Jejunal strangulation and incarceration associated with bilateral perineal hernias in a neutered male dog

CASE DESCRIPTION An 8-year-old 6.8-kg neutered male Dachshund was presented for evaluation of vomiting, diarrhea, anorexia, and swelling over the right perineal region. The dog had a history of a bilateral perineal herniorrhaphy and castration 14 months prior to presentation. CLINICAL FINDINGS Bilateral perineal hernias were confirmed by digital rectal examination. Abdominal ultrasonography confirmed the presence of intestine within the right hernia. Three days after admission to the hospital, the region of the right perineal hernia became painful, erythematous, and edematous. Computed tomography revealed jejunal incarceration within the right hernia with dilation of 1 jejunal segment that indicated intestinal obstruction. TREATMENT AND OUTCOME Abdominal exploratory surgery was performed, during which irreducible small intestinal incarceration was confirmed. Intra-abdominal jejunal resection and anastomosis was performed, and an approximately 13-cm-long section of the jejunum was resected. Bilateral perineal herniorrhaphies with internal obturator and superficial gluteal muscle transposition were performed. Six months after surgery, digital rectal examination of the dog revealed that the repair was intact. The dog had no perineal hernia–related clinical signs at the time of the recheck examination. CLINICAL RELEVANCE For the dog of the present report, surgical management of small intestinal strangulation associated with a perineal hernia was successful. Although a portion of the small intestines can frequently be found within perineal hernias in dogs, perineal hernia-related small intestinal strangulation has not been previously described, to the authors’ knowledge. Veterinarians and clients should be aware of this potential complication secondary to perineal hernia and be prepared to perform an abdominal surgical procedure to address small intestinal incarceration in affected dogs.

Selective Microfluidic Capture and Detection of Prostate Cancer Cells from Urine without Digital Rectal Examination

Urine-based biomarkers have shown suitable diagnostic potential for prostate cancer (PCa) detection. Yet, until now, prostatic massage remains required prior to urine sampling. Here, we test a potential diagnostic approach using voided urine collected without prior digital rectal examination (DRE). In this study, we evaluated the diagnostic performance of a microfluidic-based platform that combines the principle of photodynamic diagnostic with immunocapture for the detection of PCa cells. The functionality and sensitivity of this platform were validated using both cultured cells and PCa patient urine samples. Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) demonstrated this platform had a detection limit of fewer than 10 cells per 60 µL and successfully validated the presence of a PCa biomarker in the urine of cancer patients without prior DRE. This biosensing platform exhibits a sensitivity of 72.4% and a specificity of 71.4%, in suitable agreement with qRT-PCR data. The results of this study constitute a stepping stone in the future development of noninvasive prostate cancer diagnostic technologies that do not require DRE.

COVID-19 Pandemic Lockdown Resulting in an Unusual Rectal Foreign Body in a Young Male

Foreign body rectum may cause serious consequences, especially in psychologically vulnerable patients, In critical conditions like pandemic COPVID-19, when depression, fear boredom, loneliness such incidence may occur. An 18 years old young male presented in emergency with a foreign body rectum. He was a laborer on daily wages. During the COVID-19 pandemic, loneliness, anxiety, and unemployment have exposed him to bizarre behavior, resulting in inserting potato into his rectum. He denied any history of homosexuality. The diagnosis was made by examination. Per rectal examination found FB just above the anal verge. The foreign body was removed rectally under G/A. He was then referred to a psychiatrist for evaluation.

Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P < 0.001 ). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.

A STUDY ON CORRELATION OF SERUM PROSTATE SPECIFIC ANTIGEN WITH CLINICAL AND PATHOLOGICAL VARIABLES IN PATIENTS OF PROSTATOMEGALY

Background: In clinical practice, biopsies are generally performed only when the results ofprostate specific antigen (PSA) test or digital rectal examination (DRE) are abnormal. This leads to misdiagnosis of most small prostatic cancers present in many older men. Patients with lower urinary tract infection (LUTS) who have serum PSA levels higher than 4ng/ml are primarily advised to undergo prostate biopsy to rule out cancer. However, PSA is organ specific not disease specific, so the presence of other prostate diseases such as benign prostatic hyperplasia (BPH) and prostatitis may influence its effectiveness for cancer detection. Hence, the PSA based prostate cancer detection is fraught with high false positive rate. Aim:To evaluate the utility of PSA assay as a method of investigation in diagnosis of prostatic lesion. Objectives: The use of Serum PSA levels for the early detection of prostate cancer and evaluate its role with other modalities for diagnosis of prostate cancer and to diagnose different diseases of prostate, i.e. prostatitis, BPH in prostatomegaly, and its correlation with Serum PSA levels. Materials and Methods: This prospective descriptive study was conducted in Index Medical College, Hospital & Research Centre, Indore, M.P,India in the period of August 2019 to July 2021. The patients were selected from the outdoor Department of General Surgery. Results: A total of 80 male patients presenting with LUTS were included. Their mean age was 68.66 years. The majority i.e. 41 of the study group were in the age group of 61-70 years. 42 of patients had Serum PSA < 4ng/ml. Biopsy proven adenocarcinoma cases 34% of the cases are in the age group of 61-70 years. Out of the biopsy proven adenocarcinoma cases, DRE was suspicious of malignancy in 89%. Conclusion: Serum PSA levels have a significant correlation with the age group, with the increase in age there is rise in Serum PSA levels. Transabdominal ultrasound, DRE and Serum PSA has high sensitivity in diagnosis of prostatomegaly but it was found that none of the screening tool has got much efficacy in differentiating carcinoma prostate from benign hypertrophy, but the combination of DRE and Serum total PSA or DRE, Serum total PSA and ultrasound abdomen showed higher efficacy in diagnosis of carcinoma prostate. Increase in Serum PSA is directly related to carcinoma, but there is no absolute cut-off for Serum PSAfor diagnosis of carcinoma. Key-Words: Prostate specific antigen, Prostatomegaly, Benign Prostatic Hypertrophy, Digital Rectal Examination, International Prostate Severity Score, Carcinoma Prostate.

Determination of potential risk characteristics for cauda equina compression in emergency department patients presenting with atraumatic back pain: a 4-year retrospective cohort analysis within a tertiary referral neurosciences centre

ObjectiveAtraumatic back pain is an increasingly common presentation to the ED. A minority of these cases will have significant structural pathology, resulting in acute cauda equina compression (CEC). Although clinicians often look for ‘red flags’ to identify potential CEC, the prognostic accuracy of these presenting symptoms and clinical examination findings is unclear. We sought to evaluate the accuracy of individual clinical features in a large cohort of ED patients with atraumatic backpain and reference standard imaging, for the diagnosis of CEC.MethodsA retrospective case note review from 2014 to 2018 within an established ED atraumatic back pain pathway, undertaken at the largest tertiary spinal referral centre in the UK. We analysed routine data, collected prospectively by treating clinicians within a structured electronic health record clinical proforma. Data on signs and symptoms in 996 patients with suspected CEC referred for definitive MRI over a 4-year study period were extracted and compared against a final reference standard diagnosis.ResultsWe identified 111 patients with radiological evidence of CEC within the cohort referred for definitive imaging (111/996, 11.1%), of whom 109 (98.2%) underwent operative intervention. Patients with CEC were more likely to present with bilateral leg pain (OR=2.2), dermatomal sensory loss (OR 1.8) and bilateral absent ankle or ankle and knee jerks (OR=2.9). Subjective weakness was found to be associated with CEC on univariate but not multivariate analysis. We found no relationship between digital rectal examination findings and the diagnosis of CEC.ConclusionsIn our cohort, factors independently associated with CEC diagnosis on MRI included bilateral leg pain, dermatomal sensory loss. Loss of lower limb reflexes was strongly suggestive of CES (likelihood ratio 3.4 on multivariate logistic regression). Our findings raise questions about the diagnostic utility of invasive digital rectal examination.

EP.FRI.886 Clinicians’ compliance and diagnostic utility of digital rectal examination in acute abdominal emergencies: a prospective, blinded study

Aims One hundred years ago, Sir Zachary Cope described digital rectal examination (DRE) as ‘extremely important and informative’ in the assessment of the acute abdomen. Medical students have always been taught of the importance of including a DRE as part of the abdominal examination. It has however been observed that DRE is often omitted in clinical practice. The aims of the study are to determine how frequently DRE is carried out in acute abdominal emergencies and also to determine the diagnostic utility of DRE in this setting. Methods Patients over the age of 18 presenting to the on-call general surgeons in a teaching general hospital with any acute abdominal symptoms over a 15 day period were assessed prospectively. The performance of a DRE by any clinician at any point up to 24 hours post-admission was recorded, and the findings of DRE were analysed with respect to the final diagnosis. Results Out of the 168 patients presenting with an abdominal emergency, 41 (24.4%) had a rectal examination. 70.7% of DRE were done by surgical trainees and foundation doctors. Most DREs were performed when the presenting complaints were constipation, rectal bleeding, and suprapubic pain. The findings on DRE directly contributed to the final diagnosis in 11 patients. Conclusions DRE is only preformed selectively during the initial evaluation of surgical patients presenting with acute abdominal symptoms. However DRE remains a key part of clinical examination. The theoretical and practical skills in the performance of DRE should be safeguarded via continuing education and training.