Impact of the small bowel impassability on expression of the hypoxia-induced factor-1α

Objective. Studying of the hypoxia-induced factor-1α expression and peritoneal oxygenation in experimental small bowel intestinal impassability. Materials and methods. The investigation was done on 18 laboratory animals, in which 62 metrics of direct oxymetry performed with the objective to study the impact of the small bowel impassability on velocity of the mass transduction and partial pressure of oxygen and the hypoxia-induced factor-1α expression, influenced by hypoxia. Results. In experimental ileus, complete or partial one, partial pressure and velocity of the oxygen mass-transduction in peritoneum were statistically significantly lower, than such in a control, indicating on inhibition of cellular structures, utilizing the oxygen, what promotes the adhesive disease occurrence. Experimental ileus have led to lowering of the oxygen partial pressure in peritoneum by 88% - from 28.7 (in a control) to 3.5 mm Hg (p<0.01). The partial (by 277.8%) and the complete (by 248.2%) experimental ileus was characterized by enhancement of the hypoxia-induced factor-1α expression. Conclusion. Ileus, accompanied by change in the parietal and visceral peritoneum oxygenation, stimulates the abdominal cavity adhesive process development.

Peritoneal Metastases: Their Associated Imaging Features

Peritoneal Metastases (PM) detection remains a challenge even with modern imaging. Knowing imaging features of abnormal findings frequently associated with PM is of interest to improve PM detection. Although ascites is a common imaging finding of PM, the presence of ascites alone, even in patients with known cancer, is not enough to diagnose PM. The peritoneum should be read as an own organ with careful analysis of the ligament (e.g. falciform and hepatoduodenal ligament), the mesos and the omenta. Indirect manifestations of visceral peritoneal involvement is a segment of small bowel fixed to the parietal peritoneum, the appearance of blockage of free circulation of ascites, plurisegmental bowel obstruction and clumped bowel that is a strong predictor of diffuse involvement of the visceral peritoneum by a high grade tumor. Ovarian and umbilical metastases are frequently associated with PM in particular in digestive cancers. Moreover, ovarian metastases has been shown to be less responsive to chemotherapy than other metastases and should not be chosen as a target lesion for RECIST assessment. The presence of cardiophrenic angle lymph nodes also increases the possibility of metastatic spread in peritoneum. Finally, the most common PM mimickers include colonic diverticulum, mesenteric lymph nodes, splenosis implants, fat necrosis and postoperative changes after cytoreductive surgery and HIPEC.

Features of the postcovid period in women in labor

Clinical manifestations in the abdominal cavity of a woman in labor, discovered during an urgent cesarean section at 41 weeks of gestation 2 months after an acute form of COVID-19, are described. The materials of medical documentation were analyzed and the features of the course of pregnancy by trimester, urgent cesarean section, postoperative period, laboratory parameters, ultrasound data, cardiotocography, fetal condition at birth and three days later were determined.Presentation of case. 33-year-old pregnant woman (pregnant for the first time) had COVID-19 at 26 weeks of gestation. At a cesarean section for urgent indications at 41 weeks of gestation during the revision of the abdominal cavity was found that the visceral peritoneum of the uterus along the anterior and posterior surfaces, fallopian tubes, wide and round uterus ligaments, ovaries and parietal peritoneum of the pelvis, areas of the serous intestinal layer were with expressive signs of edema covered with vesicular rash, in places in the conglomerate, which were bleeding. There was no abdominal effusion.The child was born with 7–8 points Apgar score and had a negative PCR result for COVID-19. Placenta measuring 25 x 21 x 5.0 x 0.5 cm with multiple petrification, single red heart attacks. The shells are distinctly yellow-gray-green in color. The umbilical cord is 70 cm long and usual color. Amniotic fluid is clear. The early and late postoperative periods and the postpartum period proceeded without complications. At once the disorders in the blood coagulation system, immune system, positive COVID-19 IgG and IgM were identified in mother. Videin, Magniсum-antistress, preparations of acetylsalicylic acid and for the comprehensive support of the physiological state of the intestine were used in the complex treatment of the postpartum period.Conclusion. COVID-19 disease is pathology with many unknowns. Therefore, each clinical observation is important for studying of its course. Post-COVID syndrome and long-COVID syndrome have individual characteristics. Collective experience will contribute to the definition of an algorithm for the therapy of patients and personalized dispensary observation after an acute period.

Generalized peritonitis lead to shock: Diagnosis and management

The peritoneum is a membrane consisting of one layer of mesothelic cells which is separated from the vascular connective tissue underneath by the basement membrane. It forms a closed pouch where the visera can move freely inside. The peritoneum includes the abdominal cavity as the parietal peritoneum and bends to the organs as the visceral peritoneum (Marshall, 2003).Peritonitis is inflammation of the peritoneum (the serous lining that covers the abdominal cavity and abdominal organs therein). It is an acute form of illness, and is a surgical emergency. Can occur locally or in general, through an infectious process due to intestinal perforation, for example in appendix rupture orcolonic diverticulum, or non-infection, for example due to gastric acid discharge in gastric perforation, bile acid excretion in gallbladder perforation. In women, peritonitis is often caused by infection of the fallopian tubes or ovarian rupture [1].

Laparoscopic Diagnosis of Peritoneal Tuberculosis

Peritoneal tuberculosis is a rare form of tuberculosis, which involves parietal and visceral peritoneum, omentum, and intestinal mesentery. Its incidence is increasing in developed countries due to HIV infection and immigration. We present a case of peritoneal tuberculosis in a twenty two-year-old patient misdiagnosed with appendicitis. A laparoscopic surgery was performed showing multiple implants on serosal surfaces and adhesions. Laparoscopic appendectomy and peritoneal biopsies were performed. As peritoneal tuberculosis was suspected, an early antituberculous treatment was initiated. A pathological examination of the samples revealed epithelioid granulomas with a centrale caseous necrosis and acid-fast bacilli. Peritoneal tuberculosis is a challenging diagnosis that can mimic other pathologies and should be kept in mind to establish an early antituberculosis treatment avoiding the high morbidity and mortality associated with a late treatment initiation. In case of suspicion of peritoneal tuberculosis, laparoscopy with guided biopsies is useful for the establishment of a correct diagnosis.

GNET of small bowell

The case report presents a rare malignant tumor of the duodenojejunal junction with generalization in an elderly polymorbid woman, which showed symptoms of high ileus. The tumor infiltrated almost the entire with of the wall with the exception of the mucosa layer and metastatically affected the lymph nodes and the wall and visceral peritoneum. The diagnosis was determined after surgical resection based on histological and immunohistochemical examinations which proved the positivity of S100 protein and synaptophysin.

Cytoreductive surgery and hyperthermal intraperitoneal chemoperfusion in colorectal cancer and cancer of ovaries: our experience and perspectives of a new method

Objective. Studying of results of the cytoreductive operations and hyperthermal intraperitoneal chemoperfusion application for treatment of canceromatosis in colorectal cancer and ovarian cancer. Materials and methods. In 10 patients, suffering colorectal cancer (6 men and 4 women) were performed peritonectomy, diathermo-ablation of implants, made from visceral peritoneum. Average value of the peritoneal canceromatosis index have constituted 18 (14 - 21). In 11 patients, suffering ovarian cancer, panhisterectomy, peritonectomy, omentectomy, and ablation of the visceral peritoneum implants was conducted. Median value of the peritoneal canceromatosis index was 16 (12 - 20). For hyperthermal intraperitoneal chemoperfusion oxaliplatin was used. Results. Complete and optimal cytoreduction (degree CC0-CC1 in accordance to classification of P. H. Sugarbaker) was achieved in 5 patients, while suboptimal one (degree CC2) - in 10, and nonoptimal (degree CC3) cytoreduction - in 6 patients. Intraoperative complications were absent. Postoperative complications have occurred in 5 (23.8%) patients: the wound infection, persisting ileus, episode of partial ileus. Of 10 patients, suffering colorectal cancer, 5 died in 9-12 mo. One-year barrier have had survived 45.5% patients. Of 11 women-patients, suffering ovarian cancer, 7 died in 6-24 mo. One-year barrier have had survived 36.4% women-patients. Conclusion. In patients, suffering colorectal cancer, the survival median was 12 mo, while in the women-patients, suffering ovarian cancer - 18 mo. Cytoreductive operations and hyperthermal intraperitoneal chemoperfusion constitute perspective method for the survival enhancement in patients, suffering canceromatosis, but only if their selection was organized.

Prophylaxis of damage of extrahepatic biliary ducts and pancreatic ducts while performance of gastric resection in accordance to Billroth II method for complicated duodenal ulcers

Objective. To elaborate a method of mobilization and a method of closure of “complex handed” duodenal stump while operating for complicated giant penetrating pyloroduodenal ulcers with the aim to prevent iatrogenic damage of extrahepatic biliary ducts and pancreatic ducts and to improve the results of surgical treatment of this pathology. Materials and metods. In the investigation 46 patients were included, who were operated on for complicated giant penetrating pyloroduodenal ulcers. Giant pyloroduodenal ulcers have had more than 2.5 cm size. The method of duodenal mobilization and the method of suturing of a “complex” duodenal stump were proposed. The method of duodenal mobilization consists of duodenotomy in the zone of a cicatricial-ulcerative transformation and intraintestinal digital upper and anterior stretching towards yourself of all duodenal walls from adhesive process, what includes mobilization of upper-horizontal and of part of descending duodenum portiions, using incision of visceral peritoneum along right and left edges of colon on a distance, sufficient to form its stump without tension. The method of suturing of a “complex” duodenal stump consists of duodenotomy in the affected zone of circular ulcer process. This permits to determine a degree of ulcerative stenosis, to exterritorize the ulcer and after duodenal mobilization, using the above mentioned method, to apply the duodenal mobilized walls for formation of a stump. Application of a one-raw interrupted screw-up sutures permits to distribute the pressure load along all sutures what enhances a mechanical strength of the sutures placed. Results. Average duration of the operation have constituted 136.6 min (95% CI: 125.2; 152.0); a stationary stay - from 7 to 26 bed-days, 15.7 days (95% CI: 13.1; 18.2) at average. Among early postoperative morbidity there were: infection in the wound zone - 2 (4.3%), pneumonia (4.3%), stroke - 1 (2.2%), pulmonary thromboembolism - 1 (2.2%), insufficiency of the duodenal stump sutures - 1 (2.2%) observation. Postoperative mortality have constituted 4.3%, 2 patients died, in 1 (2.2%) pulmonary thromboembolism was the cause of the death, and in 1 (2.2%) - hemorrhagic insult. The duodenal stump sutures insufficiency and extensive serous-fibrinous peritonitis were revealed in the patient on the 6th postoperative day in 1 (2,2%) patient. In 1 year 31 patients were examined: while performing of fibrogastroscopy in 1 (3.2%) patient the ulcer of posterior wall of gastrojejunoanastomosis was revealed, in 7 (22.6%) - superficial gastritis, in 1 (3.2%) - erosive gastritis of gastric stump. Conclusion. The proposed procedure for duodenal mobilization and the method of the duodenal stump formation in a complicated giant circular pyloroduodenal ulcer permits to minimize a possibility of the stump sutures insufficiency occurrence as well as the prevention of iatrogenic damage of biliary and pancreatic ducts, involved in the ulcer infiltrate, injury, and may be recommended for application in clinical practice. Special attention must be drawn to duodenal decompression in postoperative period and to intestinal stimulation.

Standard and multivisceral colectomy in locally advanced colon cancer

BackgroundManagement of locally advanced colon cancer (LACC) is challenging. Surgery is the mainstay of the treatment, yet its outcomes remain unclear, especially in the setting of multivisceral resections. The aim of the study was to examine the outcomes of standard and multivisceral colectomy in patients with LACC.Patients and methodsPatients demographics, clinical and perioperative data of patients operated within study period 2004–2018 were collected. LACC was defined as stage T4 colon cancer including tumor invasion either through the visceral peritoneum or to the adjacent organs/structures. Accordingly, either standard or multivisceral colectomy (SC and MVC) was performed.ResultsTwo hundred and three patients underwent colectomy for LACC. Of those, 112 had SC (55.2%) and 91 (44.8%) had MVC. Severe morbidity and mortality rates were 5.9% and 2.5%, respectively. MVC was associated with an increased blood loss (200 ml vs. 100 ml, p = 0.01), blood transfusion (22% vs. 8.9%, p = 0.01), longer operative time (180 minutes vs. 140 minutes, p < 0.01) and postoperative hospital stay (11 days vs. 10 days, p < 0.01) compared with SC. The complication-associated parameters were similar. Male gender, presence of ≥ 3 comorbidities, tumor location in the left colon and perioperative blood transfusion were associated with complications in the univariable analysis. In the multivariable model, the presence of ≥ 3 comorbidities was the only independent predictor of complications.ConclusionsColectomy with or without multivisceral resection is a safe procedure in LACC. In experienced hands, the postoperative outcomes are similar for SC and MVC. Given the complexity of the latter, these procedures should be reserved to qualified expert centers.

Closed loop small bowel obstruction due to mid urethral sling mesh

Closed loop small bowel obstruction is a surgical emergency, which when left untreated leads to vascular compromise resulting in intestinal ischemia, necrosis and perforation. We report the case of a 61 years old female with past surgical history of hysterectomy and a mid-urethral sling, who presented to the emergency department for abdominal pain and obstipation. She was found on imaging to have a closed loop small bowel obstruction. An exploratory laparotomy revealed an adhesive band encompassing the distal terminal ileum, visceral peritoneum and the Mid‐urethral slings mesh. This is a rare complication that, to our knowledge, has not been reported in the surgical literature. This paper will discuss the clinical presentation, diagnostic studies, therapeutic intervention and outcome of this unique case.