A Novel Shaped Charge Engineered from Nano-metallic Glass Composite / High Entropy Alloy Liner for Debris Free Perforation Tunnel with Improved Reservoir Conductivity Leading to Enhanced Production

There is an unmet need for a clean perforating tunnel, for deep-water natural completions that reduces fluid friction, providing better reservoir connectivity and thus enhanced production. As a disruptive innovator in the technology space, particularly in the energy sector, we have now bridged this technology gap through the synthesis of a novel alloy, which when cold isostatic pressed into a conical shaped charge liner enables a unique response. During the detonation event, the jet created from our novel degradable liner punctures the casing and progresses to penetrate the formation until an eventual collapse. Our novel material is designed such that, during detonation, reaction products, bulk metallic glasses (BMG) and/or high entropy alloys (HEA), are formed which disintegrate into a fine powdery debris in contact with water. These degradable BMG/HEA or complexions are preferentially segregated at interfaces with high free energy. They tend to decorate the grain boundaries and domain interfaces of the impermeable skin lining the crushed zone of the perforation tunnel as amorphous intergranular films (AIFs) and plug at end of the pathway. Interacting with flowback fluids the complexions promote grain dropping, disintegrating the liner and carrot leaving behind a clean perforation tunnel. As a result, it is projected that fracture conductivity is significantly improved, resulting in enhanced productivity. In addition, a clear perf-tunnel has zero skin value. As such, when compared to a coated tunnel with gun and charge debris, it needs little or no acid to clean-up. In addition, it is anticipated that this will reduce the formation breakdown and opening pressures offering improved economics for the client. Last but not least, this leads to cost reduction of authorized field expenditure (AFE) to support optimized performance of completion designs allowing for increased production. The additional novelty of our liner designed through powder metallurgy (PM) techniques is a sub-sonic deflagration of the jet, during its collapse, resulting in sputtering of complexions and BMG/HEA residue along the perforation tunnel. These sputter-deposited jet complexions react with fluids during flowback, selectively being etched, barely needing water for the clean-up. The disintegration of this skin and slug, if any, in the perf-tunnel into fine particulates, subsequently being removed, leaves behind a clear, clean tunnel. CLEAR shaped charges have now been qualified to customer specifications in field conditions and are ready to be commercialized. Our journey of innovation does not end here. In fact, this is not even the beginning of the end, but it is, perhaps, the end of the beginning. To offset our carbon footprint and having embraced environmental and natural resources stewardship as one of our core values we are committed to contributing, as individuals and as an organization, to a flourishing human-ecological system. Through technology synthesis we have developed the concept of engineering seedpods for sustainable reforestation and Agri-tech. This had led to an endeavor for rapid tree planting through areal drones and UAVs’ to offset the effects of deforestation caused by human activities and natural disasters. In our paper we will additionally highlight this innovative technology cross-pollination and our efforts in low carbon and ESG endeavors.

A Rare Case of Pneumoperitoneum in Pregnancy: Perforation of Tubercular ileal Ulcer

The incidence of tuberculosis (TB) is rising worldwide, despite the efficacy of the BCG vaccination. Populations at greatest risk of contracting TB are migrant communities, as well as immunocompromised individuals. The diagnosis of intestinal tuberculosis can often present as a diagnostic conundrum, due to its nonspecific and varied presentation, often mimicking inflammatory bowel disease or malignancy. Free perforation is one of the most feared complications of the intestinal tuberculosis. The terminal ileum is the most common site of perforation, while the majority of (90%) perforations are solitary. We present a 25 year old 17 weeks primi presented with peritonitis with solitary perforation of terminal ileum with miscarriage of fetus and subsequent surgical wedge resection of ileum and ileo-ileal anastomosis. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and responded well. This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.

A rare complication of the great mimicker: free tubercular ileal perforation

Primary intestinal tuberculosis is an uncommon form of extra-pulmonary tuberculosis. With non-specific manifestations, unusual presentations and no proven superior diagnostic modality, differentiation and diagnosis of abdominal tuberculosis is a difficult scenario. Undiagnosed, untreated cases may present with complications. Free perforation of small bowel due to tuberculosis is a rare complication (1-2%) because of adhesion formation and reactive peritoneal thickening; however, when it occurs is most feared for its association with high mortality. We report a case of an elderly male who presented with features of intestinal perforation, treated with emergency surgery and diversion ostomy for small bowel perforation which was diagnosed post-operatively to be of tubercular etiology. Acute care surgeons may be trapped in diagnosing such cases with its non-specific imaging findings, and hence must maintain a low threshold for surgical intervention in the emergency setting.

Synchronic Pulmonary and Intestinal Tuberculosis in an Elderly Patient

We present the case of an elderly woman who presented to the ER with acute abdomen. During surgery, a free perforation in terminal ileum was found so ileostomy and resection were made. Pathology examination reported intestinal tuberculosis, and plain thorax radiography showed a classic Ghon complex. We present a brief report of this uncommon entity. Keywords: Gastrointestinal Tuberculosis; Mycobacterium tuberculosis Infections; Ileostomy

Endoscopic Repair of Delayed Stomach Perforation Arising From Penetrating Trauma: A Case Report

Background Primary endoscopic closure of perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are only few studies on the efficacy of endoscopic management in traumatic delayed gastric perforation. Case presentation: Here, we report the case of a 39-year-old woman who presented with multiple penetrating trauma in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suture of the lacerated lung was performed; however, delayed free-perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for primary repair of the gastric wall, re-perforation was noted 15 d post-operatively. The high re-operation risk prompted an endoscopic intervention using two endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications. Conclusions Endoscopic closure with this novel technique involving endoloops and endoscopic clips can be a useful therapeutic alternative to re-operation for delayed gastric perforation caused by penetrating trauma.

The Trends of Complicated Acute Colonic Diverticulitis—A Systematic Review of the National Administrative Databases

Background and Objectives: The diverticular disease includes a broad spectrum of different “clinical situations” from diverticulosis to acute diverticulitis (AD), with a full spectrum of severity ranging from self-limiting infection to abscess or fistula formation to free perforation. The present work aimed to assess the burden of complicated diverticulitis through a comparative analysis of the hospitalizations based on the national administrative databases. Materials and Methods: A review of the international and national administrative databases concerning admissions for complicated AD was performed. Results: Ten studies met the inclusion criteria and were included in the analysis. No definition of acute complicated diverticulitis was reported in any study. Complicated AD accounted for approximately 42% and 79% of the hospitalizations. The reported rates of abscess varied between 1% and 10% from all admissions for AD and 5–29% of the cases with complicated AD. An increasing temporal trend was found in one study–from 6% to 10%. The rates of diffuse peritonitis ranged from 1.6% to 10.2% of all hospitalizations and 11% and 47% of the complicated cases and were stable in the time. Conclusions: The available data precluded definitive conclusions because of the significant discrepancy between the included studies. The leading cause was the presence of heterogeneity due to coding inaccuracies in all databases, absence of ICD codes to distinguish the different type of complications, and the lack of coding data about some general conditions such as sepsis, shock, malnutrition, steroid therapy, diabetes, pulmonary, and heart failure.

Gastric Perforation in Ndola- Zambia: A Case Report

It is known that there is problem of gastric perforation (GP) in Africa, in the Japanese and the Western countries. However it occurs much less frequently [1,2]. Some cases have been free perforation and some have been major bleeding in patients with gastric cancer. Perforations are serious conditions with potentially dangerous effects however they are rare [3]. There is also evidence that neonatal gastric perforation (GP) does occur but it is a very rare event. It is associated with a poor prognosis and there is still much debate about its etiology [4]. It is believed that the perforation occurs in the lesser curvature and anterior wall of the stomach. Some authors think that gastric Perforation (GP), is caused by a mechanical rupture of the stomach wall, as a result of increased intragastric pressure, in adults, full-term and premature infants [5]. There is also a theoretical concern that the capnoperitoneum (Increased intra-abdominal pressure 10-12mmHg), may aggravate peritonitis and induce septic shock. It is associated with a poor prognosis [6]. The Gastric perforation is also seen that one of four ulcer perforations can be attributed to the use of nonsteroidal anti-inflammatory drugs, a risk factor of particular in the elderly [2]. In peptic ulcer or gastric perforation, Endoscopy and or Laparoscopy are being increasingly used in conditions even though there is complication of peritonitis [7-9].