Prevalence and Determinants of the use of Enema in under-five children in Akwa Ibom State

Background: Use of enema in children across clinical and community settings are associated with risks. This study seeks to determine the prevalence of enema practice in under-five children, substances used as enema and the reasons for enema practice by mothers. Materials and Methods: This was a descriptive cross sectional study among 252 consecutively recruited mothers of under-five children attending immunization/well babies clinics in 2 health centres in Akwa Ibom state using a semi-structured self and interviewer administered questionnaire for data collection. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 at a level of significance of P<0.05. Results: One hundred and sixty-nine (67.1%) respondents had ever given enema to their children. Mothers (69.2%) administered enema to their children which most often (72.8%) was recommended to them by others. Herbal enema was preferred to chemical and plain water enema. Common reasons for enema administration were in preparation for administration of antimalarial to ensure its effectiveness (60.4%), to relief constipation (49.7%) and abdominal pains (46.7%) and treatment of fevers (41.4%). Predictors of enema practice were age of the child (OR 0.4, 95% CI 0.212-0.765, p=0.005) and ethnic origin of the mothers (OR 9.4,95% CI 4.024-22.104, p<0.001). Conclusion: The practice of enema is common in the study area. Health practitioners should be aware of this practice in the communities, seek for this history during clinical consultation and make concerted effort in educating the mothers and other caregivers against this practice.

Enema de sulcralfato pode prevenir colite em segmentos colônicos sem trânsito fecal? / Can sucralfate enema prevent colitis in colonic segments without fecal transit?

RESUMO - RACIONAL: O estresse oxidativo é um dos principais mecanismos associados à ruptura dos mecanismos de defesa que formam a barreira epitelial cólica e reduz o conteúdo tecidual das proteínas claudina-3 e ocludina principais constituintes das junções de oclusão intercelulares. O sucralfato, possui atividade antioxidante e tem sido usado para tratar diferentes formas de colite. OBJETIVO: Mensurar o conteúdo tecidual de claudina-3 e ocludina da mucosa do cólon sem trânsito fecal, submetido à intervenção com sucralfato. MÉTODO: Trinta e seis ratos foram submetidos à colostomia do cólon esquerdo e fístula mucosa distal. Os animais foram divididos em dois grupos de acordo com a eutanásia ser realizada duas ou quatro semanas após a intervenção. Cada grupo foi dividido em três subgrupos de acordo com o tipo de intervenção realizada diariamente: solução salina isolada; sucralfato a 1 g/kg/dia ou sucralfato a 2g/kg/dia. A colite foi diagnosticada por análise histológica adotando escala de validação prévia. A expressão tecidual de ambas as proteínas foi identificada por imunoistoquímica. O conteúdo das proteínas foi quantificado por análise de imagem assistida por computador. RESULTADOS: O escore inflamatório foi maior nos segmentos cólicos sem trânsito fecal e os enemas com sucralfato reduziram o escore inflamatório nesses segmentos, principalmente nos animais submetidos à intervenção com sucralfato em maior concentração e por período mais longo de intervenção. Houve aumento no conteúdo tecidual das proteínas claudina-3 e ocludina, relacionado com a concentração de sucralfato. O conteúdo tecidual de ambas as proteínas não se modificou com a duração da intervenção. CONCLUSÃO: Enemas com sucralfato reduzem a inflamação e aumentam o conteúdo tecidual de claudina-3 e ocludina na mucosa cólica sem trânsito intestinal.

ABSTRACT - BACKGROUND: Oxidative stress is one of the main mechanisms associated with the rupture of the defense mechanisms of the colonic epithelial barrier; it reduces the tissue content of the claudin-3 and occludin proteins, which are the main constituents of intercellular tight junctions. Sucralfate (SCF) has antioxidant activity and has been used to treat different forms of colitis. AIM: This study aimed to measure the tissue claudin-3 and occludin content of the colon mucosa without fecal transit, subjected to intervention with SCF. METHODS: Thirty-six rats were subjected to left colon colostomy and distal mucous fistula. They were divided into two groups according to euthanasia that was performed 2 or 4 weeks after the intervention. Each group was divided into three subgroups according to the enema applied daily: saline alone, SCF at 1 g/kg/day, or SCF at 2 g/kg/day. Colitis was diagnosed by the histological analysis adopting the previous validate scale. The tissue expression of both proteins was identified by immunohistochemical technique. The content of proteins was quantified by computer-assisted image analysis. RESULTS: The inflammatory score was high in colonic segments without fecal transit, and enemas with SCF reduced the inflammatory score in these segments, mainly in those animals submitted to intervention with SCF in greater concentration and for a longer period of intervention. There was an increase in tissue content of claudin-3 and occludin, related to SCF concentration. The tissue content of both proteins was not related to the intervention time. CONCLUSION: Enemas with SCF reduced the inflammation and increased the tissue content of claudin-3 and occludin in colonic mucosa without fecal stream.

Sucralfate enemas reduce the oxidative tissue damage and preserves the contents of E-cadherin and Β-catenin in colonic mucosa without fecal stream

ABSTRACT Purpose: To evaluate the effects of sucralfate enemas in tissue contents of E-cadherin and ?-catenin in an experimental diversion colitis. Methods: Thirty-six male Wistar rats were submitted to a proximal colostomy and a distal mucous fistula. They were allocated into three groups: first group received daily saline enemas (2 mL/day) and the two other groups daily enemas with sucralfate at dosage of 1 or 2 g/kg/day, respectively. Six animals of each group were euthanized after two weeks and six animals after four weeks. The inflammation of the excluded mucosa was evaluated by histological analysis. The oxidative damage was quantified by measurement of malondialdehyde tissue levels. The expression of E-cadherin and ?-catenin was identified by immunohistochemistry, and its contents were quantified by computer-assisted image analysis. Results: Sucralfate enemas reduced inflammation in animals subjected to treatment with 2 g/kg/day by four weeks, and the levels of oxidative damage in mucosa without fecal stream irrespective of concentration and time of intervention. E-cadherin and ?-catenin content increased in segments without fecal stream in those animals subjected to treatment with sucralfate. Conclusions: Sucralfate reduces the inflammation and oxidative stress and increases the tissue content of E-cadherin and ?-catenin in colonic mucosa devoid to the fecal stream.

Refractory functional constipation: clinical management or appendicostomy? / Constipação intestinal funcional refratária: manejo clínico ou apendicostomia?

Abstract Objective: To compare the clinical evolution in patients with refractory functional constipation undergoing different therapeutic regimens: oral laxatives and antegrade enemas via appendicostomy or clinical treatment with oral laxatives and rectal enemas. Methods: Analysis of a series of 28 patients with a mean age of 7.9 years (2.4-11), followed-up in a tertiary outpatient clinic. Refractory functional constipation was defined as continuous retentive fecal incontinence after at least a 12-month period of consensus therapy. After the diagnosis of refractory condition, appendicostomy was proposed and performed in 17 patients. Outcomes: (1) persistence of retentive fecal incontinence despite the use of enemas, (2) control of retentive fecal incontinence with enemas, and (3) control of retentive fecal incontinence, spontaneous evacuations, with no need for enemas. Results: Six and 12 months after the therapeutic option, control of retentive fecal incontinence was observed only in patients who underwent surgery, 11/17 and 14/17, p = 0.001 and p = 0.001, respectively. At 24 months, control of retentive fecal incontinence was also more frequent in operated patients: 13/17 versus 3/11 with clinical treatment, p = 0.005. In the final evaluation, the median follow-up times were 2.6 and 3 years (operated vs. clinical treatment, p = 0.40); one patient in each group was lost to follow-up and 9/16 operated patients had spontaneous bowel movements vs. 3/10 in the clinical treatment group, p = 0.043. Surgical complications, totaling 42 episodes, were observed 14/17 patients. Conclusion: Appendicostomy, although associated with a high frequency of complications, controlled retentive fecal incontinence earlier and more frequently than clinical treatment. The choice of one of the methods should be made by the family, after adequate information about the risks and benefits of each alternative.

Resumo Objetivo Comparar a evolução clínica em crianças com constipação intestinal funcional refratária sob diferentes regimes terapêuticos: laxativos orais e enemas anterógrados via apendicostomia ou tratamento clínico com laxativos orais e enemas via retal. Métodos Análise de uma série de 28 pacientes, 7,9 anos (2,4-11), acompanhados em ambulatório terciário. Constipação intestinal funcional refratária foi definida como manutenção da incontinência fecal retentiva, em terapia consensual, por pelo menos 12 meses. Após diagnóstico de refratariedade, era proposta apendicostomia. Dezessete pacientes realizaram o procedimento cirúrgico. Desfechos: 1. Manutenção de incontinência fecal retentiva em uso de enemas; 2. Controle da incontinência fecal retentiva em uso de enemas; e 3. Controle da incontinência fecal retentiva, evacuações espontâneas, sem necessidade de enemas. Resultados Seis e 12 meses após opção terapêutica, controle da incontinência fecal retentiva foi observado apenas nos pacientes operados, 11/17 e 14/17, p = 0,001 e p = 0,001. Aos 24 meses, controle da incontinência fecal retentiva também mais frequente nos operados 13/17 versus 3/11 tratamento clínico, p = 0,005. Na avaliação final, medianas de tempo de seguimento: 2,6 e 3 anos (operados versus tratamento clínico, p = 0,40), um paciente em cada grupo abandonou o seguimento e 9/16 operados apresentavam evacuações espontâneas versus 3/10 no tratamento clínico, p = 0,043. Complicações cirúrgicas, 42 episódios, acometeram 14/17 pacientes. Conclusão A apendicostomia, embora associada a elevada frequência de complicações, controlou a incontinência fecal retentiva de maneira mais precoce e frequente do que o tratamento clínico. A escolha de um dos métodos deverá caber à família, após adequada informação sobre riscos e benefícios de cada alternativa.

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3. 479 prostate biopsy cases

ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.

Role of Mechanical Bowel Preparation for Elective Colorectal Surgery / 대한소화기학회지

The presence of bowel contents during colorectal surgery has been related to surgical site infections (SSI), anastomotic leakage (AL) and postoperative complications theologically. Mechanical bowel preparation (MBP) for elective colorectal surgery aims to reduce fecal materials and bacterial count with the objective to decrease SSI rate, including AL. Based on many observational data, meta-analysis and multicenter randomized control trials (RTC), non-MBP did not increase AL rates or SSI and other complications in colon and even rectal surgery. In 2011 Cochrane review, there is no significant benefit MBP compared with non-MBP in colon surgery and also no better benefit MBP compared with rectal enemas in rectal surgery. However, in surgeon's perspectives, MBP is still in widespread surgical practice, despite the discomfort caused in patients, and general targeting of the colon microflora with antibiotics continues to gain popularity despite the lack of understanding of the role of the microbiome in anastomotic healing. Recently, there are many evidence suggesting that MBP+oral antibiotics (OA) should be the growing gold standard for colorectal surgery. However, there are rare RCT studies and still no solid evidences in OA preparation, so further studies need results in both MBP and OA and only OA for colorectal surgery. Also, MBP studies in patients with having minimally invasive surgery (MIS; laparoscopic or robotics) colorectal surgery are still warranted. Further RCT on patients having elective left side colon and rectal surgery with primary anastomosis in whom sphincter saving surgery without MBP in these MIS and microbiome era.

Changrui enema inhibits inflammation-induced angiogenesis in acute radiation proctitis by regulating NF-κB and VEGF

Abstract Purpose Changrui enema, a traditional Chinese medicine prescription, is used as a supplementary treatment for acute radiation proctitis (ARP). Herein we explored the inhibition effects of Changrui enema on NF-κB and VEGF in ARP mice. Methods A total of 120 C57BL/6 mice were divided randomly into normal mice group, ARP mice group, western medicine enema group (dexamethasone combined with gentamicin), and Changrui enema group. ARP mice were established by pelvic local irradiation. The expression of IL-1β, NF-κB, VEGF, AQP1, AQP3, p-ERK1/2 and p-JNK was determined by immunohistochemistry or western blot. Results The study firstly found that Changrui enema alleviated ARP mice. The expression of IL-1β, NF-κB, VEGF, AQP1 and p-ERK1/2 was increased in ARP mice, and was reserved by Changrui enema. However, the expression of AQP3 and p-JNK was decreased in ARP mice, and was up-regulated by Changrui enema. Conclusions Changrui enema is an effective treatment with fewer side effects for ARP. The mechanism of Changrui enema may be related to the inhibition of inflammation-induced angiogenesis. Changrui enema inhibits IL-1β and NF-κB expression as well as VEGF expression. Interestingly, AQP1 promotes angiogenesis, while AQP3 inhibits inflammation. Changrui enema probably inhibits AQP1 expression by down-regulating p-ERK1/2, and improves AQP3 expression by up-regulating p-JNK.

Infusão venosa inadvertida de solução glicerinada: repercussões clínicas, éticas e legais / Inadvertent intravenous infusion of glycerol solution: clinical, ethical and legal repercussions / Infusión intravenosa inadvertida de solución de glicerina: repercusiones clínicas, éticas y legales

Resumo O objetivo deste trabalho é avaliar as repercussões clínicas e legais de um caso em que um profissional de saúde injetou solução glicerinada por via endovenosa em paciente idoso com comorbidades. Na ocasião, a Justiça solicitou parecer técnico a partir do qual foi feita análise em três fases: exame do fato e repercussões; revisão de literatura científica; estudo do desfecho e conclusões. O erro decorreu da formação precária do profissional e gerou as seguintes repercussões clínicas: piora da função renal e queda do hematócrito, mas não foi confirmada ocorrência de embolia gordurosa. Depreende-se, portanto, que a adequada formação de profissionais é fundamental para a qualidade em saúde, visto que erros decorrentes de qualificação deficiente e más condições de trabalho afetam diretamente o estado clínico do paciente, tanto em aspectos legais e econômicos como familiares. Diante disso, a atuação do Ministério da Educação e dos conselhos profissionais torna-se decisiva para inibir situações como essa.

Abstract The objective of this study is to evaluate the clinical and legal repercussions of a case in which a health professional injected glycerol solution intravenously in an elderly patient with comorbidities. On that occasion, the Court requested a technical opinion from which an analysis was carried out in three phases: examination of the facts and repercussions; review of scientific literature; study of the outcome and conclusions. The error was caused by inadequate professional training and generated the following clinical repercussions: worsening renal function and a drop in hematocrit, but no occurrence of fat embolism was confirmed. Therefore, it is clear that the adequate training of health professionals is fundamental for health quality, since errors due to poor qualification and poor working conditions directly affect the clinical status of the patient, both from the legal and economic aspects as well as from the family aspect. In light of this, the actions of the Ministry of Education and professional councils become key to inhibit such situations.

Resumen El objetivo de este trabajo es evaluar las repercusiones clínicas y legales de un caso en que un profesional de la salud inyecta solución de glicerina por vía intravenosa a un paciente anciano con comorbilidades. En tal ocasión, la Justicia solicitó una evaluación técnica, a partir de la cual se realizó un análisis en tres fases: examen del hecho y repercusiones; revisión de la literatura científica; estudio del desenlace y conclusiones. El error fue la resultante de una deficiente formación profesional y generó las siguientes repercusiones clínicas: empeoramiento de la función renal y caída del hematocrito; no obstante, no se confirmó la ocurrencia de embolia grasa. Se concluye, por lo tanto, que la adecuada formación de profesionales es fundamental para la calidad en salud, dado que los errores derivados de una cualificación deficiente y de malas condiciones de trabajo afectan directamente el estado clínico del paciente, tanto en los aspectos legales y económicos como familiares. Frente a esto, la actuación del Ministerio de Educación y de los consejos profesionales se torna decisiva para inhibir situaciones como la descripta.

Enemas with mesalazine increase the tissue contents of mucins in the colonic mucosa devoid of fecal stream

Abstract Purpose: To evaluate the inflammatory reaction and measure the content of mucins, in the colonic mucosa without fecal stream submit to intervention with mesalazine. Methods: Twenty-four rats were submitted to a left colostomy and a distal mucous fistula and divided into two groups according to euthanasia to be performed two or four weeks. Each group was divided into two subgroups according daily application of enemas containing saline or mesalazine at 1.0 g/kg/day. Colitis was diagnosed by histological analysis and the inflammatory reaction by validated score. Acidic mucins and neutral mucins were determined with the alcian-blue and periodic acid of Schiff techniques, respectively. Sulfomucin and sialomucin were identified by high iron diamine-alcian blue technique. The tissue contents of mucins were quantified by computer-assisted image analysis. Mann-Whitney test was used to analyze the results establishing the level of significance of 5%. Results: Enemas with mesalazine in colonic segments without fecal stream decreased the inflammation score and increased the tissue content of all subtypes of mucins. The increase of tissue content of neutral, acid and sulfomucin was related to the time of intervention. Conclusion: Mesalazine enemas reduce the inflammatory process and preserve the content of mucins in colonic mucosa devoid of fecal stream.

Meta-analysis of therapeutic effect of retention enema with traditional Chinese medicine on ulcerative colitis / 中国中药杂志

To evaluate the therapeutic effect of traditional Chinese medicine( TCM) retention enema in treating ulcerative colitis( UC) by Meta-analysis method. Randomized controlled trials( RCTs) of TCM retention enema in treatment of UC were retrieved from databases as CNKI,Wan Fang,CBM,VIP and PubMed from inception to June 2019. The quality of RCTs was assessed by using the Cochrane collaboration's tool for assessing risk of bias,Meta-analysis were performed with Rev Man 5. 3 software and publication bias was tested by using Stata 15. 1 software. There were twenty-eight articles enrolled,and 2 477 patients were included. The result of Meta-analysis showed that retention enema with TCM had significantly better effectiveness in overall curative effect( RRSASP= 1. 18,95%CI[1. 13,1. 22],Z = 8. 32,P < 0. 01; RR5-ASA= 1. 13,95% CI[1. 03,1. 21],Z = 2. 61,P < 0. 01) symptom curative effect( RR =1. 44,95%CI[1. 22,1. 71],Z = 4. 25,P<0. 01) than those of the control group,and the treatment group was lower than the control group in terms of recurrence( RR = 0. 31,95% CI[0. 17,0. 56],Z = 3. 88,P< 0. 01) and adverse events( RR = 0. 38,95% CI[0. 18,0. 78],Z = 2. 64,P<0. 01),with statistically significant differences. However,there was no significant difference in Meta-analysis result of colonoscopic mucosal change between the two groups. TCM enema is an effective method to treat ulcerative colitis.

Opioid-induced constipation: a narrative review of therapeutic options in clinical management

Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not suffice, the next step for persistent OIC is the administration of laxatives. If these are ineffective as well, treatment with peripherally active μ-opioid receptor antagonists should be considered. Enemas and irrigation are emergency measures, often used as a last resort.

Ogilvie's Syndrome after Lumbar Spinal Surgery

STUDY DESIGN: Case report. OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION: Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

Nationwide Survey for Application of ROME IV Criteria and Clinical Practice for Functional Constipation in Children

BACKGROUND: This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians. METHODS: A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea). RESULTS: A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P 6 months (63.8%) than 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002). CONCLUSION: Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.

Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?

PURPOSE: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. METHODS: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. RESULTS: Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. CONCLUSION: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound - guided prostate biopsy

ABSTRACT Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations. Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound - guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics. Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 - 0.78; P = 0.021). Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

Uso de cetamina pela via cólon-retal para contenção química de jiboias Boa constrictor Linnaeus, 1758 com teste de influência da droga sobre o sistema renal / Use of ketamine by colon-rectal route for chemical restraint in Boa constrictor Linnaeus, 1758 with test of influence of the drug on renal system

Por serem frequentes na clínica de animais silvestres, faz-se necessária a manipulação de jiboias e para isso, indispensável o conhecimento sobre as manobras precisas para o tratamento das possíveis afecções. Quando se opta pela contenção química, ou pela realização de procedimentos cirúrgicos, um dos fármacos utilizados na anestesia de serpentes é a cetamina. Viu-se a necessidade de buscar uma via alternativa, semelhante em eficácia às tradicionais para a contenção química, porém que minimizasse os riscos e efeitos adversos encontrados na sua execução. O presente trabalho sugere que a via retal seja esta alternativa, por isso, treze jiboias foram submetidas à administração de 70mg/kg de cloridrato de cetamina, com sonda uretral, através da cloaca até o cólon-reto. Foram avaliados, nos tempos 0, 10, 20, 30, 40, 50, 60, 70, 80, 90 e 120 minutos, a partir da administração do fármaco, os seguintes parâmetros: frequência cardíaca, relaxamento muscular e mobilidade, resistência à contenção ou manipulação e reação postural de endireitamento. Foi realizada coleta de 0,5mL de sangue por punção do seio venoso paravertebral cervical, antes da administração do fármaco, no dia seguinte e após nove dias. Foram dosadas as concentrações plasmáticas de cálcio, fósforo e ácido úrico de todos os exemplares a fim de verificar o perfil bioquímico renal e avaliar a influência do fármaco neste sistema. Não foram observadas alterações bioquímicas plasmáticas durante o período de avaliação. Foi possível promover a contenção química das jiboias Boa constrictor, utilizando cloridrato de cetamina pela via cólon-retal.(AU)

It is necessary to deal with Boa constrictor snakes because they are frequently treated in wild and exotic animal clinics and the knowledge about the required procedures in the treatment of the possible affections becomes imperative. When the choice for chemical restraint or sedation for surgical procedures is made, one of the drugs used in snakes is ketamine. We believed it was necessary to look for an alternative route of drug administration as effective as the regular ones, but with minimum risks and less adverse effects in its execution. Therefore thirteen snakes were submitted to the administration of 70mg/kg of ketamine hydrochloride, with an urethral tube, through the cloaca into the colon-rectum. After this, they were evaluated during the 0, 10, 20, 30, 40, 50, 60, 70, 80, 90 and 120 next minutes from the administration time using the following parameters: heart rate, muscle relaxation and mobility, handling or restraint resistance and righting reflex. Blood samples were collected from each snake by cervical paravertebral venous sinus punction, before the drug administration, on the next day and nine days after. Serum concentrations of calcium, phosphorus and uric acid were measured in order to check the renal biochemical profile and the possibility of influence of the drug on this system. It was possible to provoke chemical restraint in Boa constrictor snakes, with ketamine hydrochloride administered by the colon-rectal route.(AU)

Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus

PURPOSE: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. METHODS: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight < 1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. RESULTS: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9–34.3 weeks) and 893 g (range, 610–1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3–11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1–6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1–14 days) after the procedure. CONCLUSION: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

PURPOSE: Intussusception is a common cause of intestinal obstruction in children. While most patients can be treated by enema reduction, about 20% require surgery. We investigated the usefulness and feasibility of laparoscopic surgery and the intraoperative risk of bowel resection. METHODS: We retrospectively reviewed pediatric patients who underwent surgery for intussusception from 2010 to 2017. We collected data for age, gender, body weight, associated symptoms, duration of symptoms, white blood cell count, operating time, and postoperative complications. RESULTS: Of 155 patients, 37 (23.8%) underwent surgery due to enema reduction failure in 29 (78.3%), recurrence in 6 (16.3%), a suspicious lead point in 1, and suspicious ischemic change observed on ultrasonography in 1. The mean age was 26.8±18.9 months (range, 3.5~76.7 months), and the mean body weight was 12.9±3.9 kg (range, 5.4~22.2 kg). Laparoscopic surgery was successful in 29 patients (78.4%), and 7 (18.9%) needed bowel resection and anastomosis. The mean operating time was 56.7±32.8 min. A lead point was found in 3 patients in the bowel resection group (p=0.005); in addition, the operating time and hospital stay were longer in this group. There were no intra- or postoperative complications. CONCLUSION: Laparoscopic surgery was successful in 78.4% of the patients with a short hospital stay and early oral intake. The only predictive factor for bowel resection was the presence of a lead point. Laparoscopic surgery may be an optimal treatment intervention for children with intussusception, except for those who show initial peritonitis.

Tension pneumoperitoneum during pneumatic reduction of pediatric intussusception: case report

This paper presents a case report of tension pneumoperitoneum that occurred in a 4-month-old girl with intussusception during pneumatic reduction. Tension pneumoperitoneum is a rare but life threatening complication in air pressure enema that is commonly used to turn the intussuscepted bowel to its original position. The incidence of a simple pneumoperitoneum due to a bowel perforation associated with attempted pneumatic reduction for intussusception is as high as 4%. The simple pneumoperitoneum changed rapidly to tension pneumoperitoneum and immediate needle decompression was life-saving in this case. Similar to a tension pneumothorax, the diagnosis is clinical and management should not be delayed awaiting other confirmatory tests. The emergency physician must recognize this rare complication of pneumatic reduction and promptly treat the ensuing tension pneumoperitoneum after bowel perforation with immediate needle decompression as a part of the initial resuscitation.