Stricturanaemie and hepatic diet. Narbeshuber (Med. Kl. 1931. No. 11)

Narbeshuber (Med. Kl. 1931. No. 11), reports on the bth, who had severe gastrointestinal phenomena and symptoms of malignant anemia on the basis of intestinal stenosis from tuberculous ulcers.

P226 Does faecal Calprotectin help differentiate inflammatory from fibrous stenosis in Crohn’s disease?

Background Digestive stenosis is the most common complication of Crohn’s disease. It can be either inflammatory or fibrous. The clinical, biological and especially morphological characteristics of the stenosis can help differentiate inflammatory stenosis from fibrous stenosis. The aim of our study was to evaluate the performance of fecal calprotectin (FC), a marker of intestinal inflammation, in identifying the type of stenosis. Methods A prospective study including all patients followed for Crohn’s disease in the Gastroenterology Department of Habib Thameur Hospital over a 6-month period from July 2020 to December 2020 was performed. Clinical, biological, endoscopic and radiological data were collected. The inflammatory nature of the stenosis was mainly retained according to radiological activity signs objectified by cross-sectional imaging. All patients were given a FC assay at the time of inclusion. FC was dosed by using the Bulhmann® FCAL ELISA technique. The statistical study was carried out using the SPSS software version 22.0 (p value significant if lower than 0.05). Results Fifty patients were included in our study (mean age 40.54 years [18–67] and sex ratio (M/F) = 1.77). The average evolution time of the disease was 8 years [6 months- 27 years]. The disease was ileal in 16 patients, colic in 4 patients and ileocolic in 30. Twenty patients (40%) had an intestinal stenosis whose location was: ileocaecal anastomosis (n=9), ileal (n=8) and colic (n=3). Multiple stenoses (colic and ileal) were noted in 3 patients. Fifteen patients were on medical treatment at the time of inclusion: 7 patients were on Infliximab, 5 were on azathioprine and 3 were on 5ASA. Digestive symptoms such as diarrhoea or subocclusive syndromes were noted in 7 patients. A biological inflammatory syndrome (CRP >10mg/L) was noted in 8 patients. Of the 20 stenoses included, 8 were of the inflammatory type (40%). In the presence of stenosis, the mean level of FC was 224.9 μg/g. A high level of FC was associated with the inflammatory type of stenosis (p<0.001). A cut-off of 135 µg/g had a sensitivity 100% and a specificity of 90%. CRP did not differentiate between inflammatory stenosis and fibrous stenosis (p=0.4). Conclusion According to our study, FC is a good marker of intestinal inflammation allowing to differentiate an inflammatory from a fibrous stenosis during Crohn’s disease better than the usual biological markers. These results should be confirmed by larger studies.

P524 Endoscopic dilations of intestinal stenosis in Crohn’s disease

Background The occurrence of intestinal stenosis is a common and potentially serious complication of Crohn’s disease (CD). These strictures represent 20% of the surgical indications in CD. Endoscopic dilation is an alternative to surgery for endoscopically accessible stenosis. The aim of this study is to evaluate the effectiveness of endoscopic balloon dilation (EBD) in CD intestinal stenosis. Methods This retrospective, descriptive study realized between January 2015 and October 2020, included CD patients diagnosed at least 6 months before and complicated with symptomatic intestinal stenosis (abdominal pain, bloating, nausea and vomiting). Anorectal strictures were excluded. All patients had a cross-sectional imaging before intestinal dilation to determine the characteristics of the stenosis and exclude abscess and fistula tract near the stenosis which constitute a contraindication of EBD. All patients underwent an EBD during a colonoscopy under sedation by propofol. The short-term success of EBD has been established on both technical (passage of the endoscope across the site of stenosis after dilation) and clinical level (relief of intestinal obstructive symptoms). The long-term efficacy was defined by no need for surgery within 6 months after dilation. Results Twelve patients (6 males and 6 females), with an average age of 32 years +/-7.7, were included. The average interval between onset of CD and the onset of intestinal stricture was 8 years. Eight patients had a history of bowel resection. The stenosis was located at the terminal ileum or ileocaecal valve in 4 cases, ileocolic anastomosis in 8 cases. The stenosis was ulcerated in 9 cases, inflammatory in 5 cases and polypoid in 3 cases. All patients were on medical treatment corticosteroids, Azathioprine and / or Anti TNF. We performed 18 EBD, divided into several sessions depending on the degree of stenosis (1 EBD, 2 EBD and 3 EBD in respectively 11, 3 and 2 patients). Two patients required surgery for persisting symptoms. Technical success was obtained in 11 patients (92% of cases). Clinical success, defined by a disappearance of clinical symptoms with an HBI score of less than 4, was obtained in 9 patients (75% of cases). The mean follow-up after dilation was 23 months (range from 8 to 42 months). No major complications were observed in this study. Conclusion EBD is an effective therapeutic technique relatively safe for intestinal CD stenosis, allowing to delay or better, to avoid surgical treatment when the stenosis is well selected (stenosis<4cm, single, anastomotic, non-angled, and without adjacent abscess or fistula).

A Pilot Study Investigating the Safety and Feasibility of Endoscopic Dilation Using a Radial Incision and Cutting Technique for Benign Strictures of the Small Intestine: A Study Protocol

BackgroundSmall benign intestinal stenosis is usually treated by endoscopic balloon dilation (EBD) or surgery. Although, EBD and surgery are able to resolve the stenosis in most case, they are associated with several problems such as insufficient dilation and surgical stress, respectively. On the contrary, a novel approach called radial incision and cutting (RIC) is reported to have several benefits when compared to EBD and surgery. We can currently adopt RIC only for the strictures in the colon or terminal ileum and not for those stenotic lesions present further in the small intestine where balloon-assisted endoscopy is utilized, because long-type electric knife is currently not approved for use in Japan. We will herein conduct a pilot study to investigate the safety and feasibility of RIC for treating the benign stenoses of the small intestine using the long-type electric knife.Methods This will be a single-center, single-arm, interventional trial. The major criteria for inclusion will be age ranging from 20 to 80 years and the presence of benign stenosis in the small intestine. We will perform RIC in 10 participants. The primary outcome is the safety of this procedure, which will be assessed by measuring the frequency of adverse events of special interest. The secondary outcomes will be technical success rate, improvement in subjective symptoms, procedure time, and duration of hospitalization.DiscussionThis pilot study will provide useful information that will aid in adopting RIC for treating the benign strictures present in the small intestine. Trial registration jRCT Identifier, jRCTs022200040. Registered on 1 March 2021.URL: https://jrct.niph.go.jp/re/reports/detail/11533

35. Т. Cramer: Parametritis abscedens bei einem 12 jährigem Mädchen (Deutsche med. Wochenschr., 1892, № 33). Parametritis abscedens y 12 year old girl.

The disease begins with headaches lasting 2 days, then colicky pains in the abdomen come to the fore, with painful sensations on palpation in the Colon descendens area. Opіy only slightly and for a short time reduces pain and as a result of this rinsing of the intestines is impossible. Acceptance 01. Ricini induces vomiting. Warm poultices relieve colicky pain only when they are applied. As soon as it cools, the pain intensifies. This Status continues from September 7 to September 15, when a clearly flattened defecation appeared. Intestinal stenosis is diagnosed. Despite the use of narcotic drugs, colicky pains are so excruciating that the child rushes about in bed and screams good obscenities. The new study shows increased sensitivity in the left groin area, in the right groin area the pain is much less. Due to this edge of intestinal stenosis, an inflammatory process of the peritoneum of this space is assumed. Examination under anesthesia showed: an abscess in the left posterior fornix, which protrudes more posteriorly and presses the anterior wall of the recti into the intestinal lumen. Trial puncture into the posterior fornix. A large amount of green pus is erupting. The trocar tube is left in the abscess opening. Warm baths and warm flaxseed poultices are prescribed. Colicky pain after puncture is significantly reduced; appetite appeared. On September 20, pains again come as a result of stagnation of expiration. September 23 secondary punctuation. Significant relief of all symptoms. In the next days, the puncture site again overgrown and the pains resumed, but on September 27. during defecation, a mass of pus came out. Since then, the patient began to slowly recover. On October 15, pus came out of the last cut. The next day the temperature dropped to 36.5 . In 3 months after the onset of the disease, the patient began to attend school.