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.

Fascitis necrosante como causa de muerte en trauma de recto. Reporte de caso / Necrotizing fasciitis as a cause of death in rectal trauma. Case report

Introducción. La perforación del recto por trauma cerrado es poco frecuente y se asocia a fracturas pélvicas. En pacientes con perforaciones de recto no traumáticas se ha reportado fascitis necrosante en miembros inferiores, en la mayoría de los casos asociada a alta mortalidad. Caso clínico. Hombre de 36 años con trauma cerrado abdomino-pélvico y perforación de recto inferior, quien recibió manejo quirúrgico mediante derivación intestinal y fijación pélvica. Evolucionó con hematoma escrotal sobreinfectado, inestabilidad hemodinámica, signos de fascitis necrosante y choque séptico 4 días posterior a su ingreso. Resultados. Se tomó muestra para cultivo del hematoma escrotal que reportó E. coli. La patología del desbridamiento escrotal informó necrosis de coagulación en toda la muestra. Conclusión. El tacto rectal debe realizarse siempre ante la presencia de enfisema subcutáneo al examen físico o en la tomografía, para un diagnóstico temprano y manejo quirúrgico multidisciplinario oportuno, según el caso. La presencia de enfisema subcutáneo debe aumentar la sospecha de perforación de recto. Hay pocos reportes de fascitis secundaria a perforación de recto por trauma cerrado, por lo que no se conoce con precisión la mortalidad asociada.

Introduction. Rectal perforation due to blunt trauma is rare and associated with pelvic fractures. Signs of necrotizing fasciitis in lower limbs have been reported in non-traumatic rectal perforations, in most cases associated with high mortality. Case report. A 36-year-old man presents blunt abdomino-pelvic trauma and perforation of the lower rectum. Surgical management by intestinal diversion and pelvic fixation is performed. 4 days after admission, evolves with over-infected scrotal hematoma, hemodynamic instability, signs of necrotizing fasciitis and septic shock. Results. A sample for culture was taken from a scrotal hematoma that reported E. coli. Pathology of scrotal debridement reported coagulation necrosis in the entire specimen. Discussion. Digital rectal examination should always be performed in the presence of subcutaneous emphysema on physical examination or CT scan for early and multidisciplinary diagnosis and surgical management as appropriate. Conclusion. The presence of subcutaneous emphysema should raise the suspicion of rectal perforation. There are few reports of rectal perforation due to blunt trauma and fasciitis, so the associated mortality is not precisely known.

Assessment of risk factors for leakage after repair of perforated peptic ulcer with omental patch. Retrospective study / Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage

Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.

Perforación colónica por endoprótesis biliar impactada / Colonic perforation due to impacted biliary stent

Introducción. La colocación de endoprótesis biliares es cada día más frecuente por ser actualmente una de las mejores opciones para el tratamiento de patologías de la vía biliar. La migración de las endoprótesis es una de las complicaciones que puede ocurrir en hasta un 10,8 % de los pacientes, pero en muy raras ocasiones llegan a causar una perforación intestinal. Caso clínico. Se trata de una paciente de 61 años, a quien cinco años atrás se le realizó una colangiopancreatografía retrógrada endoscópica por coledocolitiasis. Consultó por presentar dolor abdominal, y al examen físico se encontraron abdomen agudo y plastrón en fosa ilíaca izquierda a la palpación. La tomografía computarizada informó un cuerpo extraño a nivel del colon descendente, con perforación del mismo. Se realizó laparotomía exploratoria y colostomía por perforación del colon sigmoides secundaria a prótesis biliar migrada. Resultados. La paciente evolucionó favorablemente y a los seis meses se realizó el cierre de la colostomía, sin complicaciones. Conclusión. Los pacientes a quienes se les colocan prótesis biliares requieren un seguimiento adecuado para evitar complicaciones que, aunque raras, pueden ocurrir, como la migración intestinal con perforación. El tratamiento de dichas complicaciones se hace por vía endoscópica, laparoscópica o laparotomía en caso de complicación severa.

Introduction. Endoscopic placement of biliary stents is becoming more common every day, as it is currently one of the best options for the treatment of bile duct pathologies. One of the complications that can occur is the migration of the endoprostheses in up to 10.8% of patients, which in very rare cases can cause intestinal perforation. Clinical case. This is a 61-year-old female patient, who underwent endoscopic retrograde cholangiopancreatography five years ago for choledocholithiasis. She consulted due to abdominal pain, with a physical examination that upon palpation documented an acute abdomen and a palpable plastron in the left iliac fossa. The computed tomography revealed a foreign body at the level of the descending colon, with perforation. Exploratory laparotomy and colostomy were performed due to perforation of the sigmoid colon secondary to migrated biliary prosthesis. Results. The patient progressed favorably and six months later the colostomy was closed without complications. Conclusions. Patients who receive biliary stents require adequate follow-up to avoid complications that, although rare, may occur, such as intestinal migration with intestinal perforation. The treatment of these complications can be endoscopic, laparoscopic or laparotomy in case of severe complication.

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases / 口腔疾病防治

@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

Wet bio-amniotic membrane plugging combined with transplantation in the treatment of small corneal perforations

ABSTRACT Purpose: Wet bio-amniotic membrane plugging combined with transplantation is a novel option that combined amniotic membrane plugging with amniotic membrane transplantation for the treatment of small corneal perforations. This study aimed to evaluate the efficacy of wet bio-amniotic membrane plugging in the treatment of small corneal perforations and compared it with that of the penetrating keratoplasty procedure. Methods: Forty patients (41 eyes) with small corneal perforations <3 mm in diameter treated at our hospital between July 2018 and January 2021 were retrospectively included. Among them, 21 eyes were treated with wet bio-amniotic membrane plugging (wet bio-amniotic membrane plugging group), and 20 eyes were treated with penetrating keratoplasty procedure (penetrating keratoplasty procedure group). The best-corrected visual acuity, anterior chamber formation, corneal thickness, primary disease control, postoperative complications, and graft survival rate were assessed. Results: No significant difference in baseline characteristics was found between the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups (p>0.05). The postoperative control rates of primary diseases in the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups were 95.2% and 90.0%, respectively (p=0.481). Visual acuity was improved 6 months after the operation in the wet bio-amniotic membrane plugging group and was improved at postoperative 1 month in the penetrating keratoplasty procedure group. The formation time of the anterior chamber in the wet bio-amniotic membrane plugging group was significantly shorter than that in the penetrating keratoplasty procedure group (p=0.023). The corneal thickness of the two groups significantly increased 12 months after the operation; however, the degree of thickening in the penetrating keratoplasty procedure group was higher than that in the wet bio-amniotic membrane plugging group (p<0.001). During the follow-up, postoperative complications were not different between the two groups (p>0.999). Conclusion: The results suggest that wet bio-amniotic membrane plugging is effective and safe in the treatment of small corneal perforations. Thus, it can be used as an emergency treatment alternative to penetrating keratoplasty procedure for small corneal perforations.

Diagnostic accuracy of the video otoscope in tympanic membrane perforation

Abstract Objective The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. Methods This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. Results 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p < 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. Conclusions The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. Level of evidence Is this diagnostic or monitoring test accurate? (Diagnosis)—Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).

Tratamento de perfuração iatrogênica de furca com técnica de inserção modificada do mta: relato de caso / Iatrogenic furca perforation treatment with modified mta insertion technique: case report

As perfurações endodônticas podem ocorrer patologicamente por lesão cariosa profunda, bem como durante o acesso ou na instrumentação dos canais radiculares, que em sua grande maioria estão relacionadas com a negligência ou desconhecimento das variações anatômicas internas do dente. O presente trabalho descreve um caso clínico de perfuração de furca, onde o tratamento inicial foi baseado na descontaminação e selamento da comunicação com uma técnica de inserção modificada do MTA. Após a anestesia, foi realizado o isolamento absoluto e remoção de tecido infectado presente na câmara pulpar. Feita a limpeza da perfuração utilizando soro fisiológico e modelagem do canal com o instrumento reciprocante, a obturação foi concebida com cone de guta percha e cimento biocerâmico. Em seguida, o MTA foi manipulado, de acordo com recomendações do fabricante usando água destilada na proporção 1:1 e inserido na canaleta de uma régua endodôntica com a espátula de inserção nº1. O material foi removido da canaleta e inserido na perfuração, finalizando o vedamento da mesma. Portanto, concluiu-se que o selamento da perfuração apresentou um resultado satisfatório, tanto clínico como radiográfico, destacado pela proservação de 5 meses, evidenciando discreta formação de trabeculado ósseo na região de furca(AU)

Endodontic perforations can occur pathologically due to a deep carious lesion, as well as during access or instrumentation of root canals, which are mostly related to negligence or ignorance of the internal anatomical variations of the tooth. The present work describes a clinical case of furcation perforation, where the initial treatment was based on decontamination and sealing of the communication with a modified MTA insertion technique. After anesthesia, absolute isolation and removal of infected tissue present in the pulp chamber was performed. After cleaning the perforation using saline solution and modeling the canal with the reciprocating instrument, the filling was designed with a gutta-percha cone and bioceramic cement. Then, the MTA was manipulated, according to the manufacturer's recommendations, using distilled water in a 1:1 ratio and inserted into the groove of an endodontic ruler with the #1 insertion spatula. The material was removed from the channel and inserted into the perforation, finishing its sealing. Therefore, it was concluded that the sealing of the perforation presented a satisfactory result, both clinical and radiographic, highlighted by the 5-month followup, evidencing a slight formation of bone trabeculate in the furcation region(AU)

Palatal perforation due to disseminated histoplasmosis as the first presentation of HIV-AIDS

Histoplasmosis is a systemic fungal infection caused by H. capsulatum usually in immunocompromised individuals such as those with HIV-AIDS. Though oral manifestations are rare, they could be the only and initial manifestation of HIV-AIDS. We report the case of a 23-year-old female who presented with oral ulcer and palatal perforation and detected to be suffering from disseminated histoplasmosis. She also turned out to be HIV positive. Her CD4+ count was undetectable. She responded well to intravenous liposomal Amphotericin B, oral itraconazole and antiretroviral therapy. To the best of our knowledge, histoplasmosis presenting as palatal perforation as the first manifestation of HIV-AIDS has not been reported from South India previously. A high index of suspicion is needed in such cases of exaggerated oral lesions even in states like Kerala to avoid delay in diagnosis and therapy.

RETINA ON CORNEA IN CASE OF MECHANICAL OCULAR INJURY: A CASE REPORT

Ocular injuries are one of the major factors for mono-ocular blindness in adult population. Majority of mechanical ocular injuries occurs in factories. Our patient had injury with grinder blade. On examination, vision was no perception of light in right eye, corneoscleral tear along with lens and vitreous in the wound. Ocular trauma score was 1 with chances of visual recovery nil. After primary treatment, when we had taken patient under general anaesthesia, we found whole retina lying over cornea which was a rare event. We excised that tissue and tear repair was done. None of the factors which can lead to expulsive haemorrhage was observed in patient. We have seen many patients with extensive corneoscleral tear but never seen retina coming out of the wound. We recommend to use all protective equipments for workers to prevent industrial ocular injuries.

Síndrome de Rapunzel asociado a perforación intestinal. Caso clínico / Rapunzel syndrome associated with intestinal perforation. Clinical case

Introducción. Los tricobezoares ocurren de forma frecuente en niñas y adolescentes, y se asocian a trastornos psicológicos como depresión, tricotilomanía o tricofagia. Caso clínico. Se presenta una paciente adolescente con síndrome de Rapunzel, con hallazgo adicional de perforación yeyunal debido al tricobezoar. Discusión. Dentro de las complicaciones de los tricobezoares se reporta invaginación intestinal (principalmente de yeyuno), apendicitis, obstrucción biliar, neumonía, pancreatitis secundaria y perforación, esta última como ocurrió en nuestra paciente. Conclusión. En pacientes mujeres adolescentes con dolor abdominal o abdomen agudo, se debe tener en cuenta el diagnóstico de síndrome de Rapunzel, así como sus probables complicaciones

Introduction. Trichobezoars occur frequently in young and adolescent girls, and are associated with psychological disorders such as depression, trichotillomania, or trichophagia. Clinical case. An adolescent patient with Rapunzel syndrome is presented, with an additional finding of jejunal perforation due to the trichobezoar. Discussion. Among the complications of trichobezoars, intussusception is reported (mainly of the jejunum), appendicitis, biliary obstruction, pneumonia, secondary pancreatitis, and perforation, the latter as occurred in our patient. Conclusion. In adolescent female patients with abdominal pain or acute abdomen, the diagnosis of Rapunzel syndrome should be taken into account, as well as its probable complications

Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines

Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.

Perforación gástrica neonatal recurrente: Reporte de un caso inusual

La perforación gástrica neonatal es una patología rara pero potencialmente mortal; su recurrencia es aún más rara, son escasos los reportes en la literatura internacional. Se presenta el caso de una recién nacida prematura (32 semanas) y bajo peso al nacer (1725g) que el primer día de vida presentó una perforación gástrica corregida quirúrgicamente y al cuarto día postoperatorio es reintervenida con presunción diagnóstica de dehiscencia de rafía gástrica, hallándose una nueva perforación gástrica, la cual fue reparada quirúrgicamente. En ambas ocasiones la intervención quirúrgica fue temprana. La evolución posterior y desenlace fueron favorables.

Neonatal gastric perforation is a rare but potentially fatal pathology; its recurrence is even more infrequent, and there are few reports in the international literature. We present the case of a premature newborn (32 weeks) and low birth weight (1725g) who, on the first day of life, presented a surgically corrected gastric perforation and on the fourth postoperative day was re-operated with a presumed diagnosis of gastric raffia dehiscence, finding a new gastric perforation, which was surgically repaired. On both occasions, the surgical intervention was early. The subsequent evolution and outcome were favorable.

Sarcina ventriculi associated gastritis: Mimicking lymphoma on endoscopy

Sarcina Ventriculi is a gram-positive anaerobic coccus rarely reported in patients with delayed gastric emptying, emphysematous gastritis, gastric ulcers, and perforation. So far, less than 30 cases of sarcina isolated from the stomach have been reported. Herein, we describe a case of a 66-year-old male with a history of persistent epigastric pain and regurgitation. The upper gastrointestinal (GI) endoscopy revealed gastric erythema, edema, ulceration, and food bezoar. A gastric biopsy was done to rule out lymphoma. On histopathological examination, sarcina Ventriculi was identified. This organism is likely to get underreported as it may not be that obvious on routinely stained biopsies. Given its association with life-threatening illness such as emphysematous gastritis and perforation, awareness of this organism is important. It's presence in gastric biopsies must be mentioned in the report and should prompt the clinicians to investigate further for functional causes of delayed gastric emptying and gastric outlet obstruction like occult malignancy.

A RARE PRESENTATION OF MASSIVE PNEUMOPERITONEUM FOLLOWING INGESTION OF LIQUID NITROGEN SNACK WITHOUT IDENTIFIABLE GASTROINTESTINAL PERFORATION

A 26 year old male patient presented with abdominal distension following ingestion of liquid nitrogen and was diagnosed to have massive pneumoperitoneum both clinically and radiologically. Patient underwent emergency laparotomy in search of perforation, the stomach, Intestines was examined and no hollow viscous perforation was found. All abdominal contents were normal, no tissue necrosis or haemorrhage, no free ?uid or bleeding was found in the abdomen. Two abdominal drains were placed in the lesser sac and the pelvis and abdomen were closed. The patient was stable post operatively and tolerated oral feeds and discharged on 7th post operative day. Our study revealed that despite of having massive pneumoperitoneum, site of perforation cannot be identi?ed

Early Results of Type I Tympanoplasty in Underprivileged Nepalese Children and Factors Influencing the Surgical Outcomes

Abstract Introduction Type I Tympanoplasty is a common ear surgery performed in Nepalese children, but no studies have been published about the success rate of the procedure and the factors affecting surgical outcomes. Objectives To find out the surgical outcome of type I tympanoplasty and to evaluate the factors affecting the success of the surgery in Nepalese children. Methods This is a retrospective study conducted by analyzing the medical records of a five-year period. Children aged 8-16 years who underwent type I tympanoplasty were included in the study. Surgical pro-forma and records of pre and post-operative pure tone audiometry were documented. Outcome of the surgery was considered a success in terms of graft uptake and hearing improvement six months after surgery. Results Out of 629 children who underwent type I tympanoplasty, anatomical success was observed in 93.32% (n = 587) and functional success in 76% (n = 478). Factors such as age, site and size of the perforation, status of the middle ear and contralateral ear, surgical approach, and the graft used were not the predictors of the surgical outcome. Conclusions The surgical outcome of type I tympanoplasty in Nepalese children was good. Although surgical outcome was better with older children, post-aural approach, temporalis fascia, inferiorly positioned perforations, and in children with dry middle ear mucosa, none of the parameters considered in this study were found to be a significant predictive factor of the surgical outcome.

Manejo de perforaciones, fugas y fístulas del tracto gastrointestinal con clip sobre el endoscopio. Experiencia de un centro oncológico Latinoamericano / Management of perforations, leaks and fistulas of the gastrointestinal tract with over the scope clip. Experience at a Latin American cancer center

Introducción. Las fístulas derivadas de enfermedades neoplásicas del tracto digestivo, así como las fugas posteriores a procedimientos quirúrgicos, no son infrecuentes y ocasionan una morbilidad importante cuando se manejan de forma quirúrgica. También durante los procedimientos endoscópicos se pueden presentar perforaciones y, si se logra un manejo no operatorio, se alcanza una adecuada recuperación. El objetivo de este estudio fue describir las características clínicas y los resultados de los pacientes con perforaciones, fístulas y fugas del tracto gastrointestinal, manejadas endoscópicamente con clip sobre el endoscopio. Métodos. Estudio descriptivo, retrospectivo, de pacientes con perforación, fuga o fístula postoperatoria, llevados a endoscopía digestiva con colocación de clip sobre el endoscopio, en el Instituto Nacional de Cancerología en Bogotá, D.C., Colombia, entre enero de 2016 y abril de 2020. Resultados. Se incluyeron 21 pacientes, 52,4 % de ellos mujeres. La mediana de edad fue de 66 años y del diámetro del defecto fue de 9 mm. En el 95 % se logró éxito técnico. Hubo éxito clínico temprano en el 85,7 % de los casos. El 76,1 % de los pacientes permanecieron sin síntomas a los 3 meses de seguimiento. Conclusiones. El manejo de perforaciones, fugas y fístulas con clip sobre el endoscopio parece ser factible y seguro. En la mayoría de estos pacientes se logró la liberación del clip y la identificación endoscópica del cierre inmediatamente después del procedimiento; sin embargo, en el caso de las fístulas, no se alcanzó el éxito clínico tardío en todos los casos

Introduction. Fistula of the digestive tract derived from neoplastic diseases as well as leaks following surgical procedures are not uncommon and usually cause significant morbidity when are managed surgically. Diagnostic and therapeutic endoscopic procedures may present perforations during their performance; if they are managed non-operatively, an adequate recovery is obtained. The purpose of this study was to describe the clinical characteristics and the short- and long-term outcomes of patients with perforations, fistulas and leaks of the gastrointestinal tract managed endoscopically with over the scope clip (OTSC). Methods. Descriptive, retrospective study of patients brought to digestive endoscopy with OTSC placement with diagnosis of postoperative perforation, leak or fistula at the National Cancer Institute in Bogota, Colombia, between January 2016 and April 2020. Results. Twenty-one patients were taken for OTSC application for the management of perforations, leaks and fistulas of the gastrointestinal tract, 52.4% of them were women. The median age was 66 years. The median diameter of the defect was 9 mm. Technical success was achieved in 95%. Early clinical success was described in 85.7% of the cases; 76.1% of patients remained symptom-free at 3-month follow-up. Conclusions. Management of perforations, leaks and fistulas with OTSC appears to be feasible and safe. In most of these patients, clip release and endoscopic identification of closure was achieved immediately after management; however, in the case of fistulas, late clinical success was not achieved in all cases

Long-term retinal changes after strabismus surgery, suspected signs of past scleral perforations

Purpose: Scleral perforation during strabismus surgery is considered a rare complication that usually results in no significant consequences. The true rate of such occurrences is difficult to evaluate due to the young age of most patients and the occult nature of most events. This study aimed to evaluate long?term retinal changes under the suture areas in patients post?strabismus surgery as presumed signs indicating past undiscovered scleral perforations. Methods: The study population consisted of patients with a follow?up of at least 10 years post?strabismus surgery at the [redacted for review] Eye Institute and with no known retinal conditions as well as with wide fundus visibility. We performed slit?lamp retinal periphery examinations in search of retinal scars or changes at the suture sites. Results: Seventy?one eyes from 43 patients were examined. The mean age (±standard deviation [SD]) at the time of examination was 27 years (±14), and the mean number of strabismus surgeries per patient was 1.8. Three of the examined eyes showed retinal changes at the suture sites, yielding an overall incidence rate of suspected perforation/penetration of 4.2% per eye and 3.6% per strabismus surgery. These three patients were all asymptomatic. Conclusion: Scleral perforations during strabismus surgeries could remain unnoticed since a comprehensive exam of the retinal periphery is challenging in young children, especially during the postoperative period. While retinal changes caused by inadvertent scleral perforations appear to have no clinical sequelae in a time frame of 10 years, such changes should be noted for future fundoscopic examinations

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare ef?cacy and safety of ?exible and rigid esophagoscopy in esophageal foreign body removal. It is a prospective study done in E.N.T department in KIMS Methods: MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. This prospective cohort study includes 50 patients Results: who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for Conclusion: removal of impacted esophageal foreign body

Non-traumatic esophageal perforation: A case report on Boerhaave’s syndrome

Boerhaave’s syndrome is a potentially fatal condition characterized by spontaneous perforation of a previously healthy esophagus, due to severe vomiting or straining. It often presents with non-specific symptoms such as fever, pain, and vomiting and hence may go undiagnosed. The Makler’s triad, consisting of vomiting, chest pain, and subcutaneous emphysema, may be seen in only 50% of cases. Delayed diagnosis may result in complications such as sepsis, mediastinitis, pneumothorax, and multi-organ dysfunction. In general, patients presenting later than 48 h are conservatively managed with esophageal stenting. Surgical repair is usually reserved for those patients who present within 24 h, or are managed conservatively and develop complications. Mortality rises from 0% if treated within 24 h to about 29% if delayed more than 48 h. We present a case of Boerhaave’s syndrome in a 35-year-old male who presented with spontaneous respiratory distress and hemodynamic instability, about 36 h after the onset of vigorous vomiting. The case was managed initially with endoscopic insertion of a self-expanding metallic stent, followed later by surgical closure of the esophageal perforation. The patient, however, developed post-operative septic complications and died after a week