A case report of refractory congenital chylous ascites in infant – surgical treatment with Fibrin glue

Congenital chylous ascites is a rare disease that results from abnormal development of the intra-abdominal lymphatic system. No gold standard treatment has been described so far, however, a combination of medium–chain triglyceride based diet or total parenteral nutrition along with octreotide and abdominal paracentesis is considered as a conservative management. This treatment is often a challenge to physicians since chylous ascites is often refractory and result in malnutrition and immune deficiency because of the loss of proteins and lymphocytes. We report a four-month old boy with congenital chylous ascites who was refractory to medical treatment with prolonged bowel rest, total parenteral nutrition, octreotide and repeated paracentesis. The baby well responded to surgical treatment with application of fibrin glue on the surface area of the leak site and was discharged after 2 month of hospitalization. When following up the patient had no recurrence of the ascites and he was growing up normally.

Large Duodenal Hematoma Causing an Ileus after an Endoscopic Duodenal Biopsy in a 6-Year-Old Child: A Case Report

Intramural duodenal hematoma (IDH) in children is a rare complication after esophagogastroduodenoscopy. It is commonly described in patients with additional disorders or risk factors, such as coagulopathy. We present a case of a previously healthy 6-year-old boy with a large obstructing intramural duodenal hematoma and concomitant pancreatitis after an elective esophagogastroduodenoscopy. The patient presented with typical symptoms of an IDH, such as abdominal pain and distension, nausea and vomiting. IDH was diagnosed using ultrasound and magnetic resonance imaging examination. Conservative management with gastric decompression using a nasogastric feeding tube, bowel rest, total parenteral nutrition and analgesia was performed. After three weeks, the patient was discharged from the hospital without any complaints. Interventional management of IDH in pediatric patients with a lack of response to conservative therapy or complicating IDH should be discussed in an interdisciplinary team.

Chylothorax: A Stepwise Approach to Diagnosis and Treatment

Chylothorax, a lymphatic flow disorder characterized by an abnormal circulation of lymph fluid into the pleural cavity, is the most common cause of pleural effusions during the neonatal period. This condition affects 1/15,000 neonates every year. Affected neonates often manifest with respiratory distress, electrolyte imbalances, sepsis, and even immunodeficiencies. Mortality risk is highest among neonates undergoing cardiac surgery as well as those with associated hydrops fetalis. Conservative treatment options include bowel rest with administration of parenteral nutrition, followed with medium-chain triglyceride enteral feedings, and octreotide therapy. Severe or persistent cases require surgical intervention. This can involve a unilateral or bilateral pleurectomy and thoracic duct ligation, with or without pleurodesis. Early identification and successful treatment of this condition is contingent upon awareness of the most current evidence and a timely cross-disciplinary approach to care.

The Efficacy and Safety of Methylnaltrexone for the Treatment of Postoperative Ileus

Background Postoperative ileus (POI) is a surgical complication resulting in increased morbidity and length of stay (LOS). Usual care for POI includes bowel rest and gastric decompression. It has been questioned if methylnaltrexone (MNTX), a peripheral opioid antagonist, could be used as treatment for POI. The purpose of this study was to determine if MNTX is effective and safe for POI treatment. Methods This single-center, retrospective cohort study included patients ⩾ 18 years with a POI. Patients with acute colonic pseudo-obstruction, small bowel obstruction, and gastrointestinal malignancy were excluded. The intervention was MNTX administration. The primary outcome was time to ileus resolution. Secondary outcomes included LOS, duration of nasogastric tube, total parenteral nutrition requirement, and incidence of gastrointestinal perforations. Results 110 patients were included in the analysis; 28 received MNTX. Time to ileus resolution was 9.9 days for the MNTX group and 11.4 days for the control group ( P = .38). Duration of gastric decompression was 4.6 days for the MNTX group and 4.2 days for the control group ( P = .71). Length of stay was 19.9 days for the MNTX group and 19.7 days for the control group ( P = .96). The percentage of TPN requirement was 17.9% in the MNTX group and 22.0% in the control group ( P = .65). No gastrointestinal perforations were observed in either group. Conclusion For the treatment of POI, MNTX did not significantly reduce time to resolution of ileus, LOS, duration of gastric decompression, or TPN requirements. However, no gastrointestinal perforations were seen, indicating that MNTX may be safely used in these patients.

A Descriptive Study of Clinical Presentation, Etiology and Management in Acute Mechanical Bowel Obstruction

Background: Acute mechanical bowel obstruction is a common surgical emergency and a frequently encountered problem in abdominal surgery. It constitutes a major cause of morbidity in hospitals around the world and a significant cause of admissions to emergency surgical departments. Intestinal obstruction belongs to highly severe conditions, requiring a quick and correct diagnosis as well as immediate, rational and effective therapy. Method: This is a prospective observational study which was carried on 130 patients of abdominal obstruction in the department of general surgery Sawai Man Singh Hospital Jaipur. Results: The majority of patients in our study were 31-40 years of age group. Mostly patients were male account about 86.15%. Pain abdomen was the most frequent presenting symptoms (95.38%) and absence of passage of flatus and feces was next complain (89.23%). Nausea and vomiting was present in 84.62% of patients. Abdominal tenderness was the most common physical finding on clinical examination (96.92%). Abdominal distension was present in 81.54% patients. Adhesions and bands were the most prevalent etiology of obstruction in the small bowel obstruction (58.45%) and tumour and volvulus were the most common etiology in the large bowel (12.31%). Conclusion: Intestinal obstruction is most commonly caused by intra-abdominal adhesions, Koch’s abdomen, malignancy and obstructed hernia. Conservative treatment with bowel rest and fluid resuscitation is successful in a variable proportion of patients. Patients with clinical degradation on assessment and radiological scans evoking ischemia or strangulated bowel obstruction need urgent surgery. Keywords: Bowel Obstruction, Pain, Adhesions, Tumour.

Case report of COVID-19 positive new born with necrotizing enterocolitis (NEC)

COVID-19 caused by SARS-Cov-2 virus has spread rapidly across the world. Children are just as like as adult to become infected with virus but have lesser symptoms and less severity of the disease. Necrotizing enterocolitis is one of the common gastrointestinal emergencies in neonatal intensive care unit. More than 85% of cases of NEC occur among preterm and very low birth weight. Preterm babies are vulnerable to develop NEC because of high incidence of perinatal distress factor, stasis of gut due to autonomic immaturity, poor barrier function of gut or immune defences, lack of feeding with human milk and higher incidence of nosocomial infections. During the current COVID-19 pandemic, no similar finding has been reported in the neonatal population to date. In this review we summarize the case report of two newborns admitted in our NICU who were COVID 19 positive presented to us with symptoms suggestive of necrotizing enterocolitis (NEC) and their outcome based on presence of comorbidity. Our case reports two case of two COVID-19 positive newborns admitted in our NICU with history, examination and investigations suggestive of necrotizing enterocolitis. Early initiation of antibiotics covering bowel flora, bowel rest and resuscitation, similar to our tried and true medical management of NEC, should be considered for initial management to avoid surgical intervention

Case Report of Ischemic Colitis Post Mild Covid 19 Infection

Background: COVID-19 has emerged as a global health pandemic emergency with a massive effect on public health globally. In addition to its effects on respiratory tract, COVID-19 disease had been linked to many gastrointestinal symptoms. Rarely, it has been associated with intestinal ischemia due to the resultant hypercoagulable state. Case Summary: We report a case of a young lady previously healthy, who presented with severe abdominal pain associated with tenesmus and mucoïdbloody diarrhea, diagnosed to have ischemic colitis post covid19 infection. One of the port of entry of coronavirus 2 (SARS-CoV-2), to cause infection, is via an angiotensin-converting enzyme2 (ACE2). View that these ACE 2 receptors are highly expressed at the level of gastrointestinal tract, a variety of symptoms will occur. Recently, coagulopathy due to COVID-19 has emerged as a major component of the disease. The resultant ischemia has been reported to be associated with a hypercoagulable state. Lately, few cases were described worldwide of intestinal ischemia due to COVID-19 infection, mainly occuring in patients presenting with severe respiratory illness. Our patient did not complain of severe COVID-19 infection in the context of dyspnea or respiratory distress and did not have any features of shock requiring a vasopressor therapy. Treatment for ischemic colitis mainly involves supportive care with bowel rest. Conclusion: New datas concerning covid 19 infection are emerging. Ischemic colitis is a new aspect of manifestation of the infection, which can take place without necessarily being linked to a severe infection with covid 19 as in our case.

Lactobacillus reuteri in Its Biofilm State Improves Protection from Experimental Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a devastating disease predominately found in premature infants that is associated with significant morbidity and mortality. Despite decades of research, medical management with broad spectrum antibiotics and bowel rest has remained relatively unchanged, with no significant improvement in patient outcomes. The etiology of NEC is multi-factorial; however, gastrointestinal dysbiosis plays a prominent role in a neonate’s vulnerability to and development of NEC. Probiotics have recently emerged as a new avenue for NEC therapy. However, current delivery methods are associated with potential limitations, including the need for at least daily administration in order to obtain any improvement in outcomes. We present a novel formulation of enterally delivered probiotics that addresses the current limitations. A single enteral dose of Lactobacillus reuteri delivered in a biofilm formulation increases probiotic survival in acidic gastric conditions, increases probiotic adherence to gastrointestinal epithelial cells, and reduces the incidence, severity, and neurocognitive sequelae of NEC in experimental models.

Spontaneous dissection of coeliac and superior mesenteric artery: double whammy

Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It usually involves one artery, most commonly the superior mesenteric artery (SMA) followed by the coeliac artery. We are reporting a rare case where both coeliac and SMA were showing dissection. We are reporting a case of 60-year-old hypertensive male who came with worsening abdominal pain for 5 days; CT scan showed coeliac and SMA dissection without any imaging evidence of intestinal ischaemia. He was successfully managed medically with bowel rest and anticoagulation. Two weeks of follow-up CT scan showed no progression or thrombus formation. For complicated cases, percutaneous transluminal angioplasty of a visceral artery or open surgical exploration or hybrid approach is required. However, for stable uncomplicated cases, medical therapy alone is sufficient.

Isolated Spontaneous Mesenteric Artery Dissection: A Rare Entity

Isolated spontaneous dissection of the mesenteric artery in the absence of involvement of the aorta or its branches is an uncommon vascular entity. It is generally seen in males and presents with gastrointestinal symptoms due to mesenteric ischemia. However, asymptomatic cases are increasingly being diagnosed due to increased use of computed tomography (CT) angiography. The course is usually self-limiting, and conservative management with bowel rest, strict blood pressure control, anticoagulants, sedatives for pain, and close observation usually suffices. Surgery or endovascular stenting is usually reserved for those exhibiting bowel ischemia or impending rupture. We report a case of a young female with isolated spontaneous mesenteric artery dissection with thrombus, which did not improve with medical therapy and was managed promptly by surgery due to the presence of bowel ischemia.