The spleen is a very hostile environment for tumor cells due to its anatomic location, blood supply, and rich immunological property – which makes it one of the most unique organ to be involved in metastatic diseases.15 Splenic metastases from non-hematologic malignancies are rare ranging from 0.6 to 7.1% base on autopsy reports of cancer patients, and 1.1 to 3.4% base on review of splenectomy cases.14 Moreover, isolated splenic metastases are more infrequent with only 31 cases reported from 1969 to October 2015.16 A splenic abscess is an unusual formation and is usually caused by hematogenous spread from an infection. Such expected frequency varies in different autopsy studies between 0.14% and 0.7%.1 Albeit rare, abscess can also result from migration of gut flora brought about by direct invasion of tumor cells from a neighboring neoplasm.17 This is a case of a 36-year-old female who came in with a history of abdominal pain, chills and fever for seven months. CT scan of the whole abdomen revealed splenic abscess with suspicion of a splenic rupture. The patient underwent exploratory laparotomy with abscess evacuation, splenectomy and double barrel colostomy and given with intravenous antibiotics. Histopathology results showed metastatic adenocarcinoma in the spleen. Thorough deliberation of her case was done and she was eventually managed as a case of Colon Cancer Stage IV and underwent chemotherapy. Splenic abscess developing from splenic metastasis from a colonic adenocarcinoma is rare and with concomitant high mortality rate. More often than not, splenic metastasis is discovered in advanced stage together with metastatic tumor in other organs while isolated splenic metastasis is even more uncommon. A splenic abscess as an initial demonstration of a colon cancer is not a common daily encounter of physicians hence a high index of suspicion coupled with sensitive and specific imaging is necessary in order to provide prompt medical and surgical intervention.

Human ; Female ; Adult: 25-44 Yrs Old ; Abdomen ; Adenocarcinoma ; Autopsy ; Colostomy ; Gastrointestinal Microbiome ; Pain ; Research Report ; Infections ; History ; Splenic Rupture ; World Health Organization ; Neoplasms ; Disease ; Fever ; Hematologic Neoplasms

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Human ; Female ; Adult: 25-44 Yrs Old ; Laparoscopy ; Appendectomy ; Appendix ; Appendicitis ; Abdominal Pain

Gliomatosis peritonei (GP) is a condition characterized by the dissemination of mature glial tissues throughout the peritoneal cavity. It is usually associated with immature ovarian teratoma but presents with mature cystic teratoma (MCT) in 1% of cases. GP, associated with MCT, is a benign disorder. The majority of cases remain asymptomatic and rarely recur. Here, we present a case of a 22-year-old woman with a history of abdominal enlargement and severe abdominal pain who underwent exploratory laparotomy, peritoneal fluid cytology, bilateral salpingo-oophorectomy, appendectomy, omental biopsy, and Jackson-Pratt drain insertion with histopathologic result of GP with MCT. A month later, the patient had a recurrence of abdominal enlargement, necessitating a second surgery. Immunohistochemistry for histopathologic evaluation and diagnostic imaging are crucial in confirming the diagnosis and guiding the treatment strategy. A multidisciplinary team approach in monitoring and comprehensive support is significant in optimizing outcomes for patients with aggressive GPs associated with MCT. Further research and clinical experience are essential to establish a standardized guideline to improve the management and clinical outcome of this condition.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Salpingo-oophorectomy ; Peritoneal Cavity ; Appendectomy ; Abdominal Pain ; Ascitic Fluid ; Immunohistochemistry

OBJECTIVE: To compare the therapeutic efficacy of portal and tail vein transplantation of bone marrow-derived mesenchymal stem cells (BMSCs) against cholestatic liver fibrosis in mice. METHODS: BMSCs were isolated and co-cultured with starvation-activated hepatic stellate cells (HSCs). HSC activation markers were identified using immunofluorescence and qRT-PCR. BMSCs were injected into the liver tissues of bile duct ligation (BDL) mice via the tail and portal veins. Histomorphology, liver function, inflammatory cytokines, and the expression of key proteins were all determined in the liver tissues. RESULTS: BMSCs inhibited HSC activation by reducing α-SMA and collagen I expression. Compared to tail vein injection, DIL-labeled BMSCs injected through the portal vein maintained a high homing rate in the liver. Moreover, BMSCs transplanted through the portal vein resulted in greater improvement in liver color, hardness, and gallbladder size than did those transplanted through the tail vein. Furthermore, BMSCs injected by portal vein, but not tail vein, markedly ameliorated liver function, reduced the secretion of inflammatory cytokines, including TNF-α, IL-6, and IL-1β, and decreased α-SMA + hepatic stellate cell (HSC) activation and collagen fiber formation. CONCLUSION The therapeutic effect of BMSCs on cholestatic liver fibrosis in mice via portal vein transplantation was superior to that of tail vein transplantation. This comparative study provides reference information for further BMSC studies focused on clinical cholestatic liver diseases.
Animals ; Mice ; Mesenchymal Stem Cell Transplantation ; Liver Cirrhosis/etiology* ; Male ; Cholestasis/therapy* ; Mice, Inbred C57BL ; Hepatic Stellate Cells ; Mesenchymal Stem Cells

The gut-brain axis is a bidirectional communication pathway connecting the central nervous system and gastrointestinal tract,playing a key role in the occurrence and development of diseases related to this axis.The vermiform appendix,as a part of the gut that is connected to the cecum,has a unique anatomical location,a rich microbiome,and abundant immune cells.Appendicitis and appendectomy have been found to be associated with the development of diseases related to the gut-brain axis.This review first introduces the anatomy and functions of the vermiform appendix and then expounds the associations of appendicitis and appendectomy with diseases related to the gut-brain axis.Furthermore,this review summarizes and prospects the mechanisms of the vermiform appendix in affecting the occurrence and development of diseases related to the gut-brain axis.
Humans ; Appendix/anatomy & histology* ; Brain ; Appendicitis ; Appendectomy/adverse effects* ; Gastrointestinal Microbiome ; Brain-Gut Axis

BACKGROUND

Appendicitis is the most common acute surgical disease in children. Due to a nonspecific presentation and progression of the disease, a significantly higher presentation of appendiceal perforation may be expected in young children. With perforation there is an elevated risk of intraabdominal abscess, wound infection, post-operative ileus, higher rates of readmission and longer length of stay. Laparoscopic appendectomy is the recommended first line treatment however many centers from developing countries are still in the early stages of adopting such an approach and do appendectomies in an open manner. This study outlines our institution’s experience with a laparoscopy-first approach in managing pediatric appendicitis. Surgical outcomes from laparoscopic and open procedures during the study period will be compared.

METHODS

This retrospective cohort analysis encompasses all pediatric appendicitis cases at our institution from 2022 to 2023. As a major pediatric surgery referral center, there were a total of 273 cases during that period. Patient records were reviewed for surgical approach and outcomes.

RESULTS

The mean patient age was 11.87 years with a male:female ratio of 1.84. Average duration of symptoms prior to consult was 2.47 days. Most of the patients had complicated appendicitis (57.8% ruptured, 10.2% gangrenous). For the surgical approach, 42.9% underwent open appendectomy (OA) and 57.1% had LA with a conversion rate of 7.14%. Irrespective of disease severity, LA was superior to OA in terms of time to resume feeding (2.84 vs 4.07 days), post-op length of stay (5.29 vs 6.95 days), and surgical site infection rate (3.3% vs 16.2%). Operative times were not statistically different, with cases performed by fellows being faster than their resident counterparts by a few minutes. Other morbidities for LA included intraabdominal abscess (1.9%) and postoperative adhesions requiring adhesiolysis (1.3%), while the OA group reported 1 case each for adhesions, intraabdominal abscess, and incisional hernia.

CONCLUSION

This study highlights the advantages and complications of laparoscopic appendectomy in the pediatric population as implemented in a tertiary government center. It also provides preliminary data on a significant cohort of patients with complicated appendicitis who underwent laparoscopic management in the local setting.

Human ; Laparoscopy ; Appendectomy ; General Surgery ; Philippines

OBJECTIVE

The study aims to compare the demographic profile, management, and outcomes of patients with foreign body ingestion before and during the COVID-19 pandemic.

METHODS

Design: Retrospective Review of Records

Setting: Tertiary Government Training Hospital

Participants: Records of 156 patients, 81 from the pre-pandemic period (2018-2020) and 75 during pandemic period (2020-2022), diagnosed with aerodigestive foreign bodies

RESULTS

One hundred fifty-six (156) patients, 81 from the pre-pandemic period (2018-2020) and 75 during pandemic period (2020-2022) were included in this study. Median age pre pandemic is 9 years old (Standard deviation = 22.19) and 16 years old (Standard deviation = 19.63) during pandemic. The male-to-female ratio for pre-pandemic and during pandemic is 54:27 and 52:23, respectively. The majority of the patients ingested coins (53% pre-pandemic and 44% during pandemic) followed by dentures (22% pre-pandemic and 35% during pandemic). T-test results show that Time from Ingestion to Consult shows a borderline statistically significant difference between the pre-pandemic and during-pandemic periods for the time from ingestion to consult (t-value = -1.967; p-value of 0.051), implying a slight difference in the time patients took to seek medical help after ingesting a foreign body between the two periods. Time from Consultation to the Operating Room indicates that there is significant difference between the pre-pandemic and during pandemic time from consultation to the operating room (t-value= -2.037; p-value= 0.043, suggesting significant change in the time taken to move patients from consultation to the operating room between the two periods, possibly indicating changes in hospital protocols or patient flow during the pandemic.

CONCLUSION

Results showed that there was a noticeable shift in the age distribution of patients, with older patients encountered during the pandemic period, suggesting changes in healthcare-seeking behavior and accessibility. Data also showed that more patients in both periods were male, consistent with existing literature on foreign body ingestion demographics. The median time (in hours) from ingestion to consultation increased significantly during the pandemic, indicating delays in seeking medical care. This was likely due to travel restrictions, fear of COVID-19 in public, and changes in public health protocols. Despite these consultation delays, the median time from consultation to the operating room remained consistent, reflecting the efficiency of healthcare providers in the tertiary hospital. Operating time and the level of foreign bodies in the esophagus did not differ significantly between the two periods, implying a stable surgical procedure. The significant difference in the overall time across patients from consultation to the operating room during the pandemic suggests changes in hospital protocols and patient flow management.

Human ; Foreign Bodies ; Eating ; Ingestion ; Esophagoscopy ; Covid-19

OBJECTIVES: To investigate the underlying causes and clinical manifestations in infants undergoing colonoscopy, and to analyze changes in disease spectrum. METHODS: Clinical data from 180 infants who underwent a total of 184 colonoscopies at the Department of Gastroenterology, Children's Hospital Affiliated to Shandong University from January 2015 to December 2024 were retrospectively analyzed. Patients were grouped by age: ≤6 months (n=41) and >6-12 months (n=139); and by examination period: 2015-2019 (n=83) and 2020-2024 (n=97). Primary causes for performing colonoscopy, final diagnoses, and disease spectrum evolution were assessed. RESULTS: Among 184 colonoscopies, the leading causes prompting examination were hematochezia (37.8%, 68/180), diarrhea (36.7%, 66/180), and co-occurring hematochezia and diarrhea (21.1%, 38/180). Causes for performing colonoscopy differed significantly by age group (P<0.05). Colonic polyps were only detected in the >6-12 months group (P<0.05). Compared to the 2015-2019 group, the 2020-2024 group had fewer food allergy-related gastrointestinal diseases (P<0.05) but more colitis (P<0.05). CONCLUSIONS Colonoscopy is essential for diagnosing infantile digestive disorders, with disease spectra varying by age and time period.
Humans ; Infant ; Colonoscopy ; Male ; Female ; Retrospective Studies ; Infant, Newborn ; Diarrhea/etiology* ; Gastrointestinal Hemorrhage/etiology*

Permanent stoma is an important method often selected in the surgical treatment of colorectal cancer, mainly including but not limited to the sigmoid colon single-lumen stoma after abdominoperineal resection. Since the stoma needs to be retained permanently, preoperative intervention for the stoma, the stoma surgical procedure, prevention and treatment of complications, and long-term postoperative follow-up are all closely related to the patient's quality of life. Under the guidance of the Colorectal Surgery Group of the Society of Surgery, Chinese Medical Association, the Colorectal Tumor Professional Committee of the Chinese Medical Doctor Association, and the Anorectal Physicians Branch of the Chinese Medical Doctor Association, led by the Stoma Study Group of the Anorectal Physicians Branch of the Chinese Medical Doctor Association and with the academic support of Chinese Journal of Gastrointestinal Surgery, experts in related fields were gathered. By drawing on the latest domestic and international guidelines and relevant literature, combining clinical practice and expert opinions, and through repeated discussions and revisions, 24 recommendations were put forward for preoperative evaluation and preparation, surgical technical operation specifications, postoperative management, complication prevention and treatment, and long-term follow-up. The aim is to provide guidance for the clinical practice of permanent stoma in colorectal cancer surgery in China.
Humans ; Colorectal Neoplasms/surgery* ; Consensus ; Ostomy/methods* ; Quality of Life ; Surgical Stomas ; China ; Colostomy

Tianhe procedure^® is a functional sphincter-preserving surgical approach developed for rectal cancer patients following radiotherapy. This technique involves extended proximal resection of the colon beyond the pelvic cavity, followed by anastomosis of the non-irradiated proximal colon to the distal rectum or anal canal. This strategy aims to reduce the incidence of anastomotic complications and postoperative bowel dysfunction. However, there is currently a lack of standardized practice guideline for implementing Tianhe procedure^® in China. Therefore, the Chinese Radiation Intestinal Injury Research Group, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, the Anorectal Branch of Chinese Medical Doctor Association, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, and the Colorectal Cancer Committee of China Anti-cancer Association, and the Gastrointestinal Surgical Branch of Guangdong Medical Doctor Association, have jointly convened a panel of national experts to discuss and establish this standardized surgical procedure. This standard, based on the latest evidence from literature, research advancements, and expert experience, focuses on key aspects of the Tianhe procedure^®, including its precise definition, indications, critical procedural steps, postoperative complications, and functional rehabilitation strategies. It aims to promote standardized implementation and broader clinical adoption of this innovative surgical technique.
Humans ; Rectal Neoplasms/radiotherapy* ; Anal Canal/surgery* ; Anastomosis, Surgical/methods* ; Organ Sparing Treatments/methods* ; Rectum/surgery* ; Postoperative Complications/prevention & control* ; Digestive System Surgical Procedures/methods*