of mesenchymal origin, which presents great microscopic and molecular similarity to clear cell sarcoma found in other parts of the body, such as tendons and aponeurosis. It is characterized by its rapid evolution, high recurrence rate and frequent diagnosis as metastatic disease.1,2 (AU)

Effects of warm acupuncture on post-stroke cognitive impairment based on the theory of intestinal flora / 国际中医中药杂志

Objective:To observe the effects of warm acupuncture on post-stroke cognitive impairment (PSCI) based on the theory of intestinal flora.Methods:A randomized controlled trial was conducted. 60 patients with PSCI in the Department of Acupuncture and Neurology of the First Affiliated Hospital of Xinjiang Medical University from October 2020 to June 2022 were selected as the observation objects, and were divided into 2 groups by random number table, with 30 cases in each group. On the basis of cognitive rehabilitation training, the treatment group was given warm acupuncture treatment, and the control group was given routine acupuncture treatment. 2 groups were treated for 4 weeks as 1 course, and a total of 4 courses were treated. Montreal cognitive assessment (MoCA) was used to assess patients' cognitive function before and after treatment, and mini-mental state examination (MMSE) was used to assess patients' intelligence level. The numbers of bifidobacteria and lactic acid bacteria in fecal samples were calculated, and plasma gamma-aminobutyric acid (GABA) levels were detected by ELISA to evaluate the clinical efficacy.Results:During the study, 1 case was lost in each of the two groups, and finally 29 cases were included in the curative effect statistics. The total effective rate was 79.3% (23/29) in the treatment group and 65.5% (19/29) in the control group, with statistical significance ( χ2=43.39， P<0.05). After treatment, MoCA score [(24.23±1.36) vs. (21.26±1.30), t=3.12] and MMSE score [(25.35±1.24) vs. (21.52±1.22), t=3.25] in the treatment group were higher than those in the control group ( P<0.05); Bifidobacterium [(9.20±1.25) LgCFU/g vs. (7.23±1.21) LgCFU/g, t=2.98], Lactic acid bacteria [(8.24±1.12) LgCFU/g vs. (6.25±1.22) LgCFU/g, t=2.92], and the level of GABA [(283.80±83.54) mmol/L vs. (264.76±61.38) mmol/L, t=10.54] were higher than those in the control group ( P<0.05 or P<0.01). Conclusion:Warm acupuncture and moxibustion can effectively regulate the number of intestinal beneficial bacteria in PSCI patients, increase the level of GABA, promote brain tissue repair and improve cognitive function.

Differences in gut microbiota among primary school students with different levels of sugar sweetened beverage consumption / 中国学校卫生

Objective@#To explore the differences in the gut microbiota of primary school students with different levels of sugar sweetened beverage intake, so as to provide scientific evidence for better identification of health risks in children and the development of targeted health policies.@*Methods@#In June 2022, a total of 192 healthy primary school students from Chengdu were selected using a stratified cluster random sampling method. The sugar sweetened beverage intake was assessed through a dietary frequency questionnaire. Based on the median daily sugar sweetened beverage intake, primary school students were categorized into a low intake group ( n =96) and a high intake group ( n =96). The gut microbiota in fresh fecal samples from the two groups of primary school students was analyzed using 16S rRNA high throughput sequencing, and the diversity and community structure differences in the gut microbiota were compared.@*Results@#Children in the low intake group had a sugar sweetened beverage intake of (21.3±1.6) mL/d, while the high intake group had an intake of (269.6±37.3) mL/d. Diversity analysis results showed that there were no statistically significant differences between the low intake and the high intake group in terms of α diversity metrics: Observed_otus index [298.50 (259.75, 342.25), 305.50 (244.25, 367.75)], Goods_coverage index [1.00 (1.00, 1.00), 1.00 (1.00, 1.00)], Chao index [304.18 (260.75, 348.78), 305.88 (245.68, 370.88)], Shannon index [5.88 (5.29, 6.45), 5.71 (4.89, 6.28)] and Simpson index [0.95 (0.91, 0.97), 0.94 (0.88, 0.97)] ( Z =-0.64, -0.76, -0.54, -1.76, -1.67, P >0.05). Furthermore, no statistically significant difference was observed in β diversity between the two groups ( R 2=0.006, P >0.05). At the genus level, the abundance of Blautia [0.033 (0.018, 0.055)] and Fusicatenibacter [0.009 (0.005, 0.015)] were higher in the low intake group compared to the high intake group [0.024 (0.013, 0.041),0.006 (0.003, 0.011)]and differences were statistically significant ( Z =-2.52, -2.81, P <0.05). LEfSe analysis highlighted intergroup differences primarily in Blautia, Fusicatenibacter and Sarcina( LDA= 3.56,3.12,3.53, P <0.05).@*Conclusions@#There is no significant difference in the diversity and overall structure of the gut microbiota in primary school students with different levels of sugar sweetened beverage intake. However, there are species variations at the genus level. The information can serve as a scientific basis for identifying health risks in primary school students and formulating targeted health strategies.

Research progress on drug treatment and drug resistance mechanism of gastrointestinal stromal tumors / 中国临床药理学与治疗学

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal-derived tumors of the gastrointestinal tract. Tyrosine kinase inhibitors (TKIs) are the cornerstone of GIST therapy, but mutations in resistance genes pose many problems for treatment, especially the heterogeneity of KIT resistance mutations. In recent years, with the release of a number of GIST related drug research and experimental results, the great potential of targeted therapy, immunotherapy and combination therapy to treat GIST in different directions has been revealed, providing more therapeutic directions for GIST. This article will review the experimental research and future direction in recent years.

Correlation between stool form and diversity of intestinal flora among children and adolescents / 中国学校卫生

Objective@#To investigate the differences and diversity changes in gut microbiota between children and adolescents with constipation and diarrhea, and healthy individuals, and to explore the correlation between changes in stool consistency and gut microbiota, in order to provide a scientific reference for the research on intestinal microecology among children and adolescents.@*Methods@#From October 2021 to March 2022, a total of 42 children and adolescents with constipation and 37 with diarrhea from a tertiary hospital in Hangzhou City, and 43 healthy individuals from 3 primary and secondary schools were included in this study. Fecal samples of children and adolescents were collected and then stool genomic DNA was extracted for 16S rRNA gene high throughput sequencing, and the sequencing results were analyzed. In the analysis of alpha diversity, the Kruskal-Wallis rank sum test was used to compare the differences between the three groups, and the FDR multiple testing correction was used for pairwise comparisons. In the analysis of beta diversity, the Adonis test was used to compare the overall differences between the three groups, and the ANOSIM test was used for pairwise comparisons. In the LEfSe analysis, the LDA scores obtained through LDA analysis (linear regression analysis).@*Results@#Alpha diversity analysis showed that there were statistically significant differences in the Shannon index (4.01, 3.81, 4.19) and Simpson index (0.05, 0.06, 0.04) between the diarrhea group, constipation group, and healthy group ( H=6.05, 6.35, P <0.1). Further pairwise comparison showed that the Shannon index and Simpson index of the healthy group were higher than those of the constipation group ( P <0.1). Beta diversity analysis showed that the impact of grouping factors on inter group differences was statistically significant ( R 2=0.045, P <0.1). Community composition analysis showed that there were 234 species in total among the three groups, and 36 unique species in the healthy group, 36 species in the diarrhea group, and 48 species in the constipation group. Species difference analysis showed significant differences in species composition at the genus level among the three groups ( H=0.000 05, 0.000 16, 0.000 20, 0.000 21, 0.000 53, 0.001 39, P <0.1), including Lachnospiraceae of Firmicutes phylum, Eubacterium hallii, Veillonellaceae, Qscillospiraceae, Butyricicoccaceae and Staphylococcaceae, respectively. KEGG abundance statistics and COG functional analysis showed that there were no significant differences in gene expression abundance of the same function among the three groups ( P >0.1).@*Conclusions@#The different stool consistency of children and adolescents is related to changes in gut microbiota composition. Compared to the healthy group, children with constipation or diarrhea have disrupted gut microbiota balance, with a shift in dominant bacteria and a higher abundance of opportunistic pathogens.

Relationship between gastrointestinal symptoms and COVID-19 infection in the pediatric population: a scoping review / Relación entre síntomas gastrointestinales e infección por COVID-19 en la población pediátrica: revisión del alcance / Relação entre sintomas gastrointestinais e infecção por COVID-19 na população pediátrica: revisão de escopo

ABSTRACT Objective: To map the evidence in the literature about the relationship between gastrointestinal symptoms and COVID-19 in the pediatric population. Method: This is a scoping review following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. The search was carried out on the following bases: Embase, Google Scholar, PubMed, Scopus, LILACS, CINAHL, Scielo, Web of Science and Virtual Health Library Portal, between July and August 2023. Original studies available in full, in any language, were included. Results: Ten studies were chosen that pointed to three premises: (1) the ACE2 receptor is found in the epithelial cells of the gastrointestinal tract; (2) gastrointestinal symptoms are mediated by stress and infection is justified by the gut-brain axis; (3) it develops the process of Multisystem Inflammatory Syndrome in children, affecting the gastrointestinal tract. Conclusion: The synthesis of evidence provided three assumptions which guide the origin of gastrointestinal symptoms. The identification of gastrointestinal symptoms in children affected by COVID-19 can assist in the clinical approach and management of care and treatments.

RESUMEN Objetivo: Mapear la evidencia en la literatura sobre la relación entre síntomas gastrointestinales y COVID-19 en la población pediátrica. Método: Se trata de revisión de alcance siguiendo las recomendaciones del Instituto Joanna Briggs y PRISMA Extension for Scoping Reviews (PRISMA-ScR): Lista de verificación y explicación. La búsqueda se realizó sobre las siguientes bases: Embase, Google Scholar, PubMed, Scopus, LILACS, CINAHL, Scielo, Web of Science y Portal Biblioteca Virtual en Salud, entre julio y agosto de 2023. Se incluyeron estudios originales disponibles en su totalidad, en cualquier idioma. Resultados: Se eligieron 10 estudios que apuntaban a tres premisas: (1) el receptor ACE2 se encuentra en las células epiteliales del tracto gastrointestinal; (2) los síntomas gastrointestinales están mediados por el estrés y la infección está justificada por el eje cerebro-intestino; (3) desarrolla el proceso del Síndrome Inflamatorio Multisistémico en niños, afectando el tracto gastrointestinal. Conclusión: La síntesis de evidencia proporcionó tres supuestos que guían el origen de los síntomas gastrointestinales. La identificación de síntomas gastrointestinales en niños afectados por COVID-19 puede ayudar en el abordaje clínico y el manejo de la atención y los tratamientos.

RESUMO Objetivo: Mapear as evidências na literatura acerca da relação entre sintomas gastrointestinais e a COVID-19 na população pediátrica. Método: Trata-se de scoping review seguindo as recomendações do Instituto Joanna Briggs e PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. A busca foi realizada nas bases: Embase, Google Acadêmico, PubMed, Scopus, LILACS, CINAHL, Scielo, Web of Science e Portal da Biblioteca Virtual em Saúde, entre julho e agosto de 2023. Foram incluídos estudos originais disponíveis na íntegra, em qualquer idioma. Resultados: Foram eleitos 10 estudos que apontaram para três premissas: (1) o receptor ECA 2 é encontrado nas células epiteliais do trato gastrointestinal; (2) os sintomas gastrointestinais são mediados pelo estresse e a infecção é justificada pelo eixo cérebro-intestino; (3) desenvolve o processo de Síndrome Inflamatória Multissistêmica em crianças, afetando o trato gastrointestinal. Conclusão: A síntese de evidências proporcionou três pressupostos os quais orientam a origem dos sintomas gastrointestinais. A identificação dos sintomas gastrointestinais em crianças acometidas por COVID-19 pode auxiliar na abordagem clínica e manejo de cuidados e tratamentos.

A Review on Polyherbal Formulations and Herbal Medicine for Management of Ulcer with Recent Trends

A peptic ulcer (PU) is common gastrointestinal disorder which is seen among many people. It is an erosion in a segment of the gastrointestinal mucosa, typically in the stomach (gastric ulcer) or first few centimeters of duodenum (duodenal ulcer) that penetrates through the muscularis mucosae. Ulceration occurs when there is a disturbance of the normal equilibrium caused by either enhanced aggression or diminished mucosal resistance. It may cause by Helicobacter pylori infection, regular usage of non-steroidal anti-inflammatory’s, irregular food habits, stress, and gastric acid secretions. There are several synthetic medications available to treat ulcers. However, compared to herbal supplements, these medications are more expensive and likely to have more side effects. Various herbal medicines have traditionally been used to cure PU disease. The active phytochemical components of a single plant are insufficient to produce the desired therapeutic effects. Combination of two or more than two herbs is called polyherbal formulation. Polyherbal formulations are used to improve the therapeutic potential. The medicinal effect will be boosted and the toxicity will be reduced when various herbs are combined in appropriate ratios in the polyherbal formulation that this study is based on the herbs, polyherbal formulations (in treating PU), recent work, and patent on polyherbal formulations based on pharmacological activities.

Excéresis de quiste mesentérico gigante en paciente femenina de 36 años / Excision of a giant mesenteric cyst in a 36-year-old female patient

INTRODUCCIÓN: Los quistes mesentéricos son tumores intra-abdominales definidos como cualquier quiste en el mesenterio del tracto gastrointestinal, ubicándose más frecuentemente en intestino delgado (íleon 60%) cuya incidencia es de tan solo 1 en 350.000 casos, haciendo relevante la publicación de los casos identificados para ampliar el conocimiento y conducta que se debe tener frente a los mismos. CASO CLÍNICO: Se trata de una paciente femenina de 36 años de edad, que acudió con cuadro de dolor abdominal acompañado de importante aumento del diámetro abdominal de un año de evolución, agudizado hace 4 días, por lo que se realizó ecografía abdominal donde se observó una masa quística de aproximadamente 7554ml, completando con estudio tomográfico donde no se observó aparente compromiso de grandes vasos, identificándose quirúrgicamente masa quística dependiente de mesenterio que comprometía la tercera y cuarta porción del duodeno, por lo que requirió resección de las mismas con anastomosis primaria, tras lo cual paciente mostró adecuada respuesta tras el procedimiento. DISCUSIÓN: El tratamiento de elección frente a un quiste mesentérico es la resección del mismo, debido a que otros métodos han mostrado altas tazas de recurrencia, sin embargo, el abordaje quirúrgico varía de acuerdo al cuadro clínico, teniendo como primera opción la resolución laparoscópica, no obstante, se optó por la realizar una laparotomía dado el gran volumen del quiste evidenciado en estudios de imagen. CONCLUSIONES: Los quistes mesentéricos tienen buen pronóstico una vez que son resecados completamente, sin embargo, es importante tomar en cuenta que el riesgo de compromiso vascular se vincula con el tamaño del mismo, algo que se puede confirmar solo durante el procedimiento quirúrgico, es por ello que se debe anticipar estas situaciones y tomar las medidas para reducir las consecuencias del mismo.

INTRODUCTION: Mesenteric cysts are intra-abdominal tumors defined as any cyst in the me-sentery of the gastrointestinal tract, most frequently located in the small intestine (ileum 60%) whose incidence is only 1 in 350,000 cases, making the publication of the cases relevant. iden-tified to expand the knowledge and behavior that must be followed regarding them. CLINICAL CASE: This is a 36-year-old female patient who presented with abdominal pain accompanied by a significant increase in abdominal diameter for one year, exacerbated 4 days ago, so an abdominal ultrasound was performed where a cystic mass of approximately 7554 ml, completed with a tomographic study where no apparent involvement of the great vessels was observed, surgically identifying a cystic mass dependent on the mesentery that compromised the third and fourth portions of the duodenum, which required resection of the same with primary anastomosis, after which the patient showed an adequate response after the procedure. DISCUSSION: The treatment of choice for a mesenteric cyst is its resection, because other methods have shown high rates of recurrence; however, the surgical approach varies according to the clinical picture, with laparoscopic resolution being the first option; however, it was decided to perform a laparo-tomy given the large volume of the cyst evident in imaging studies. CONCLUSION: Mesenteric cysts have a good prognosis once they are completely resected, however, it is important to take into account that the risk of vascular compromise is linked to its size, something that can be confirmed only during the surgical procedure, which is why These situations must be anticipated and measures taken to reduce their consequences

La ingesta accidental Quiste de duplicación duodenal en un paciente pediátrico. Reporte de caso

Introducción. Los quistes de duplicación duodenal son malformaciones raras, que ocurren durante el desarrollo embriológico del tracto gastrointestinal. Caso clínico. Se presenta el caso de un niño de tres años, con cuadro clínico de dolor abdominal, náuseas y vómitos. La ecografía y la tomografía computarizada informaron una imagen quística entre el hígado, riñón derecho y colon. Resultados. Se realizó laparoscopia encontrando un quiste de duplicación duodenal con moco en la primera porción del duodeno. Se practicó una resección del quiste y mucosectomía del segmento restante. Conclusión. Los síntomas de un quiste de duplicación duodenal son inespecíficos y su hallazgo frecuentemente es incidental. El tratamiento quirúrgico depende del tamaño, la ubicación y su relación con la vía biliar.

Introduction. Duodenal duplication cysts are rare malformations that occur during the embryological development of the gastrointestinal tract. Clinical case. The case of a three-year-old boy with abdominal pain, nausea, and vomiting is presented. Ultrasound and computed tomography revealed a cyst between the liver, right kidney, and colon. Results. Laparoscopy was performed, finding a duodenal duplication cyst with mucus in the first portion of the duodenum. A resection of the cyst and mucosectomy of the remaining segment were performed. Conclusion. The symptoms of a duodenal duplication cyst are nonspecific and its finding is frequently incidental. Surgical treatment depends on the size, location, and relationship to the bile duct.

Quiste de duplicación duodenal en un paciente pediátrico. Reporte de caso / Duodenal duplication cyst in a pediatric patient. Case report

Introducción. Los quistes de duplicación duodenal son malformaciones raras, que ocurren durante el desarrollo embriológico del tracto gastrointestinal. Caso clínico. Se presenta el caso de un niño de tres años, con cuadro clínico de dolor abdominal, náuseas y vómitos. La ecografía y la tomografía computarizada informaron una imagen quística entre el hígado, riñón derecho y colon. Resultados. Se realizó laparoscopia encontrando un quiste de duplicación duodenal con moco en la primera porción del duodeno. Se practicó una resección del quiste y mucosectomía del segmento restante. Conclusión. Los síntomas de un quiste de duplicación duodenal son inespecíficos y su hallazgo frecuentemente es incidental. El tratamiento quirúrgico depende del tamaño, la ubicación y su relación con la vía biliar.

Introduction. Duodenal duplication cysts are rare malformations that occur during the embryological development of the gastrointestinal tract. Clinical case. The case of a three-year-old boy with abdominal pain, nausea, and vomiting is presented. Ultrasound and computed tomography revealed a cyst between the liver, right kidney, and colon. Results. Laparoscopy was performed, finding a duodenal duplication cyst with mucus in the first portion of the duodenum. A resection of the cyst and mucosectomy of the remaining segment were performed. Conclusion. The symptoms of a duodenal duplication cyst are nonspecific and its finding is frequently incidental. Surgical treatment depends on the size, location, and relationship to the bile duct.

Niveles de pH gastrointestinal posprandial en juveniles de Piaractus brachypomus (Serrasalmidae) y Schizodon fasciatus (Anostomidae) / Postprandial gastrointestinal pH levels in juveniles of Piaractus brachypomus (Serrasalmidae) and Schizodon fasciatus (Anostomidae)

RESUMEN Se realizó un estudio comparativo para determinar variaciones del pH gastrointestinal posprandial en juveniles de Piaractus brachypomus (n = 21) y Schizodon fasciatus (n = 21) en condiciones de cultivo. Previo ayuno de 24 horas, los peces fueron alimentados tres veces al día a saciedad aparente, empleando una dieta mixta, conformada por alimento balanceado y músculo de corazón de pollo (proporción 1:1). La estimación del pH en el estómago, en la porción anterior y en la porción media del intestino se realizó antes de la alimentación y ocho horas posprandial, utilizando un electrodo de pH con punta tipo lanza. Se observaron diferencias significativas (p < 0,05) de los valores de pH en el estómago y en la porción media del intestino, según el tiempo de digestión en ambas especies; mientras que, en la porción anterior del intestino, solo S. fasciatus mostró diferencias significativas (p < 0,05). En ambas especies se observó un incremento del pH estomacal a la primera hora posprandial (2,39 a 4,78 en P. brachypomus, 4,47 a 4,73 en S. fasciatus), motivado por el efecto del alimento ingerido y con una reducción de los valores al finalizar el experimento. Durante las horas de evaluación, los valores de pH intestinal para P. brachypomus y S. fasciatus estuvieron entre 6,68 y 7,47 y 6,86 y 7,60, respectivamente, aumentando de manera distal a lo largo del intestino. Se concluye que ambas especies presentan una acidificación estomacal permanente, mientras que la porción anterior y media del intestino mantienen un pH ligeramente neutro durante la digestión y asimilación del alimento.

ABSTRACT A comparative study to determine variations in postprandial pH values along the gastrointestinal tract was performed among juveniles of Piaractus brachypomus (n = 21) and Schizodon fasciatus (n = 21) in rearing conditions. After fasting for 24 hours, the fish were fed three times a day to apparent satiety, with a mixed diet containing pelleted balanced food and chicken heart muscle (ratio 1:1). The evaluation was made before feeding and postprandial (eight hours), where the pH values of the stomach, in the anterior and in the middle portions of the intestine were estimated, using a pH electrode with a lancetype tip. Significant differences (p < 0.05) at the stomach and the middle portions of the intestine, according to the digestion time were observed in both species, while at the anterior portions of the intestine, only S. fasciatus showed significant differences (p < 0.05). In both species, an increase in stomach pH was observed in the first postprandial hour (2,39 to 4,78 in P. brachypomus, 4,47 to 4,73 in S. fasciatus), led by the effect of the ingested food, and the pH values were reduced at the end of the experiment. During the evaluation hours, intestinal pH values for P. brachypomus and S. fasciatus were between 6,68 and 7,47 and 6,86 and 7,60, respectively, increasing distally along the intestine. It is concluded that both species present a permanent stomach acidification, and that the anterior and middle portions of the intestine maintain a slightly neutral pH during digestion and assimilation of food.

Vanek's tumor: a rare differential diagnosis of colonic submucosal lesions

Gastrointestinal submucosal lesions represent a diagnostic challenge, including benign or malignant lesions, so they are identified more accurately by histopathological study accompanied by immunohistochemistry. This is a case of a 21-year-old man with a bleeding submucosal lesion in the cecum. The patient underwent a right colectomy. Microscopic finding was compatible with Vanek's tumor.

Lesiones submucosas gastrointestinales representan un reto diagnóstico, incluyen lesiones benignas o malignas, que se identifican con mayor exactitud con estudios histopatológicos, incluyendo inmunohistoquímica. Se reporta el caso de un paciente varón de 21 años con lesión submucosa hemorrágica localizada en el ciego, por lo que se realiza colectomía. Hallazgos microscópicos son compatibles con Tumor de Vanek.

Tumor inflamatorio miofibroblástico gastrointestinal. Reporte de caso / Gastrointestinal myofibroblastic inflammatory tumor. Case report

Introducción. El tumor miofibroblástico inflamatorio es una enfermedad proliferativa rara, de etiología incierta, caracterizada por la proliferación de miofibroblastos epitelioides o fusionados mezclados con células inflamatorias, predominantemente mononucleares. En general se considera una lesión benigna, aunque en algunos casos esta neoplasia ha mostrado un comportamiento agresivo en cuanto a recidiva local y metástasis. El tratamiento definitivo es la resección quirúrgica completa. Caso clínico. Paciente de 67 años con dos meses de evolución de fiebre y masa abdominal, en quien se realizó una tomografía computarizada de abdomen que identificó una lesión de aspecto infiltrativo tumoral, comprometiendo la grasa retroperitoneal en la transcavidad de los epiplones. Por vía percutánea se tomó una biopsia que informó un pseudotumor inflamatorio retroperitoneal. Fue llevado a cirugía radical abdominal, con patología quirúrgica final que describió un tumor miofibroblástico inflamatorio de compromiso multifocal, adherido a la serosa del estómago e intestino delgado, sin compromiso muscular. Discusión. El tumor inflamatorio miofibroblástico es una entidad rara, de etiología por esclarecer y difícil diagnóstico. Presentamos el caso clínico de un paciente con tumor inflamatorio miofibroblástico gastrointestinal.Conclusión. Se describe el caso clínico de un paciente con un tumor inflamatorio miofibroblástico gastrointestinal, de presentación rara en nuestro medio. Es importante la comparación con casos similares para poder hacer conclusiones útiles en la práctica clínica

Introduction. Inflammatory myofibroblastic tumor is a rare proliferative disease of uncertain etiology, characterized by the proliferation of epithelioid or fused myofibroblasts mixed with predominantly mononuclear inflammatory cells. In general, it is considered a benign lesion, although in some cases this neoplasm has shown aggressive behavior in terms of local recurrence and metastasis. The definitive treatment is complete surgical resection. Clinical case. A 67-year-old patient with a two-month history of fever and an abdominal mass underwent a computed tomography scan of the abdomen that identified an infiltrative tumor, compromising the retroperitoneum fat in the lesser cavity. A biopsy was taken percutaneously, which reported a retroperitoneal inflammatory pseudotumor. He was taken to radical abdominal surgery, with final surgical pathology describing an inflammatory myofibroblastic tumor with multifocal involvement attached to the serosa of the stomach and small intestine without muscle involvement. Discussion. Inflammatory myofibroblastic tumor is a rare entity, of unknown etiology and difficult to diagnose. We present a clinical case of gastrointestinal myofibroblastic inflammatory tumor to better understand this entity.Conclusion. The clinical case of a patient with a gastrointestinal myofibroblastic inflammatory tumor, a rare presentation in our environment, is described. Comparison with similar cases is important to draw useful conclusions in clinical practice

Endoscopic Findings in Patients with Moderate to Severe COVID-19: A Cross-sectional Study

Introduction: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection has diverse gastrointestinal manifestations, often requiring endoscopy. Objective: The primary objective is to describe the need for endoscopic procedures from a sample of hospitalized patients with moderate to severe coronavirus disease 2019 (COVID-19). The secondary objective is to describe the characteristics, findings, and interventions. Materials and methods: An observational, descriptive, cross-sectional study was conducted from May 2020 to December 2021 about indications, endoscopic findings, interventions, anesthesia requirements, and adverse events from a sample of patients with moderate to severe COVID-19 in whom gastrointestinal endoscopic procedures were performed for any indication. Results: Of 2,312 hospitalized patients with moderate to severe COVID-19, 2.72% required endoscopic procedures, with a predominance of men (75%), an average age of 65.7 years, and the majority for upper gastrointestinal endoscopy (68%). The most frequent indications were gastrointestinal bleeding (62%) and enteral access (28.3%). An ischemic compromise was documented in three patients. Of those with digestive bleeding, 9.5% required hemostatic therapy, and 65% were on ventilatory support and sedation during the endoscopic procedure. In half of these cases, anesthesiology support was required without periprocedural adverse events, nor was a negative pressure room required in any procedure. Conclusions: In patients with moderate to severe COVID-19 requiring gastrointestinal endoscopy, clinical judgment is necessary to define the relevance of the procedure; in many cases, conservative management may be considered.

Introducción: la infección por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) tiene manifestaciones gastrointestinales diversas, que en muchas ocasiones requieren de endoscopia. Objetivo: como objetivo primario, describir la necesidad de procedimientos endoscópicos a partir de una muestra de pacientes hospitalizados con enfermedad por coronavirus de 2019 (COVID-19) moderado a grave, y como objetivo secundario, describir en detalle las características, los hallazgos y las intervenciones. Materiales y métodos: estudio observacional descriptivo de corte trasversal desde mayo de 2020 a diciembre de 2021 acerca de las indicaciones, hallazgos endoscópicos, intervenciones, requerimiento de anestesia y eventos adversos a partir de una muestra de pacientes con COVID-19 moderado a grave en quienes se realizaron procedimientos endoscópicos gastrointestinales por cualquier indicación. Resultados: de 2312 pacientes hospitalizados con COVID-19 moderado a grave, 2,72% requirió procedimientos endoscópicos, con predominio de los hombres (75%), edad promedio de 65,7 años y la mayoría para endoscopia digestiva alta (68%). Las indicaciones más frecuentes fueron hemorragia gastrointestinal (62%) y acceso enteral (28,3%). Se documentó compromiso isquémico en tres pacientes. En aquellos con sangrado digestivo, 9,5% requirió terapia hemostática, 65% se encontraba con soporte ventilatorio y sedación al momento del procedimiento endoscópico, y en la mitad de estos casos se requirió el apoyo de anestesiología, sin presentarse eventos adversos periprocedimentales, ni requerimiento de sala de presión negativa en ningún procedimiento. Conclusiones: en el paciente con COVID-19 moderado a grave con requerimiento de endoscopia gastrointestinal es necesario un juicio clínico para definir la pertinencia del procedimiento, y en muchos casos puede plantearse un manejo conservador.

Efficacy of subcutaneous negative pressure drainage device in the prevention of surgical site infections of superficial incisions in the open surgery of the lower gastrointestinal tract / 国际外科学杂志

Objective:To investigate the role of subcutaneous negative pressure drainage device in the prevention of surgical site infections (SSI) of superficial incisional in lower digestive tract open surgeries.Methods:Clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from October 2018 to June 2020 was analyzed by a propensity score matching (PSM), and the clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from February to December 2021 was analyzed by a randomized controlled trial (RCT). Chi-square tests were conducted to analyze the association of subcutaneous negative pressure drainage device with SSI of superficial incisional. Univariate and multivariate Logistic regression analysis were used to identify the risk factors for SSI in superficial incisions.Results:Patients with subcutaneous negative pressure drainage device encounter significantly less SSI of superficial incisional in both the PSM study ( P=0.007) and the RCT study ( P=0.049). In the PSM study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.012, Pmulti=0.009) and postoperative anastomosis leak ( Puni=0.054, Pmulti=0.034). In the RCT study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.061, Pmulti=0.017), eldly ( Puni=0.076, Pmulti=0.032), long incision ( Puni=0.078, Pmulti=0.040). Conclusion:Subcutaneous negative pressure drainage device can significantly reduce SSI of superficial incisional in lower digestive tract open surgeries.

Clinical application of transcatheter arterial methylene blue angiography in the localization of lower gastrointestinal arterial bleeding / 介入放射学杂志

Objective To evaluate the clinical application value of transcatheter arterial methylene blue angiography in the localization of lower gastrointestinal arterial bleeding.Methods Ten patients with lower gastrointestinal arterial bleeding received interventional celiac artery angiography.After the bleeding responsible arteries were identified,a microcatheter was super-selectively placed in the bleeding responsible artery.During surgical procedure,the methylene blue solution was injected through the microcatheter to display the bleeding segment of the intestinal tract,providing precise localization of the bleeding intestinal segment for surgical resection.Results Transcatheter arterial methylene blue angiography could clearly display the bleeding segment of the intestinal tract.The bleeding segments of the intestinal tract in the 10 patients were quickly and accurately removed.After surgery,the gastrointestinal bleeding stopped,and no surgery-related complications occurred.Conclusion Transcatheter arterial methylene blue angiography can accurately detect the arterial bleeding segment of the lower gastrointestinal tract,which provides precise localization for quickly removing the bleeding segment of intestinal tract,therefor,this technique is worthy of widespread clinical application.(J Intervent Radiol,2023,32:1230-1232)

Prognostic stratification of baseline PET metabolic parameters combined with Bcl-2/c-Myc dual expression in patients with primary gastrointestinal diffuse large B-cell lymphoma / 中华核医学与分子影像杂志

Objective:To explore whether baseline PET metabolic parameters combined with B-cell lymphoma-2 (Bcl-2)/cellular-myelocytomatosis viral oncogene (c-Myc) dual expression (DE) can improve the prognostic stratification of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL).Methods:From March 2011 to November 2019, 74 patients (33 males, 41 females; age: 20-87 years) pathologically diagnosed with PGI-DLBCL prior to treatment in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School and the First Affiliated Hospital of Nanjing Medical University were retrospectively included. Baseline PET/CT scans were calculated automatically using the boundaries of voxels presenting a SUV max≥2.5, and metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were determined. Expressions of Bcl-2 and c-Myc were detected at protein levels by immunohistochemistry (IHC). A predicting model comprised of MTV and DE was constructed and patients were divided into 3 groups, including low-risk group (low MTV and non-DE), mediate-risk group (high MTV or DE) and high-risk group (high MTV and DE). The distributions of progression-free survival (PFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results:Of 74 patients, 20 relapsed or progressed, 13 died, and 29.7%(22/74) patients were DE positive. Multivariate analysis revealed that MTV (hazard ratio ( HR)=9.110, 95% CI: 1.429-18.615, P=0.012) and DE ( HR=9.837, 95% CI: 1.690-57.260, P=0.011) were independent predictors of PFS, while MTV ( HR=12.470, 95% CI: 3.356-46.336, P<0.001) was the only independent predictor of OS. In the predicting model for PFS, low-risk group ( n=42) and mediate-risk group ( n=20) exhibited significant difference ( χ2=7.84, P=0.005), and mediate-risk group and high-risk group ( n=12) also exhibited significant difference ( χ2=18.72, P<0.001). Conclusions:MTV and DE can independently predict PFS of patients with PGI-DLBCL, and MTV can independently predict OS. The predicting model for PFS combining MTV with DE may further improve the ability of clinicians to stratify patients in terms of differential prognoses.