https://www.clinsurggroup.us/journals/archives-of-clinical-gastroenterology A Peertechz Open Access Journal en-us 22 Apr, 2025 https://www.clinsurggroup.us/articles/ACG-11-228.php Background: Plummer-Vinson Syndrome (PVS) is a rare clinical entity defined by the triad of dysphagia, iron deficiency anemia, and esophageal webs. While commonly associated with upper aerodigestive tract malignancies, its link with gastric tumors is exceptionally rare. Case presentation: We report a case of a 66-year-old male with PVS who was ultimately diagnosed with gastric adenocarcinoma. The patient presented with progressive solid food dysphagia, iron deficiency anemia, and significant weight loss. Endoscopic evaluation revealed a cervical esophageal web and, following dilation, an ulcerated gastric mass. Histopathological examination confirmed moderately differentiated gastric adenocarcinoma. The patient underwent total gastrectomy followed by chemotherapy with favorable early outcomes. Discussion: This case illustrates a rare but important association between PVS and gastric cancer. Chronic iron deficiency may play a role in carcinogenesis via oxidative stress and inflammatory pathways. Literature review supports a potential pathophysiological link, though epidemiological data remains limited. Conclusion: Clinicians should maintain a high index of suspicion for gastrointestinal malignancies in patients with PVS, particularly when symptoms are persistent or atypical. Early endoscopic evaluation and thorough investigation are warranted to exclude underlying cancer. 19 Apr, 2025 https://www.clinsurggroup.us/articles/ACG-11-227.php Hernia repair surgery has seen significant advancements in recent years, as public awareness of concerns about mesh in surgery has increased. It emphasizes the importance of developing new treatment methods to increase survival rates and improve quality of life following surgery. New mesh compositions and absorbable biomaterials are more durable and biocompatible than ever. The evolution in minimally invasive techniques such as laparoscopy and endoscopy has further contributed to less scarring and post-operative pain. The adoption of robotic surgery in hernia repair has gained popularity due to its enhanced precision and reduced recovery times. Moreover, advances in the modern era of science and research have enabled stem cells and growth factors to be used to promote tissue repair. These advancements have collectively taken a significant leap forward to produce effective results from repairing these defects. 25 Feb, 2025 https://www.clinsurggroup.us/articles/ACG-11-226.php Colonic vasculitis is a rare condition that can mimic Inflammatory Bowel Disease (IBD) due to its clinical presentation. We report the case of a 45-year-old female, a passive smoker, presenting with isolated colonic vasculitis manifested by bloody mucus diarrhea. Investigations, including colonoscopy and histopathology, allowed the differentiation of this vasculitis from IBD. The patient was successfully treated with systemic corticosteroid therapy, leading to significant clinical improvement. This case highlights the importance of precise diagnosis in atypical presentations and the potential role of passive smoking in triggering such pathologies. 29 Nov, 2024 https://www.clinsurggroup.us/articles/ACG-10-225.php Background: Multi-cystic Lymphangioma (MCL) is a rare intra-abdominal entity in adults. The diagnosis of a core biopsy specimen is challenging due to its rarity in general surgical pathology service. Invasive surgical management can be avoided with accurate core biopsy diagnosis. Methods: We present six cases of adult intra-abdominal MCL and highlight their clinical, radiological, and pathological characteristics. Demographic, clinical, radiological, and histopathological parameters were collated for analysis. Results: Six patients (out of 958,574 cases) were identified (prevalence: 0.6/100,000 cases). Previous abdominal surgery (67%, n = 4) and abdominal pain with palpable abdominal mass (67%, n = 4) at presentation were notable in this cohort. Abdominal CT showed cystic mass with septations, punctate calcification, and fatty halos raising the differential diagnosis of mesenteric cyst (n = 2), duplication cyst (n = 2), or disseminated metastases (n = 2). MCL was distributed across the jejunal mesentery (n = 3) and was managed with exploratory laparotomy and resection (n = 4). Characteristic histopathological features include multiple variably sized cystic spaces lined by attenuated flattened epithelium, cysts filled with proteinaceous fluid, and interspersed by stroma with several dense lymphoid aggregates. The lymphatic endothelium showed positivity for D2-40 and CD31. Post-operative follow-up at 50.4 ± 49.2 months did not show any clinical or radiological recurrence. Conclusion: Adult intra-abdominal MCL are rare and radiologically indistinguishable from other intra-abdominal lesions. Diagnostic uncertainty on core biopsy evaluation in our series required invasive surgical exploration. The recognition of the histological triad of lymphoendothelial cysts, smooth-muscle or fibrous stroma, and associated lymphoid aggregates are diagnostic for MCL. Cystectomy alone is curative (144 months without recurrent). 23 Nov, 2024 https://www.clinsurggroup.us/articles/ACG-10-224.php Bezoars are collections of non-digestible organic material, which after being ingested, accumulate over time in the stomach or small intestine. The most common presentation of the bezoar is in the form of phytobezoar, which is by the accumulation of undigested particles of plant origin. Phytobezoars are hard masses of undigested plant materials that accumulate in the stomach and small intestine. We present the case of a 42-year-old patient with a history of cholecystectomy who presented an intestinal sub-occlusion with suspected oblitoma. The tomography was reported as oblitoma because the image was suggestive. We performed exploratory laparotomy with the presence of a tumor mass in the sub-occluded ill area, one meter from the ileocecal valve ileal. The surgical decision was tumor resection plus manual end-to-end anastomosis. The pathology results were for phytobezoar. 30 Oct, 2024 https://www.clinsurggroup.us/articles/ACG-10-223.php The status quo that results from medical malpractice litigation is 85,000 medical malpractice lawsuits filed per year, of which 66% are potentially frivolous. There are also 3 million claims but only 85,000 are represented. There is something wrong with this status quo, which prompts questions about traditional decision-making Traditional decision-making is inductive reasoning. Deductive reasoning is hypothesis testing. The objective evidence and the burden of proof are the same in both; except hypothesis testing has a greater level of confidence. The differences are examined in detail. Of the parties involved in dispute resolution, medical experts are essential, medical experts are doctors. Doctors are familiar with hypothesis testing and threats to validity. Doctors, who are medical experts, are duty-bound to be objective. Hypothesis testing best satisfies this duty. Nothing prohibits medical experts from using hypothesis testing when they review a case to arrive at an opinion; although, until now, none do. Yet, as doctors, it is expected of them and they can never be prohibited from doing so. In the final analysis, traditional decision-making subjectively infers a departure from the standard of care; however, hypothesis testing objectively proves it. 02 Jul, 2024 https://www.clinsurggroup.us/articles/ACG-10-222.php Background: Accessory spleens are congenital embryological aberrations usually found within the splenic hilum with no clinical significance. An Intra Pancreatic Accessory Spleen (IPAS) is an uncommon benign pancreatic lesion encountered clinically. The occurrence of an Epidermoid Cyst arising within an IPAS (ECIPAS) is exceedingly rare and is often misdiagnosed as a pancreatic pathology such as mucinous cystic neoplasm, cystic degeneration within a solid tumor such as a neuroendocrine tumor, or a lymph node. Case report: A 68-year-old male presented with intermittent post-prandial abdominal pain for over 2 years. Abdominal computer tomography identified a 5.2 cm calcified cyst within the pancreatic tail and a mucinous pancreatic neoplasm/pancreatic pseudocyst was considered in the differential diagnosis. The results of endoscopic ultrasound and fine needle aspiration were indeterminate. Due to persistent abdominal pain, the patient underwent a laparoscopic distal pancreatectomy with splenectomy. A gross examination of the distal pancreatic/splenectomy specimen confirmed a well-demarcated cystic lesion with brownish fluid within the pancreatic tail. Microscopic examination revealed a nonpathological pancreas separated by a fibrous capsule with a large cyst arising within an intrapancreatic accessory spleen. The cyst was lined with multilayered non-keratinized stratified squamous epithelium positive for pancytokeratin, CA 19-9, CK5/6, and p63 with no lymphocytic infiltrates and absent hair/ dermal appendages confirming an epidermoid cyst. CD8 outlined the dendritic network of the littoral cells of the splenic tissue in the cyst wall. Post-operative follow-up at 6 weeks was uneventful. Conclusion: The preoperative diagnosis of ECIPAS is extremely difficult as this entity shares overlapping radiological features with other cystic lesions such as mucinous pancreatic cysts. It is important for anatomic pathologists to recognize and consider the intrapancreatic compartment as a possible site for accessory spleen. As histopathology is the final determinant of this diagnosis, increased clinical awareness with an accurate diagnosis of this entity may prevent patients from unnecessary surveillance and/or extensive oncological-based surgical resection. 31 May, 2024 https://www.clinsurggroup.us/articles/ACG-10-221.php Introduction: A paraganglioma is a tumor originating from the sympathetic or parasympathetic nervous system. Its diagnosis is sometimes difficult, especially if it occurs in an atypical location. We report the case of a patient who presented with a diagnosis of gastric GIST and underwent surgical resection and whose postoperative histopathological examination revealed that it was a paraganglioma. Case report: A 38-year-old female patient who underwent cesarean section one year ago, had isolated epigastralgia for two years, the clinical examination was without abnormalities, and the patient benefited from an oesogastroduodenal fibroscopy showing an extrinsic compression aspect at the level of the greater curvature, the abdominal CT scan showed an 8 cm intraperitoneal mass in contact with the lesser gastric curvature evoking a gastrointestinal stromal tumor aspect. The biological work-up was without abnormalities. Surgery was performed to remove the retroperitoneal mass and a final diagnosis of paraganglioma was made, eliminating the initial diagnosis of gastrointestinal stromal tumor. Discussion: There are lessons to be learned from our case first, paraganglioma can be misdiagnosed. Second, misdiagnosis can be misled by clinical diagnosis and imaging. Third, misdiagnosis can lead to high morbidities and mortality. Conclusion: The correct knowledge of this pathology, including the differential diagnosis, is fundamental to establishing the correct diagnosis. In addition, close follow-up of these cases should be considered because of the high risk of metastatic disease. 27 Feb, 2024 https://www.clinsurggroup.us/articles/ACG-10-220.php This integrative review explores the connection between Non-Alcoholic Fatty Liver Disease (NAFLD) and Hepatocellular Carcinoma (HCC). NAFLD is characterized by the presence of steatosis in more than 5% of hepatocytes in the absence of excessive alcohol consumption (> 20 g/day in men and > 30 g/day in women) or other chronic liver diseases. On the rise globally, the vast majority is associated with risk factors, mainly obesity and type 2 diabetes mellitus. Advanced NAFLD, including non-alcoholic steatohepatitis, emerges as an important precursor to HCC, in some cases, even before the presence of cirrhosis, due in addition, recent studies highlight NAFLD as a main cause of liver transplantation for HCC. Non-invasive diagnostic methods, such as fibroscan liver elastography, exhibit promise for evaluating hepatic steatosis. Therapeutic interventions aim to slow the progression of NAFLD and mitigate the risks of HCC. 13 Oct, 2023 https://www.clinsurggroup.us/articles/ACG-9-218.php Acute colonic pseudoocclusion or Ogilvie syndrome is an acute expansion of the previously healthy colon, occurring in the absence of an obstructive lesion. Pathological circumstances such as pancreatitis or neuroleptic medication have been recognized as predisposing. The incidence of this digestive complication varies from 0.5% to 1%. The aim of our work is to recall, through a case of acute colon pseudo-obstruction in a patient with acute pancreatitis, the clinical and paraclinical data of this syndrome and its physiopathological bases, as well as its therapeutic management. The clinical picture was characteristic of our patient: significant abdominal meteorism. The abdominal scan showed an enormous colonic dilation without mechanical obstacles. The evolution was favourable after colonoscopic exsufflation. Ogilvie syndrome is a rare occurrence that can lead, without effective treatment, to cecal perforation with a poor prognosis. It is, therefore, necessary to establish the diagnosis early and especially to carry out strict radiological surveillance after the implementation of medical treatment, in which colonoscopy is a valuable contribution. 01 Jun, 2023 https://www.clinsurggroup.us/articles/ACG-9-217.php Kombucha is a mushroom fermented in sweetened black or green tea, originally found in Asia, being used as a remedy for many ailments in this region. Kombucha is not a usual mushroom because it represents the symbiosis between yeast and a variety of bacteria aggregated through a permeable membrane. Among the benefits of Kombucha tea are the potential antioxidant effect against free radicals, and the clinical effects on diabetes for its hypoglycemic, lipid-lowering, and immune stimulation. But secondary to the lack of evidence to support these benefits, several publications emerged to mention the side effects of Kombucha consumption. The present article is trying to collect the data reported in the literature regarding the side effects of Kombucha. 24 Mar, 2023 https://www.clinsurggroup.us/articles/ACG-9-216.php Introduction: Adenosquamous Carcinoma (ASC) of the anus presenting both glandular and squamous histopathologic features is a rare colorectal neoplasm. Case presentation: A 63-year-old man presented with a one-year history of intermittent rectal pain and bleeding on a perineal fistula. Pathological analysis of the surgical specimen revealed adenosquamous carcinoma of the anus, The patient received neoadjuvant treatment with chemotherapy and radiotherapy over a period of five weeks. then he underwent abdominoperineal resection and a permanent colostomy. Histology revealed invasive adenosquamous carcinoma on the resection specimen and the patient was started on adjuvant therapy with FOLFIRINOX. Discussion: Primary ASC of the colon and rectum are extremely rare clinical entities with poor prognosis. Most of the data come from individual case reports and a few small series, making it a challenge to understand the histogenesis of the disease. And the treatment modalities are not yet well codified, which has an impact on overall survival. Conclusion: Early diagnosis and radical surgery with other available therapeutic modalities can improve clinical outcomes. 20 Mar, 2023 https://www.clinsurggroup.us/articles/ACG-9-215.php Hydatid cyst is caused by the parasite Echinococcus granulosus commonly found in temperate regions. Primary peritoneal hydatidosis is a rare entity. Diagnosis can be made with ultrasound and contrast-enhanced CT of the abdomen and pelvis and serology. Eosinophilia is a strong indicator of hydatid cysts as a differential diagnosis. Open excision of the cyst combined with medical treatment remains the treatment of choice. 10 Nov, 2022 https://www.clinsurggroup.us/articles/ACG-8-214.php Pseudomyxoma peritonei also referred to as gelatinous ascites, is a rare disorder, described for the first time by R. Wyerth in 1884. It is characterized by the presence of mucous disseminated throughout the peritoneal cavity generally arising from the rupture of an appendicular mucocele. Pseudomyxoma peritonei can be asymptomatic, discovered during a laparotomy. The most common symptom is abdominal distension associated with diffuse abdominal pain. An abdominal CT scan is the most specific diagnostic tool. It shows pathognomonic signs of gelatinous ascites. Mucinous neoplasms of the appendix are the most frequent cause of pseudomyxoma peritonei accounting for 90% of cases. Pseudomyxoma peritonei needs to be considered as a borderline malignant disease because of its inevitable persistence and progression without an adapted therapeutic approach: cytoreductive surgery combined with perioperative intraperitoneal chemotherapy in specialized centers. The principal prognostic factors are the prior surgical history, the completeness of cytoreduction and especially the histopathologic grade. We report the case of pseudomyxoma peritonei secondary to appendiceal mucinous adenocarcinoma. 29 Oct, 2022 https://www.clinsurggroup.us/articles/ACG-8-213.php Autosomal dominant polycystic kidney disease is a hereditary disease, characterized by the development of cysts in the renal parenchyma with extra-renal manifestations. Liver damage is rarely a source of complications. A Budd-Chiari syndrome could occur following the compression of the supra-hepatic veins by the cysts. It is an exceptional mechanical complication. We present a case of a 54 year old woman, with a diagnostic of an asymptomatic autosomal dominat polycystic kidney disease since childhood was admitted to our hospital due to significantly increased abdominal girth. The physical examination showed grade III ascites. A paracentesis for relief at admission disclosed an exudative fluid. A abdominal computed tomographic scan showed multiples cystic lesions in the kidneys and liver, with a large hepatic cyst responsible for compression of the suprahepatic veins and the inferior vena cava resulting in chronic Budd-Chiari syndrome. The treatment was radiological drainage followed by percutaneous sclerosis of cysts to alleviation of the compression. Unfortunately, the patient died a few days after an intraperitoneal cystic rupture. 28 Sep, 2022 https://www.clinsurggroup.us/articles/ACG-8-212.php The incidence of extramammary Paget’s disease (EMPD) is very low. It is very important to distinguish between primary Paget’s disease and secondary process. An 85-year-old man was consulted for the presence of an erythematous plaque located in the anal and gluteal area, confirming Paget cells in the biopsy. 26 Sep, 2022 https://www.clinsurggroup.us/articles/ACG-8-211.php Hepatitis B (HBV) and C (HCV) are two other forms of infections for which co-infection in HIV has been associated with alteration of the immune response, increased risk of progression to liver diseases, and increased risk of hepatotoxicity associated with antiretroviral therapy. This study aimed to establish the prevalence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCVAb) among HIV patients, evaluate response to treatment between the different categories and identify the possible risk factors associated with this burden of hepatitis B/C among HIV patients and the resulting responses to HAART in Kumba Health, in the South West Region of Cameroon. Method: We performed a systematic screening using Rapid Diagnostic Test, for HBsAg and HCVAb among 299 HIV patients enrolled at the treatment centers in Kumba Health District (District hospital Kumba, Kumba Town Sub-Divisional hospital, and the Apostolic hospital Banga Bakundu), with all positives for HBV or HCV confirmed by the ELISA and results analyzed using SPSS version 20. Out of the 299 participants, 52 HIV patients, 36 HIV/HBV, and 12 HIV/HCV patients were involved in the prospective cohort study for 24 months which permitted monitored the immune response (CD4 counts and viral load test), as well as variation of biochemical parameters (ALAT/ASAT, albumin, bilirubine, creatinine) and weights of the studied participants. Result: Out of the 100 HIV patients involved in the prospective cohort, 36 and 12 were hepatitis B and C virus-positive respectively. Following the analysis of the viral load and CD4 cell counts, there were differences in response to HAART after 24 months between the mono-infected and co-infected patients, taking into consideration the, CD4 cell counts (HIV: 930.846 cells/mm3, HIV/HBV: 595.139 cells/mm3 and HIV/HCV: 678.500cells/mm3), and viral load (HIV: 1777.85copies/ml, HIV/HBV: 2232.61copies/ml and HIV/HCV: 750.83copies/ml). There were variations in biomarkers of the liver (ALAT/ASAT, bilirubin, and albumine) and renal function (creatinine) for both patients. There were also variations of the different biomarkers linked to the infection status of the different participants. Conclusion: There were positive variations in viral load and CD4 cell counts among the studied participants, with a more rapid response to the mono-infected HIV patients compared to the co-infected patients. Similar strength was observed in the variation of the different biomarkers and such variation indicates that co-infection of HIV patients with either hepatitis B or C virus can affect rapid response to HAART and the variations in the level of Biochemical markers among the different categories are linked to the alteration of the functions of the respective organs and so this result could be used for health decisions regarding co-infections. 06 Sep, 2022 https://www.clinsurggroup.us/articles/ACG-8-210.php I have observed what seems to be a rare but novel symptom that has not been documented in the medical literature, in a subject that I have been studying. The observation was a worsening of flatus and stool odor in this subject, a few days after the subject started an unphysiologically high dose of dietary molybdenum. 30 Aug, 2022 https://www.clinsurggroup.us/articles/ACG-8-209.php Molybdenum is a trace mineral needed in small quantities by most life forms. In living organisms, a molybdenum atom is found within molybdenum-dependent enzymes or molybdoenzymes. Molybdoenzymes catalyze reactions in carbon, sulfur, and nitrogen metabolism. Only four molbdoenzymes have been identified in humans. Most of the known molybdoenzymes are found in bacteria. Dietary molybdenum can be administrated to humans, to treat Wilson disease and tungsten poisoning; and it may be useful in arthritis. Sulfur-reducing bacteria are the bacterial group that reduces certain sulfur molecules to hydrogen sulfide. These bacteria can inhabit anaerobic parts of the gastrointestinal tract of mammals and are the predominant producer of hydrogen sulfide in the human colon. Hydrogen sulfide plays a major role in the malodor of human flatus. Some individuals have reported an increase in foul odoriferous gases from the colon after molybdenum supplementation. The underlying mechanism as to how this occurs is currently not known. Possible bacteria that are involved could be sulfur-reducing bacteria and methionine dissimilating bacteria. Supplementing sheep with molybdenum and with sulfur exclusively in the form of methionine can stimulate the growth of sulfur-reducing bacteria and increase the level of sulfides in the rumen. The molybdoenzyme, thiosulfate reductase, is found in sulfur-reducing bacteria and catalyzes the reduction of thiosulfate to hydrogen sulfide. The source of thiosulfate could be from ruminal epithelial cells detoxifying methanethiol, produced by methionine dissimilating bacteria, degrading the dietary methionine to methanethiol. Therefore, the molybdenum could be activating thiosulfate reductases of sulfur-reducing bacteria in the rumen of these animals. The human colon can also harbor sulfur-reducing bacteria, and dietary molybdenum and methionine can reach this organ. Therefore, dietary molybdenum may be stimulating the growth of sulfur-reducing bacteria in some individuals. Sulfides in the human colon could have beneficial and detrimental effects on health. Such effects could include the already mentioned malodor of flatus, the stabilizing of the microbiome-mucosa interface in an intestinal dysbiosis, the treatment of hypertension and the promotion of inflammation in ulcerative colitis. 08 Jul, 2022 https://www.clinsurggroup.us/articles/ACG-8-208.php Caecum volvulus is, in frequency, the second part of the colon concerned by volvulus after the sigmoid and before the transverse colon. This pathology occurs in the cecum with abnormal mobility The mechanism of volvulus can be summarized in 2 either by torsion or tilting. The clinical picture is that of an acute intestinal occlusion by strangulation. The abdomen without preparation (ASP) and the abdominal CT are the radiological examinations of the first choice for the diagnosis. It is a surgical emergency, the conduct of which is to make a resection of the cecum and the terminal ileum. We report the case of a cecal volvulus admitted to the emergency room with an acute intestinal obstruction, the diagnosis was confirmed by an abdominopelvic CT scan and the treatment consisted of an ileocecal resection with immediate restoration of continuity, the postoperative follow-up was simple. 28 Apr, 2022 https://www.clinsurggroup.us/articles/ACG-8-207.php Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system and cholecystectomy is one of the commonly performed surgeries. This study intends to evaluate the demographic of patients with cholelithiasis, its various mode of presentation, surgical intervention, and its outcome. Methods: This was a quantitative retrospective cross-sectional study conducted in the College of Medical Sciences- a Superspeciality Tertiary Care Teaching Hospital in Bharatpur, Chitwan in central Nepal. All patients undergoing laparoscopic or open cholecystectomy in the department of GI and General Surgery at the College of Medical Sciences from 1st May 2017 to April 30, 2021were included in the study. Study tools were records of the patients retrieved from the medical record section. Results: A total of 355 patients data were analyzed. The mean age of the study samples was 46.43 +/- 16.47 years. Female predominance was seen at 76.18% with M: F ratio of 1:3.18. The most common presenting symptoms were pain abdomen (70.4%), bloating of the abdomen (63.9%), and fatty dyspepsia (46.8%). Acute cholecystitis was seen in 14.36%, biliary pancreatitis in 6.2%, and gallbladder perforation in 2.25% cases. Laparoscopic cholecystectomy was done in 269(83.94%), open cholecystectomy in 57(16.05%), and laparoscopic converted into open cholecystectomy 29 in (9.73%). Intra-operative complications like gallbladder perforation and controlled bleeding were seen in 10.14% and 4.23% of cases. Post-operative complications like bile leak and major bile duct injury were seen in 6.19% and 1.40% of cases. Regarding management of bile leak, conservative management was successfully done in 54.54% of cases while they were managed with ERCP in 27.27%, hepaticojejunostomy in 13.63%, and with T-tube repair in 4.5% cases. The overall mortality was 0.8%. 18 Apr, 2022 https://www.clinsurggroup.us/articles/ACG-8-206.php Celiac disease is an immune-mediated enteropathy, caused (in genetically predisposed or susceptible individuals) by the ingestion of gluten, the complex of water-insoluble proteins found in cereal grains such as wheat, rye and barley. In terms of terminology, it is the complex natural history and extremely polymorphous clinical presentation that has created some confusion. In fact, to date, at least three different forms of celiac disease are known, in addition to the simple non-celiac gluten sensitivity, since in common clinical practice most patients do not present the classic symptoms such as malabsorptive syndrome with diarrhoea, steatorrhoea, weight loss and nutritional deficiency, but rather an anaemia, asthenia, meteorism, abdominal tension, osteoporosis and infertility, thus painting an extremely varied and complex symptomatic picture that is linked to enteric microbiota and microbiome issues. Celiac disease affects the mucosa of the small intestine, while it generally spares the submucosa, muscolaris propria and serosa; if the disease does not involve the whole of the small intestine but only part of it, it is usually more serious in the proximal than the distal tract. The simultaneous presence of shortened villi, crypt hyperplasia, the abnormal cytological appearance of the absorbent surface and increased lamina propria cells is required for the diagnosis of celiac disease. Based on these findings, several forms of celiac disease have been identified in the clinic: typical, atypical (and in turn silent, latent, and potential), and sensitive non-celiac. Based on these considerations a specific diagnostic scheme is suggested to frame the celiac universe more functionally and structurally (so-called Diagnostic Scheme for Celiac Disease and Nonceliac Gluten Sensitivity, DSCNC), identifying at least eight clinical hypotheses based on the serological, genetic, bioptic and allergological tests suggested). From a pharmacological and integrative point of view, the protocols shared by the scientific community remain in place: gluten-free diet, vitamin and salt supplementation if appropriate, pharmacological therapy (antibiotics, antihistamines, corticosteroids and immunosuppressants) if necessary, also in the future with the majority orientation oriented towards oral glutenase able to counteract the effects of gliadin in sensitive subjects, the use of larazotide acetate to remedy the increase in intestinal permeability and tTG inhibitors to reduce the toxic effects of gluten intake. The state of the art on celiac disease is not yet able to explain the precise aetiology and atypical forms of the disease, as well as the real impact of genetic predisposition on clinical manifestations. Research continues and seems to point the way to a complete resolution of this enteropathy that has been so prevalent over the last two decades. 09 Feb, 2022 https://www.clinsurggroup.us/articles/ACG-8-205.php Background: Atrophy of the gastric mucosa and intestinal metaplasia is considered malignant precursor lesions of gastric cancer, which is considered the fifth most common neoplasm in the world and the third cause of death from cancer. The main risk factor is the infection by Helicobacter pylori (H. pylori), which increases up to six times the risk of gastric cancer, through gastritis, atrophy, and hypochlorhydria, consequences of the infection. Other risk factors are also worth noting, like smoking and a family history of gastric cancer. Objective: To investigate the prevalence of malignant precursor lesions and their associated factors in patients who underwent upper gastrointestinal endoscopy. Methods: A descriptive, observational study was performed based on an analysis of endoscopic gastric biopsies performed in two affiliated private laboratories to the Unified Health System (Sistema Único de Saúde [SUS]) in a city in Paraná state. Patients were assessed for age, sex, active or recent smoking, family history of gastric cancer, and previous treatment for H. pylori. The samples were evaluated for the presence of glandular atrophy, intestinal metaplasia, dysplasia, and H. pylori infection. Results: A total of 1,549 medical records and patient reports were evaluated and 945 were eligible, the average age was 52.2 (±14.3) years old and most patients (73.3%) were female. The prevalence of H. pylori infection was 47.5% (n= 449) and the highest percentage was between 30-39 years (58.7%). Among H. pylori-positive (+) patients who had developed intestinal metaplasia, there is more risk of having incomplete than complete metaplasia (OR: 4.34; 1.1–17.1; 95%CI). Patients who smoke are more increase the risk to developed glandular atrophy (OR: 1.91; 1.09-3.33; 95%CI) and intestinal metaplasia (OR: 1.93; 0.72-5.11; 95%CI). Conclusion: The study reinforces risk factors such as smoking and H. pylori infection as precursors for developing pre-neoplastic lesions in a population in southern Brazil, highlighting the importance of smoking cessation and prevention of H. pylori infection and the treatment of infected patients. 04 Feb, 2022 https://www.clinsurggroup.us/articles/ACG-8-204.php A 39-year-old man with newly diagnosed and well controlled hypertension was in his usual state of good health. He was diagnosed with a retroperitoneal tumor during a health check-up, which was suspicious of adrenal tumor by abdominal computed tomography. 19 Oct, 2021 https://www.clinsurggroup.us/articles/ACG-7-203.php Hepatobiliary complications of sickle cell disease are rare, cirrhosis remains very exceptional, especially in heterozygous forms of the disease. We report the case of a 19-year-old patient whose etiologic investigation of hemolytic anemia revealed heterozygous sickle cell disease complicated by hepatic cirrhosis. The diagnosis of cirrhosis was made due to the presence of signs of hepato-cellular insufficiency, portal hypertension syndrome and hepatic dysmorphia on imaging. The etiological assessment was negative. The liver biopsy was not performed due to the risk of bleeding. The interest of this observation is to evoke hepato-biliary complications (in particular cirrhosis) in patients with sickle cell anemia, in order to avoid a pejorative evolution burdened with serious complications. 08 Oct, 2021 https://www.clinsurggroup.us/articles/ACG-7-202.php The endodermal sinus tumor or Yolk sac tumor is a rare ovarian tumor that classically occurs in adolescents and young women, it is a histological type rarely found in clinical practice. We report the case of a 24-year-old woman presenting with an ovarian tumor of the endodermal sinus with hepatic metastasis revealed by a painful abdominal mass in the right hypochondrium associated with a deterioration of the general condition. The blood Alpha-Fetoprotein (AFP) level was 71,300 ng / ml. Abdominal magnetic resonance imaging revealed multiple liver nodules and masses, associated with a magma of secondary lymphadenopathy. The immunohistological study of the hepatic puncture biopsy allowed the diagnosis of a hepatic localization of an ovarian endodermal sinus tumor (Yolk-Sac-Tumor). The tumor was classified stage IV-B of the FIGO 2014 classification, which does not allow a curative approach. Chemotherapy treatment (BEP protocol) was started. 20 Sep, 2021 https://www.clinsurggroup.us/articles/ACG-7-201.php The effect of vitamin D3 (VD3) on gastric ulcers was investigated by evaluating ulcer index, biochemical aggressive, and protective factors. Rats were divided into 4 groups; untreated indomethacin ulcer, VD3 pre-treated + indomethacin ulcer, untreated pyloric-ligation ulcer and VD3 pre-treated + pyloric-ligation ulcer. Treatment with VD3 (400 IU/kg intramuscular) was done daily for 6 days and an hour before ulcers induction. Four hours post-induction, the blood sample was obtained for the determinations of 1,25-dihydroxy vitamin D (1,25-DHCC), Parathyroid Hormone (PTH), and Calcium (Ca). Laparotomy was performed and the stomach was harvested for gastric acidity, ulcer index, and biochemical evaluations. The data were analyzed using statistical tools and the “student t-test” was performed at p<0.05. VD3 pre-treatmment caused an increase in serum levels of 1,25-DHCC, has no significant effect on PTH and Ca levels but decreased gastric acidity and ulcer index (p<0.05) with protective ratios of 42.11% and 60.00% against indomethacin and pyloric-ligation ulcers respectively. Pretreatment resulted in decreased gastric MDA, increased gastric protein, mucin, and nitric oxide levels. Gastric protection by VD3 was through oxidative stress inhibition and stimulation of mucus and blood flow against indomethacin and pyloric ligation gastric damage. 26 Jul, 2021 https://www.clinsurggroup.us/articles/ACG-7-200.php The human intestinal Microbiota is considered the second brain, because of its implications and correlations in hundreds of functional and dysfunctional processes. Therefore, if knowing the Microbiome (and the Microbiota) is important from a neurobioimmunological point of view, on the other hand it is equally important to investigate the correlations between dysbiosis and the onset of specific physical and psychological diseases. This study focuses on the scientific literature on natural and integrative treatments for intestinal dysbiosis, in order to identify a protocol that has the lowest possible risk and the best possible results, both in the acute phase (for the resolution of symptoms or as a preventive function) and in the chronic phase (for the management of the morbid condition and its clinical consequences). 16 Jun, 2021 Objectives: The aim of this study is to analyse predictors for overall survival (OS) after TIPS in patients with refractory ascites in end-stage liver cirrhosis. Methods: A total of 213 consecutive patients (129 male, 84 female, age 59.9±10.5 years) with TIPS for refractory ascites were included. Patient characteristics, clinical outcome and survival data were analysed from institutional databases and respective records from referring physicians and registration offices. Data were completed with a telephone questionnaire. Results: Patients presented in clinical stage Child-Pugh A, B, and C in 4.2%, 72.3%, and 23.5%. The primary and secondary success rate for TIPS was 97.2% and 100%. 3d mortality was 0.9%. There were 10 major complications (4.7%) and 2 minor complications (1%). 1-, 2-, 3-, and 5-year OS was 64.1%, 54.5%, 51.6% and 44.6%, respectively. MELD>14, advanced age>70 years, cirrhosis caused by viral hepatitis, cardiac diseases and other co-morbidities, as well as early need for haemodialysis within 4 weeks after TIPS were predictive for inferior survival. Vice versa, early response of ascites after TIPS seems to be correlated with improved survival. Conclusions: TIPS with PTFE-covered stent grafts is safe and effective for treatment of refractory ascites in patients with decompensated liver cirrhosis in this real-world setting. OS after TIPS is not only predicted by pre-interventional liver function but also by the aetiology of liver cirrhosis, personal factors like age, sex, and various co-morbidities. The demonstrated risk factors should be considered for decision making for TIPS. 14 Jun, 2021 https://www.clinsurggroup.us/articles/ACG-7-199.php Peritoneal tuberculosis accounts for 0.1-0.7% of all tuberculosis patients, the clinical signs are non-specific apart from a complication; The incidence of intestinal obstruction due to tuberculosis bands from 12% to 60%. Tuberculosis can affect any part of the body, but the abdomen is one of the most common sites after the lungs, The clinical presentation of abdominal tuberculosis is usually nonspecific and, therefore, often leads to a delay in diagnosis and thus the development of complications such as intestinal obstruction, Imaging plays an important role in the positive diagnosis of the occlusion. We report the case of a 61-year-old patient with no particular pathological history admitted to the emergency room with a bowel obstruction syndrome which the surgical exploration found a bowel obstruction on a primary tuberculosis band. 11 Jun, 2021 https://www.clinsurggroup.us/articles/ACG-7-198.php Intestinal obstruction in children are mostly caused by congenital anomalies of the gastrointestinal tract. Ingested foreign bodies can cause GI disturbance including obstruction. Bezoars are concretions of human or vegetable fibers that accumulate in the gastrointestinal tract. The most common type of bezoar in human is the trichobezoar, which is mostly made of hair, followed by bezoars made of vegetable or fruit fiber (phytobezoars), milk curd (lactobezoars), or any indigestible material. Intestinal obstruction due to bezoars is an uncommon cause of intestinal obstruction among children and adolescents. We present seven cases of intestinal obstruction in children and young adults caused by bezoars between 2012 and 2019. The age ranged from 11 months to 16 years. There were four females to three males. One adolescent girl had trichobezoars, another had tricho-phytobezoars, three had phytobezoars and two had lactobezoars. The presentations were epigastric discomfort, nausea, intestinal obstruction, chronic malnutrition, recurrent vomiting and abdominal distension. One adolescent girl with Rapunzel syndrome, required psychiatric treatment following removal of the trichobezoar. All the children except one required surgery. A child with lactobezoar improved with conservative treatment and passed the bezoar after enema. All the operated patients had uneventful recovery. The mean follow up was 83.5 months. 10 Jun, 2021 https://www.clinsurggroup.us/articles/ACG-7-197.php Continuous peritoneal lavage is part of a set of minimally invasive techniques, called the Step up approach. These techniques have been used in the management of acute necrotizing (severe) pancreatitis (SAP), as they remove toxins and reduce serious metabolic disorders, although their effects on mild acute pancreatitis and on the content of peritoneal cells during mild and SAP are still unknown, since inflammation is an important factor in the progression of the disease. The peritoneum is a tissue with important immunological functions, and the characterization of peritoneal cells during acute pancreatitis can be a relevant strategy to understand the mechanism by which peritoneal lavage has worked during clinical practice, as well as to uncover possible pharmacological targets. This review presents an approach to minimally invasive techniques in the management of AP, emphasizing peritoneal lavage and its nuances. 08 Jun, 2021 https://www.clinsurggroup.us/articles/ACG-7-196.php A 21-year-old girl was transferred to our hospital with 1-year history of abdominal pain and vomiting that had progressed over the preceding 3 weeks. She had presented to the local hospital with a 3-day history of fever before presentation. Physical examination revealed normal vital signs and mild periumbilical tenderness with active bowel sounds. Laboratory tests of the blood confirmed a white-cell count of 13,400 per cubic millimeter (reference range, 4000 to 10,000). Computed Tomography (CT) of the abdomen revealed lymphnode enlargement of ileocecal region. 01 Jun, 2021 https://www.clinsurggroup.us/articles/ACG-7-195.php Introduction and Objectives: Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the USA, and a major cause of medication discontinuation. However, DILI is often under-diagnosed, primarily due to the lack of agreed upon diagnostic criteria and limiting coding nomenclature. Materials and methods: We conducted a retrospective observational analysis of demographic, clinical, and laboratory data for 55 patients hospitalized in an Israeli tertiary care medical center between 2005-2017 and diagnosed with DILI. Results: We identified 55 patients hospitalized with DILI over 12 years. DILI was associated with female gender and older age. Hepatocellular injury was the most common type of liver injury (49.0%). Common manifestations included fever (41.8%), weakness (41.8%) and jaundice (34.5%). The major offending drug group was antibiotics (35.0%) with amoxicillin and clavulanate being the most common drugs (7.2%). Most cases were caused by drugs administered orally (84%), while cholestatic injury was associated with intravenous administration. De Ritis ratio (AST/ALT) was above 1.0 in 75% of cases. Conclusions: Most DILI was caused by oral antibiotics. The incidence of DILI in our study was low, possibly due to under-diagnosis or misclassification. The adoption of the updated international classification of disease 10th edition may improve reporting rates. Utilization of the De Ritis ratio may help to differentiate between DILI and viral hepatitis. 01 Jun, 2021 https://www.clinsurggroup.us/articles/ACG-7-194.php The human intestinal microbiota is considered “an organ within an organ”, partially shrouded in mystery, as the issue related to the bacterial component but less the viral component and the other microorganisms present has been thoroughly investigated. To date, research has focused attention on the bacterial component and on the correlations between intestinal dysbiosis and the onset or worsening of dozens of physical and psychological pathological conditions, as well as integrative therapies to re-establish eubiosis, linked to targeted prebiotics and probiotics; however, the scientific community has not yet focused on the exact distribution of all the microorganisms that are part of the microbiota and the complete mapping of the microbiome, as well as the development of a protocol of specific therapies to be implemented (integrative or with monoclonal antibodies) to facilitate the reconstructive processes of natural eubiosis. If therefore, knowing the Microbiome (and the Microbiota) is important from a neuroimmunological point of view, on the other hand, it is essential to deepen the correlations with the onset of some physical and psychological pathologies; in particular, focusing the studies on the already well-known “microbiota-intestine-brain” axis would help to demonstrate whether the onset of psychopathological conditions are a contributing cause of dysbiosis or (more likely) dysbiosis causes an altered production of serotonin, dopamine, GABA and noradrenaline, capable of generating or worsening directly related psychopathologies, such as anxiety, depression, mood disorders, schizophrenia, psychotic and personality disorders. On the other hand, it is known that psychiatric drug therapies do not cure the morbid condition but aim to stabilize the patient who becomes dependent on it, and then witness a rapid worsening in the event of drug suspension or interruption. If we then wanted to search for an objective to investigate, the writer proposes to focus on the hypothesis according to which intervening on intestinal dysbiosis could decrease or eliminate the neurobiochemical cause at the base of many psychic disorders, such as anxiety, depression, bipolar and psychotic disorders, decreasing or eliminating the necessarily prescribed drug therapy. 19 May, 2021 https://www.clinsurggroup.us/articles/ACG-7-193.php The SARS-CoV-2 pandemic dramatically involved elderly subjects, causing a very high number of deaths in this specific population, with a risk of mortality reaching 50% in subjects older than 80 years [1-3]. As a consequence, as the world prepares for a mass campaign to vaccinate as many people as possible in the shortest time, older and frailty individuals have been recognized as categories to be vaccinated first. Several countries assessed that it was mandatory to work on vaccine campaigns in these groups of patients, therefore elderly patients and residents in care homes were among the first group of individuals to be vaccinated [4]. But what is the evidence that the vaccines are safe and effective in this population? This paper reviews the vaccine currently available, with a particular focus on the evidence of their safety and efficacy in the older population. 22 Apr, 2021 https://www.clinsurggroup.us/articles/ACG-7-192.php Background: Appendices of the testis and epididymis are small congenital structures attached to the testis and epididymis respectively. The aim of this study was to assess the incidence of appendices of the testes and epididymis in children who had inguinal and scrotal surgeries. Materials and methods: This was a retrospective study of children aged 15 years and younger who underwent groin/scrotal surgeries between January 2015 and December 2019 at the pediatric surgery unit of Enugu State University Teaching Hospital Enugu (ESUTH), Nigeria. During the surgery, the presence or absence of appendices of testis and epididymis were assessed. Results: A total of 521 inguinal/scrotal surgeries were performed during the study period but only 378 patients had appendices of the testis and epididymis: This gives an incidence of 72.6%. Infants were mostly affected and the right testis had more appendices. There were more inguinal hernia/hydrocele and herniotomy was the most performed surgical procedure. Surgical site infection was the most common post-operative complication but there was no mortality. Conclusion: Appendices of the testes and epididymis although may be small and vestigial in children, it is quite common in children. 06 Mar, 2021 https://www.clinsurggroup.us/articles/ACG-7-191.php Eosinophilic colitis is an exceptionally rare condition, the clinical symptoms is polymorphic and non-specific. The diagnosis is based on the grouping of endoscopic and essentially histological, clinical arguments. We describe the case of a male patient with eosinophilic colitis revealed by bloody mucous diarrhea and acute abdominal pain. The diagnosis has been made after eliminating the parasitic, inflammatory and drug causes. This posed a diagnostic problem for us because of the non-specific symptoms associated with the lack of standardized histological criteria and the lack of clear, codified consensus regarding treatment. 02 Mar, 2021 https://www.clinsurggroup.us/articles/ACG-7-190.php Background: EBV-positive Mucocutaneous Ulcer (EBV-MCU) is a newly recognized clinicopathological entity characterized by ulcerated lesions affecting cutaneous and/or mucosal sites typically in immunosuppressed patients. To our knowledge, only 2 cases of EBV-MCU have been described following allogeneic Hematopoietic stem cell transplantation (alloHSCT). Here we describe a case of EBV-MCU that developed acutely 22 days after HSCT with massive intestinal bleeding and rapidly worsening clinical condition. Case report: A 46-year-old male was diagnosed with Severe Aplastic Anemia (SAA) and underwent immunosuppressive therapy. Because lacking response, he subsequently underwent Matched Unrelated Donor (MUD) allogeneic HSCT after Myeloablative Conditioning (MAC). The donor and the patient were IgG positive and IgM negative for EBV Viral Capsid Antigen (VCA) before transplantation, while the donor was seronegative for CMV and the patient was seropositive. Hematologic recovery was reached rapidly after engraftment. During aplasia, the patient experienced Hepatic Veno-occlusive Disease, treated with Defibrotide. From day 22 after allografting, the patient developed worsening melena and rectal bleeding. CT angiography of the abdomen showed multiple jejunal bleeding sites, compatible with severe erosion of the intestinal mucosa. EGDS, Colonoscopy, and Capsule Endoscopy confirmed multiple duodenal and jejunal ulcers. Duodenal biopsies were performed for histological evaluation. PCR for EBV-DNA and CMV-DNA was negative throughout the course. Stool cultures were negative for viral, bacterial, and fungal infections. The patient was empirically treated with steroids and Ganciclovir, associated with massive transfusional support. After many attempts to stop the bleeding with multiple intestinal peripheric arterial embolization and medical therapy, because of worsening clinical conditions, the patient was indicated to laparotomy with a double ileostomy to remove the bleeding intestinal tract. Just before the surgical intervention, histological findings confirmed the diagnosis of EBV-MCUs and the last serologic evaluation finally showed increasing EBV-DNA-emia. Unfortunately, before admission to the Surgery Room, the patient became septic, most likely from bacterial superinfection. After a cardiac arrest, he finally died. Conclusion: Massive intestinal bleeding is a rare major complication after HSCT. It is important to properly recognize the etiology among massive chemotherapy-induced mucositis, acute Graft versus Host Disease (aGvHD), and bacterial, fungal, or viral infections. Not only CMV-related infections but also EBV-related lesions should be considered, especially in patients previously treated with intense immunosuppressive therapies. Even if EBV-MCU is known to have an indolent course here we described an aggressive course, maybe related to intense immunosuppression and inflammatory background. These cases may need additional treatments other than conservative management. Besides, strict observation should be done to recognize evolution towards systemic disease (PTLDs) and the need for more intensive treatment with chemotherapy. 22 Jan, 2021 https://www.clinsurggroup.us/articles/ACG-7-189.php The coronavirus disease-2019 (COVID-19) is primarily a disease of the respiratory system and is manifested by an infectious pneumonia, with fever, cough and breathlessness as the most common presenting symptoms. However quite a few number of the patients may suffer involvement of gastrointestinal system and liver. There is mild to moderate abnormality in the levels of liver enzyme observed in the patients with hepatic involvement, whereas gastrointestinal symptoms include nausea, vomiting and diarrhea. Nonetheless, gastrointestinal disease in COVID-19 patients may present with severe life threatening conditions, like gastrointestinal bleed, intestinal ischemia, acute liver failure and necrosis. The virus bind and invade the cells through Angiotensin Converting Enzyme 2(ACE2) receptors, which are expressed not only on endothelial cells of lung alveoli but also markedly expressed on epithelial lining of the oral mucosa, intestinal mucosa and cholangiocytes. Viral RNA has also been detected from stool specimens of COVID-19 patients, even during the convalescent phase, which is a matter of concern for the transmission of the disease via fec0-oral route and needs to be elucidated. 16 Jan, 2021 https://www.clinsurggroup.us/articles/ACG-7-188.php Objective: Vascular Endothelial Growth Factor (VEGF) plays an important role in tumor angiogenesis. Although several studies revealed on association of VEGF polymorphisms with gastric cancer, still the results are inconclusive. The role of (VEGF) -2549 I/D and +405G/C polymorphisms in gastric cancer of Telangana Population is evaluated in the present study. Methods: A case control study was carried out on 540 individuals which comprised of 180 Gastric Cancer patients and 360 healthy control subjects.  The association of functional single nucleotide polymorphisms (SNPs) of the VEGF gene (-2549 I/D and +405G/C) were evaluated by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP). Results: VEGF -2549 polymorphism with I/D and I/Igenotypeshoweda threefold higher risk (95%CI= 1.75-4.63 and 95%CI= 1.72-5.78) to gastric cancer. A significant association was observed with respect to I allele (AOR= 1.67; 95%CI= 1.29-2.15; P= 7.641e-05) while genotypic and allelic frequencies of VEGF +405G/C polymorphism did not show any significant differences in both the groups. A significant increase in the frequency of I-G haplotype in Gastric cancer cases was observed compared to control with an AOR of 2.23 (95%CI= (1.51-3.27); P= 0.0001). Conclusion: In conclusion VEGF -2549I/D polymorphism and I-G haplotype conferred significant susceptibility towards gastric cancer, whereas, no such association with respect to +405G/C polymorphism was observed. 24 Dec, 2020 https://www.clinsurggroup.us/articles/ACG-6-187.php Background: Intestinal malrotation is a congenital disorder resulting from abnormal rotation of the intestine during fetal development. The aim of this study was to evaluate our experience in the management of pediatric patients with intestinal malrotation. Materials and methods: This was a retrospective study of children aged 3 years and below who were treated for intestinal malrotation between January 2014 and December 2018 at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. Results: Sixty-one patients had laparotomy for intestinal malrotation during the study period. There was predominance of male patients and the age range was 10 days to 3 years. Abdominal pain and upper gastrointestinal tract contrast study were the most common symptom and investigation respectively. Intestinal obstruction caused by congenital (Ladd’s) bands was the most common intra-operative finding and Ladd’s procedure was the most performed surgical procedure. Most patients did not develop any post-operative complications. However, surgical site infection was the most common complication following surgery. Mortality occurred in 8 (13.1%) patients. Conclusion: Intestinal malrotation symptoms occur more in males and abdominal pain is a common and consistent symptom. Upper gastrointestinal contrast study is usually diagnostic. There are morbidity and mortality associated with treatment of intestinal malrotation. 23 Dec, 2020 https://www.clinsurggroup.us/articles/ACG-6-186.php Over the last decades overweight, obesity and non-alcoholic fatty liver disease (NAFLD) in childhood and adolescence increased. NAFLD is strongly associated with insulin resistance, hypertension, dyslipidemia and other pro-atherogenic conditions. It was the aim of the trial to analyze the prevalence of NAFLD, risk factors and comorbidities in a cohort of overweight and obese children and adolescents. Patients and methods: Totally 79 children and adolescents with overweight/obesity (age 13.3 ± 2.4 years, BMI 33.4 ± 6.5 kg/m², BMI-SDS 2.72 ± 0.52) participated in a structured treatment and teaching program [STTP] (36.1 ± 5.9 days) for weight reduction were included. Results: NAFLD was diagnosed in 42/79 (53%) of patients. Patients with NAFLD were older (14.0±2.2 vs 12.5±2.5 years, p=0.005), had a higher BMI (36.8±6.4 vs 29.6±4.1 kg/m², p<0.001), BMI-SDS (2.96±0.48 vs 2.45±0.42, p<0.001) and higher fasting C-peptide (0.77±0.33 vs 0.61±0.28 nmol/l, p=0.018), fasting insulin concentrations (23.4±11.4 vs 15.4±12.1 µIU/ml, p=0.004) and HOMA-index (4.80±2.48 vs 3.22±3.46, p=0.022). Moreover patients with NAFLD had higher values in thickness of A. carotis intima. After an in-patient treatment lasting in the mean 5 weeks children/adolescents reached a mean weight reduction of 3.8±2.7 (range, -15.5-+0.8) kg (p<0.001) along with an improvement of risk parameters. The most important factors associated with NAFLD (R-square=0.444) revealed by the multivariate analysis were: body weight (ß=0.407, p<0.001), HOMA (ß=0.265, p=0.014) and HDL-cholesterol (ß=-0.229, p=0.018) at onset of the trial. Discussion: Children/adolescents with NAFLD were more likely overweight or obese, had more frequently metabolic risk factors and a higher thickness of A. carotis intima media. The data also suggest an improvement in metabolic and cardiovascular risk factors after a significant weight reduction. 09 Dec, 2020 https://www.clinsurggroup.us/articles/ACG-6-185.php Background: In the very recent studies it has been reflected that direct laryngoscopic endotracheal tube intubation following induction of anaesthesia is invariably associated reflex sympathoadrenal discharge with changes in hemodynamic stress response. Objective: The main objective of this Randomized Controlled Clinical Trial (RCT) is to compare the efficacy of intravenous use of dexmedetomidine in relation to dexmedetomidine in attenuating the hemodynamic response to laryngoscopy and intubation. Study design: This study was conducted as a Randomized Controlled Clinical Trial (RCT) in Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh with a total of 150 patients of elective surgery under general anaesthesia. Patients were divided into two groups on the basis of systemic random sampling, group D (dexmedetomidine group) and group L (lignocaine group) with 75 and 75 patients in respective groups. Results: Mean ± SD of age were 42.4 ± 5.459 and 40.8 ± 9.975 years respectively in group D & L. And Majority (54.7%) patients in group D were male, whereas in group L, it was 46.7%. Relatively smooth and more stable changes were observed in systolic, diastolic and Mean Arterial Pressure (MAP) following intravenous infusion of dexmedetomidine in contrast intravenous infusion of lignocaine in response to laryngoscopy and endotracheal intubation. The incidence of hypertension was 2.0% (03) and 6.7% (05) in cases of Group D and Group L respectively. Tachycardia was found in 6.7% (05) and 12.0% (05) in respective group. The incidence of hypotension, bradycardia and arrhythmia was nil in this study. Conclusion: Dexmedetomidine attenuates the hemodynamic stress response to laryngoscopy and intubation more effectively compared with lignocaine without any deleterious effects. Furthermore, dexmedetomidine decreases dose of thiopentone for induction of anaesthesia. 17 Nov, 2020 https://www.clinsurggroup.us/articles/ACG-6-184.php Purpose: The purpose of this study was to examine the clinical indication for laparotomy, the intra-operative findings and the 30 days post-operative outcome of laparotomy in Gulu university teaching hospitals. Methods: Using an approved protocol, a six month descriptive longitudinal study was conducted on patients undergoing laparotomy in the two main Gulu University teaching hospitals of St. Mary’s Hospital Lacor and Gulu regional referral. Using a sample size of 66, cases were recruited consecutively, clerked, investigated and conventionally prepared for surgery. Intra-operative diagnosis was ascertained as well as the operative procedure and post-operatively the patients were followed up for 30 days complications including death. Results: Overall, the mean age was 35.04yrs (SD+/- 16.522), but there were more males (59.4%) than females (40.6%). There was a statistically significant positive correlation between the clinical diagnosis and the intraoperative findings (r = 0.405, P value = 0.001). Within the 30days, the most frequent complication observed was surgical site infection (SSI) (20%, n=13), followed by wound dehiscence (17.2%, n=11), crude mortality rate was 15.6%, (n=10) and complication requiring emergency re-operation (10.9%, n=7). Ileal perforations tended to have bad outcomes. Age of patient was found to be a significant factor in determining the outcome. Conclusion: Descriptive longitudinal study on both elective and emergency laparotomy is possible in our setting. Whereas patients’ age is an important factors in determining outcome and ileal perforation tend to do better if prioritized with ileostomy, overall the 30days mortality rate for laparotomy was 15.6%. 07 Oct, 2020 https://www.clinsurggroup.us/articles/ACG-6-183.php A 31-years-old male patient, with no previous symptoms, admitted to the ER with massive hematemesis that started about 2 hours ago and already with hemodynamic repercussions. After initial care with clinical management for compensation, and airway protection (intubation) he underwent esophagogastroduodenoscopy (EGD), which was absolutely inconclusive due to the large amount of solid food remains and clots already in the proximal esophagus with increased esophageal gauge. 29 Aug, 2020 https://www.clinsurggroup.us/articles/ACG-6-181.php Introduction: Ulcerative Colitis (UC) is an Inflammatory Bowel Disease (IBD) that can be divided into two periods: active and remission. Individuals affected by this pathology can manifest symptoms of anxiety and depression, as well as low quality of life, due to the symptomatology of this disease when active. Objective: Demonstrate the relationship between anxiety and depression with UC and its influence on quality of life. Material and methods: The present study involved 97 individuals affected with UC, who were assessed through the application of the HADS and IBDQ on the social network Facebook, as well as their individual feeds. The survey began after approval by the Research Ethics Committee of the Federal University of Fronteira Sul, upon obtaining informed consent from the patients. Results: The majority of the assisted participants was female, white, married, and residents of southwest Brazil. A prevalence of symptoms of anxiety and depression was observed in individuals with low quality of life and status of disease activity. Discussion: The results show that individuals who exhibited an active disease status presented a lower quality of life, anxiety, and depression. 13 Aug, 2020 https://www.clinsurggroup.us/articles/ACG-6-180.php Carcinoma cuniculatum is a rare variant of well-differentiated squamous cell carcinoma of the esophagus, with fewer than twenty cases reported in the literature [1]. Diagnosis is often delayed due to failure of endoscopic biopsies to yield a definitive tissue diagnosis. We present the case of a patient with carcinoma cuniculatum of the esophagus who was misdiagnosed as achalasia, and consequently did not undergo surgical resection of the malignancy for nine months. 27 Jul, 2020 https://www.clinsurggroup.us/articles/ACG-6-179.php Trichobezoar is a concretion of chewing and swallowing hair or any other indigestible materials that accumulate in the gastrointestinal tract. Rapunzel syndrome refers to a rare condition when a gastric trichobezoar extends into the small bowel. We describe the case of a 16-year-old female who presented with chronic abdominal pain, loss of appetite and weight loss. Based on her past medical history, trichophagia has already been revealed at preschool age. Imaging tests indicated a large filling of the stomach. Upper gastrointestinal endoscopy showed a large trichobezoar in the stomach with prolonga on through the pylorus. The patient underwent exploratory laparotomy and the trichobezoar was removed. Upper gastrointestinal endoscopy is the preferred modality for diagnosis and in most cases the treatment is surgical. 15 Jul, 2020 https://www.clinsurggroup.us/articles/ACG-6-178.php Gastrointestinally-mediated food allergy (GMA) incidentally may cause non-erosive oligoarthritis. A 56-year-old woman with seronegative spondyloarthritis observed arthritic flares following ingestion of certain foods. Blood analyses were unremarkable. Segmental gut lavage revealed plasmacellular infiltrates and eosinophilia in terminal ileum. Food allergen-specific IgE-analysis of lavage fluid showed significant polyvalent intestinal IgE-sensitization (>0.35kU/mg protein) towards wheat, rye, egg, soybean, pork, beef, nuts. Repeated exposure to the aforementioned foods caused arthritis within 48 hours; elimination diet engendered long-term remission. Seronegative local IgE-mediated GMA (type I) was diagnosed. Especially seronegative rheumatoid arthritis and undifferentiated oligoarthritis should be scrutinized for food-related muscoloskeletal symptoms before initiating immunosuppression. 30 May, 2020 https://www.clinsurggroup.us/articles/ACG-6-177.php Background: Irritable bowel syndrome (IBS) has been considered a functional disease, however evidences suggest organic abnormalities as disbiosis. The aim of this study was to evaluate bacterial overgrowth syndrome in IBS patients. Methods: Patients with IBS were submited to the expired H2 and CH4 breath test, with analyzes of exhaled air in fasting (zero minutes) and after the administration of 10g of lactulose, at times: 15, 30, 60, 90, 120, 150 and 180 minutes. The test was considered positive when the values of H2 or CH4 at 90 minutes were 20 ppm above baseline values. 27 May, 2020 https://www.clinsurggroup.us/articles/ACG-6-176.php Introduction: Well-differentiated, Neuroendocrine Tumors (NET) are highly heterogenic and slow-growing pathologies, characterized by unspecific symptomatology and elevated expression of somatostatin receptors (SSTR). Despite the high incidence of NETs, several patients are diagnosed in advance stages of the disease when surgery is insufficient to treat the pathology. Peptide receptor radionuclide therapy (PRRT) has emerged as a new state-of-the-art treatment for NET-patients in advanced stages. 18 May, 2020 https://www.clinsurggroup.us/articles/ACG-6-175.php The objective of this communication is to present and analyze the recent results from the LAPIBSS study in order to improve future clinical trials on the effects of Lactobacillus strains in the treatment of irritable bowel syndrome (IBS). Using a tightly-controlled clinical trial protocol with the highest Jadad score of 5/5, the current trial aimed to demonstrate the efficacy of a 2-strain mixture of Lactobacillus acidophilus to improve IBS symptoms. Eighty patients diagnosed for IBS according to Rome III criteria were recruited to a multicentric, double-blinded, in parallel groups, placebo-controlled, randomized trial. Patients were provided with a daily dose of two capsules containing either two probiotic strains (5×109cfu/capsule) or placebo for 8 weeks. The primary endpoint was abdominal pain score assessed with a 100-mm visual analogue scale (VAS). 12 May, 2020 https://www.clinsurggroup.us/articles/ACG-6-174.php Background and objectives: The clinical findings of Celiac Disease (CD) change over time. Instead of classical symptoms such as diarrhea, growth retardation, abdominal bloating, atypical symptoms such as chronic constipation and abdominal pain may be the only sign of CD. In this study, we aimed to evaluate the clinical features of our patients with CD. Material and methods: This retrospective study was conducted between March 2017 and January 2019. 61 children with CD were included in the study. Local Ethics Committee approval was received. As an initial diagnostic test, tissue transglutaminase antibody (tTG) IgA test and total IgA test were analysed in all patients. Endomysial antibody (EMA) IgA test was analysed in patients with positive tTG IgA. If both celiac tests are detected as positive, gastroduodenoscopy was performed for definitive diagnosis of CD. 05 May, 2020 https://www.clinsurggroup.us/articles/ACG-6-173.php Gallbladder rupture is a rare but serious complication of acute cholecystitis. We describe two cases of acute cholecystitis in patients not candidate for surgery that underwent internal biliary drainage with endoscopic and percutaneous approach, respectively. Both experienced gallbladder rupture in the postoperative period. The complication occurred after percutaneous internal drainage was treated conservatively, whereas the latter occurred after the endoscopic maneuver required an external percutaneous approach. After a brief revision of the literature about the interventional management of acute cholecystitis, the Authors discuss the possible reasons of galbladder rupture. 20 Apr, 2020 https://www.clinsurggroup.us/articles/ACG-6-172.php The traditional definition of tissue ischemia-a decreased level of oxygen deliverability by bloodstream that results in cell hypoxia. Anatomical and functional hindrance to blood flow is the basis of tissue hypoperfusion. Arterial, venous and functional disturbances in blood circulation lead to acute intestinal ischemia. In 85-90 % of cases acute mesenterial ischemia was caused by arterial reasons: thrombosis or embolism. Venous thrombosis is responsible for 10%-15% of acute mesenterial ischemia cases. 20 Apr, 2020 https://www.clinsurggroup.us/articles/ACG-6-171.php Tumor Lysis Syndrome (TLS) is a major oncological emergency involving metabolic perturbations. It occurs when tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy. TLS is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia following massive lysis of malignant cells. Although this syndrome is well described, it is rarely seen or suspected in solid malignancies. The frequency and severity of TLS is partly dependent upon the biology of the disease and type of therapy administered. We report in this work two cases of tumor lysis syndrome occurring after chemotherapy for endocrine colon carcinoma with small metastatic cells. 11 Apr, 2020 https://www.clinsurggroup.us/articles/ACG-6-170.php Currarino Syndrome (CS) or triad is rare entity that was first reported by Currarino in 1981 as a pathology involving three anomalies; anorectal malformation, a sacral bony defect and a presacral mass. CS can be familial or sporadic, with an autosomal dominant inheritance mode. The English literature reported over 310 cases of Currarino triad with the cases diversity in age, clinical presentation, and management. 27 Mar, 2020 https://www.clinsurggroup.us/articles/ACG-6-169.php Gastroenteritis in human by Salmonella enterica subspecies diarizonae is rare and usually observed in neonates and children with history of contact with reptiles. Salmonella enterica subspecies diarizonae were isolated from two young adult male patients with symptoms of acute gastroenteritis. The isolates were identified by Vitek 2 compact system and agglutination by specific antisera. The isolates were susceptible to Amikacin, Imipenam, Cefazolin and Ceftazidime. Patient rapidly responded to Amikacin and Ceftazidime therapy. Arizona group Salmonella should be looked in cases of gastroenteritis whenever there is history of proximity with reptiles. 15 Feb, 2020 https://www.clinsurggroup.us/articles/ACG-6-168.php Background and objectives: Primary Biliary Cholangitis (PBC) and Autoimmune Hepatitis (AIH) are uncommon autoimmune diseases in the United States. There is limited information in regards to those two conditions in Black Americans and subjects of Hispanic ethnicity; thus, we conducted a study to characterize patients with these diseases in a community hospital that serves this type of population Methods: A retrospective review from 2001 to 2017 of all electronic medical records of patients with diagnoses of PBC or AIH according to the International Classification of Diseases (ICD 10) was conducted. This period was chosen because of feasibility. 25 Jan, 2020 https://www.clinsurggroup.us/articles/ACG-6-167.php Introduction: Liver abscess is a serious condition due to its complications. The most frequent complication is rupture. Our aim is to determine the predictive risk factors of liver abscess rupture at the Saint Louis Regional Hospital Center. Material and methods: This is a prospective descriptive and analytical study over the period of 1st January 2016 to 28th February 2019. We included liver abscess records regardless of age. An univariate and then multivariate analysis according to a Cox model allowed us to determine the factors associated with the occurrence of rupture. 31 Dec, 2019 https://www.clinsurggroup.us/articles/ACG-5-166.php Introduction: Recently, Full Spectrum Endoscopy (FUSE) was introduced as a novel colonoscopy platform. In contrast to other endoscopy systems illumination with the FUSE system is achieved by Light-Emitting Diodes (LEDs) and not by a xenon light source. Currently, the FUSE-system does not provide high-definition imaging yet. In patients with IBD, precise assessment of disease activity (i.e. mucosal healing) is of paramount importance to predict disease outcome and to guide therapy. 27 Nov, 2019 https://www.clinsurggroup.us/articles/ACG-5-165.php Retrorectal cystic hamartomas, or tailgut cysts, are rare congenital lesions that are usually present as tumors with a considerable size in presacral area. Frequently, these lesions are asymptomatic so the diagnosis may be delayed. 24 Aug, 2019 https://www.clinsurggroup.us/articles/ACG-5-164.php It is very uncommon situation in which primary colonic carcinoma is asymptomatic and presents as isolated splenic metastasis. Involvement of spleen by secondary tumors is usually seen in disseminated spread of tumor. However, isolated splenic involvement by tumor metastasis is an infrequent event, except in cases of lymphoid origin malignancy where spleen is commonly involved. We hereby report a case of 50 years old man who presented with gradually increasing pain abdomen for 3 months. USG report showed splenomegaly indicating either splenic abscess or hemangioma. 23 Jul, 2019 Recently, long non-coding RNAs (lncRNAs) have emerged as crucial players in the initiation and progression of multiple cancers including gastric cancer (GC). LncRNA HOXA11 antisense RNA (HOXA11- AS) has been found to be an oncogenic factor in GC. However, the molecular mechanisms responsible for these oncogenic properties have not been thoroughly elucidated. 10 Jul, 2019 https://www.clinsurggroup.us/articles/ACG-5-162.php Introduction: An emergency laparotomy is a life saving procedure undertaken mostly in acute cases without much preparation of the patient. Despite being one of the most common urgent surgical procedures, it still proves to be a challenge for the surgeons of the world. 29 May, 2019 https://www.clinsurggroup.us/articles/ACG-5-161.php Introduction: In 2010, World Health Organization defined mixed adeno-neuroendocrine carcinoma as rare tumor with two malignant components: neuroendocrine and adenocarcinomas. A rare mixed adenoneuroendocrine carcinoma of the ampulla of Vater was diagnosticated in this report. Methods: Diagnosis, surgery and follow-up performed at the Surgical Clinic Service of the Lauro Wanderley University Hospital, from November 2017 to March 2019. Authorized by the patient and approved by the Ethics and Research Committee. 26 Feb, 2019 https://www.clinsurggroup.us/articles/ACG-5-160.php The aim of this study was to test the clinical and mucosal benefit of a natural gastro-oesophageal mucosal protector DOGDG-121 in non-erosive GERD comprising from NERD, to Functional Heartburn and Hypersensitive oesophagus while also ascertain the symptom-free duration in patients with prior symptomatic relapsing GERD. 68 consecutive adult patients, reporting mild heartburn symptoms two or more days a week or at least moderate symptoms more than once a week for at least six months duration were prospectively recruited. Inclusion criteria were: recurrent typical GERD symptoms, such as heartburn and/or acid regurgitation and a duration of symptoms>6 months. Patients were divided in two groups comparable as for age, gender, BMI and pHmetry profile. 17 Jan, 2019 https://www.clinsurggroup.us/articles/ACG-5-159.php Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder, characterized by the triad of vascular malformations (angioma), venous and or lymphatic malformations and asymmetrical disturbed growth of soft tissues and/or bone. Primary rectal linitis is a rare digestive tumor with very poor prognosis. We report the case of a 41-year-old patient with Klippel trenaunay syndrome who was diagnosed with primary rectal linitis. 06 Nov, 2018 https://www.clinsurggroup.us/articles/ACG-4-158.php Ciliated hepatic foregut cyst is a rare benign liver lesion with about a hundred cases described in the literature. It is the hepatic equivalent of the bronchogenic cyst, of which it shares the same histological characters. One of these key features in imaging is its location in the anterior sub-capsular region of the IV segment of the liver. The treatment is surgical because of the risk of degeneration. We report a case of ciliated cyst examined in ultrasound, CT and MRI. 06 Nov, 2018 https://www.clinsurggroup.us/articles/ACG-4-157.php Primary intestinal lymphangiectasia (PIL) is a rare protein losing gastroenteropathy that usually affects children and teenagers. There are only a few cases described in the literature. The diagnosis is confi rmed by the presence of intestinal lymphangiectasia based on endoscopic fi ndings and histology. 25 Oct, 2018 https://www.clinsurggroup.us/articles/ACG-4-156.php Although mortality after pancreatectomy in high-volume centers is less than 3%, morbidity is still as high as 18-52%. Postpancreatectomy vasculary complication is less frequent but much mortal than anastomotic problems. Postpancreatectomy vasculary complication is a life-threatening entity and it must be managed urgently. Here we report a case treated with emergent laparotomy for delayed liver ischemia and massive bleeding after total pancreatectomy. Patient was discharged without any complication at the 3rd week of emergent laparotomy for aneurismatic hemorrhage. 29 Sep, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000055-acg.php Solid pseudopapillary tumor (SPT) is a rare pancreatic neoplasm, classified as low-grade malignant tumor by the World Health Organization in 2000. Surgical treatment usually provide curative intent. Here in we report a 30 years-old woman whom had been operated upon possible benign pancreatic head mass diagnosed histopathologically as solid pseudopapillary tumor. And we aimed to review the literature on the basis of the case. In conclusion, solid pseudopapillary tumors are slow-growing tumors, with unpredictable potential for malignancy. Aggressive surgery yields favorable results even in the presence of vascular invasion and metastatic disease. 27 Sep, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000054-acg.php A 52 years old woman presented to emergency service after eating chicken meat few days before that. She had upper abdominal pain, vomiting, weakness and fever of 38C°. A control abdominal CT scan showed linear 50 mm foreign body that perforated the pyloric wall and penetrated into the liver. US, CT and fibro gastroscopy have been used to discover cause for the patient’s problem. 27 Aug, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000053-acg.php Background: Portal vein septic thrombophlebitis is a rare and serious event of late diagnosis and secondary to intra-abdominal infection. Case report: A 21-year-old man was admitted to the hospital with loss of weight, fever, chills, hepatosplenomegaly, and history of abdominal pain in the right iliac fossa previously treated with ciprofloxacin. At the entrance physical examination, he was emaciated and had no signs of abdominal pain upon palpation. 05 Jul, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000052-acg.php Background: Eosinophilic infiltration of the pancreas is usually associated with generalized diseases like “sclerosing pancreatitis”, “eosinophylic gastroenteritis” and “systemic mastocytosis”. Most patients have systemic findings such as eosinophilia, elevated IgE levels and gastrointestinal tract infiltration Isolated eosinophilic infiltration of the pancreas is much less common and is usually found in the histological evaluation of pancreatic specimens resected with the misdiagnosis of pancreatic cancer. Methods: Herein we report a rare benign pancreatic tumor that was operated on with the misdiagnosis of malignancy. 12 Apr, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000051-acg.php We developed a new method: percutaneous choledocho-duodenal shunt (PCDS) for complete biliary obstruction patient. At fi rst, percutaneous transhepatic cholangio drainage (PTCD) is performed as usual manner with local anesthesia. After the patient is recovered from bilirubinemia, percutaneous endoscopic gastrostomy (PEG) is performed with pull-through method under local anesthesia. Catheter of PEG is replaced to jejunal catheter after the gastrostomy is completed. These two catheters (catheter of PTCD and Jejunal catheter) are connected each other with extra-peritoneal shunt. The method is useful for the patient with complete biliary obstruction who cannot be performed biliary stenting. 11 Apr, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000050-acg.php Introduction: Hepatocellular carcinoma (HCC) is a major public health problem worldwide and is the second most common cause of cancer related deaths worldwide. If liver functional reserves and future liver remnant are adequate than liver resection is preferred choice in Child Pugh class A and selected cases of early Child Pugh class B, while Child Pugh B and C are candidates for liver transplantation. 14 Mar, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000049-acg.php Between the hiatal hernias, the type IV is the less frequent by the great defect, but this type had a high incidence of incarceration (5%), and a mortality rate up to 27%. 06 Mar, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000048-acg.php Leakage of pancreatic enzymes leading to either formation of abdominal collection or pancreatic fi stula is one the most feared complications after pancreaticoduodenectomy. Owing to high morbidity and cost related to pancreatic fi stula, multiple interventions including various types of pancreaticoenteric anastomosis have been proposed to prevent this complication. 22 Feb, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000047-acg.php Primary Gastrointestinal Follicular Lymphoma is very rare. It is considered as an indolent lymphoma, but a complication such as a perforation can increase the morbidity and mortality. We report the case of a 57-years-old man who had a perforation primary follicular lymphoma of the jejunum presenting as aneurismal form. He had peritonitis at his admission, and his abdominal CT revealed a massive pneumoperitoneum and a segmental dilatation of the small intestine. 07 Feb, 2018 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000046-acg.php Gastroparesis (GP) is a disorder that affects the motility of the stomach resulting in delayed gastric emptying (GE) without mechanical obstruction and has accompanying symptoms that include nausea, vomiting, early satiety, bloating, and epigastric pain. It was reported that increased eosinophils were identifi ed in the fi rst part of the duodenum in a subset of patients with the entity of functional dyspepsia (FD) and the main symptom of early satiety. It is recognized that approximately 40% of FD patients may also have delayed gastric emptying, termed Idiopathic GP (ID-GP). Therefore, to investigate the hypothesis that duodenal eosinophilia may be present in patients diagnosed with ID-GP we investigated whether there is any evidence of increased numbers of duodenal eosinophils in patients with the diagnosis of IDGP as compared to diabetic GP (DM-GP) patients and controls who had a normal GE. 20 Dec, 2017 https://www.clinsurggroup.us/articles/doi10.17352-2455-2283.000045-acg.php Background: Medicinal plants from the Brazilian Cerrado are used in folk medicine to treat several diseases such as gastric disorders. 04 Sep, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-144.php Background: Idiopathic myointimal hyperplasia of mesenteric vein (IMHMV) is an extremely rare cause of venous mesenteric ischemia. It is defi ned as non-thrombotic occlusion of the mesenteric veins secondary to myointimal hyperplasia. IMHMV is a poorly understood condition involving the rectosigmoid colon predominantly young previously healthy male individuals 28 Aug, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-143.php Portal hypertension is a severe complication of liver cirrhosis frequently leading to formation of ascites. We describe two patients that presented with a spontaneous rupture of an umbilical hernia, a rare complication of liver cirrhosis. 24 Aug, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-142.php Granulomatous gastritis is a condition which may occur in association with Crohn’s disease, sarcoidosis, Wegener’s granulomatosis, tuberculosis, foreign body reaction or certain drugs including cocaine. Here, we report a diagnosis of granulomatous gastritis in a sarcoidosis patient who presented with non-specifi c dyspeptic complaints. 23 Aug, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-141.php Multiple myeloma (MM) is a malignant proliferation of plasma cells that secrete monoclonal immunglobin (M protein). It accounts for 1% of all cancers and 10% of hematological malignancies. Mean age at diagnosis is 66 years. 06 Jul, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-140.php Sixty seven year old male patient with hypotension, tachycardia, 38.5°C fever, tensioning left inguinoscrotal hernia and hyperemia (acute scrotum). By abdominal computed tomography, recto-sigmoid perforation in diverticulitis area with collection and free air in hernial sac, was observed. 26 Jun, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-139.php Weight is one of the very important parameters of good health. Obesity is now a recognized disease, considered to be a global epidemic. 06 Jun, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-138.php The two Nobel prizes in physiology or medicine of 1995 and 2011 establish Drosophila genetics as a signifi cant contributor of genes and signaling pathways relevant to human disease, including innate immunity and cancer. 31 May, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-137.php Aims: The study evaluated children’s nutritional status at the moment of hospitalization. Patients and Methods: The nutritional status of 113 hospitalized patients was retrospectively evaluated at the time of hospitalization in the Clinic of Pediatric Gastroenterology between May 2013 and November 2014. During hospitalization, height for age, weight for age, and weight for height z scores were calculated. 22 May, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-136.php Back ground: The application of laparoscopic technique for cholecystectomy is expanding very rapidly and now performed in almost all major cities and tertiary level hospitals in our country. 22 May, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-135.php Background: The laparoscopic surgery technique has rapidly spread because of its several advantages over conventional open surgery. 18 May, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-134.php Patients with GERD and Barrett’s oesophagus should be encouraged to continue long term use of PPI therapy as a preventive measures for oesophageal adenocarcinoma. 04 May, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-133.php I read with great interest a paper published recently in Gut [1], as its fi nding that patients with Crohn’s disease (CD) have more pronounced reduction and dysbiosis 24 Mar, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-132.php Colonoscopy has been shown to be effective in the detection and removal of precancerous lesions and early cancers, and as a result, colorectal screening programs are in preparation, or in place throughout the world. Screening efforts are reducing the incidence of colorectal cancer (CRC) and allow diagnosis CRCs at an earlier stage. 08 Mar, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-131.php Pneumatosis cystoides intestinalis (PCI) is an uncommon entity without the characteristics of a disease by itself and it is characterized by the presence of gas cysts within the submucosa or subserosa of the gastrointestinal tract. 10 Feb, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-130.php Background and Study Aims: as there is no single golden rule for the diagnosis and activity of ulcerative colitis disease, this study is going to discuss the clinical relevance of calprotectin and PTX 3 in cases of ulcerative colitis and their roles as non-invasive methods to diagnose UC and determine disease activity. 31 Jan, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-129.php The anorectum plays an important role in regulation of defecation and in maintenance of continence [1]. 19 Jan, 2017 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-3-128.php Acute pancreatitis (AP) is a systemic immunoinfl ammatory response to auto-digestion of the pancreas and peri-pancreatic organs. It is a frequent gastrointestinal disease with an important morbimortality, reaching 30% in severe cases. 30 Dec, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-127.php Background: Ascaris lumbricoides is one of the most frequent human helminthiasis, but the complication with liver abscess is very rare and severe, being a challenge for the correct and timely diagnosis. 17 Dec, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-126.php Background: Acute cholangitis is a life threatening condition with multiple possible origins; one of this is the distal intermittent obstruction of biliary three by a duodenum yuxtapapillar diverticulum, an infrequent condition known as Lemmel syndrome. 16 Dec, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-125.php The liver is accountable for many critical functions within the body and loss of those functions can cause significant damage to the body. Liver disease is a extensive term that covers all aspects that cause the liver to fail to perform its proper functions. 08 Dec, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-124.php Objective: Vitamin D (Vit D) deficiency is a very common problem in obese children, but clinical guidelines for maintenance or treatment have not been published for this population. The aim was to assess the benefit of 2 months Vit D supplementation given to deficient obese children from WV. 06 Dec, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-123.php A 51 year - old – male, consuming alcohol almost 180 ml/day for 20 years was admitted elsewhere with vomiting for 10 days, reduced urine output for 5 days and severe epigastric pain radiating to back for 3 days. 27 Jul, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-122.php Ingestion of a corrosive substance can produce severe injury to the gastrointestinal tract and can even result in death. The degree and extent of damage depends on several factors like the type of substance, the morphologic form of the agent, the quantity, and the intent. In the acute stage, perforation and necrosis may occur. Long-term complications include stricture formation in the esophagus, antral stenosis and the development of esophageal carcinoma. Endoscopy should be attempted and can be safely performed in most cases to assess the extent of damage. Procedure related perforation is rare. Stricture formation is more common in patients with second and third degree burns. This review summarizes our current knowledge and evidence based management of this unique but not uncommon pathology of the upper gastrointestinal tract. 28 Jun, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-121.php Isolated pancreatic trauma (IPT) secondary to an abdominal blunt trauma, is an uncommon condition- IPT diagnosis usually is insidious, requiring the integration of multiple parameters, regarding anamnesis, physical examination, blood analysis and radiologic tests. Nowadays, exists controversy in the literature about management of the IPT. We report a case of a young male with a body-tail pancreatic transection, secondary to an abdominal blunt trauma. Distal pancreatectomy with spleen preservation was performed with successful postoperative course. We discuss diagnostic and therapeutical options in IPT. 25 Jun, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-120.php Introduction: The systemic amyloidosis usually doesn’t save the digestive tract, but this involvement is present in approximately 60% of patients with AA Amyloidosis and only in 8% and 1% of patients with AL Amyloidosis (respectively through biopsy and clinically). Beside gastrointestinal involvement is rarely symptomatic and clinical events are not specific. 18 Jun, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-119.php In Hungary, the mortality rates from colorectal cancer are dramatically high, therefore the reduction by population screening as a public health measure is considered as one of the priorities of the National Public Health Programme. The aim of screening is to reduce the burden of cancer on the population by discovering latent disease in its early stage and treating it more effectively than if diagnosed later in a symptomatic stage. In the beginning, a human-specific immunological test was applied in the “model programmes”, as a screening tool to detect the occult blood in the stool; compliance was 32% in average. However, the objectives of the model programmes have not been achieved, because – among other reasons – a debate on method of choice and the strategy to follow have divided the professional public opinion. In this paper the debated issues are critically discussed, being convinced that – at present – population screening seems to be the most promising way to alleviate the burden of colorectal cancer. 17 Jun, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-118.php Von Hippel-Lindaudisease (VHLD) is a rare hereditary tumor syndrome, inherited in autosomal dominant manner. Patients diagnosed with VHLD have a high risk of developing neoplasms of various organs (eyes, central nervous system, bone, kidney, adrenal glands, epididymis, broad ligament and pancreas). Due to its rarity, most of the physicians fail to properly diagnose it in time, and they might expose patients to a risk of unnecessary surgeries with important consequences in a long run. When this condition is diagnosed, lifelong follow-up is necessary. Pancreatic involvement it is seen in most patients with VHLD and various pancreatic lesions have been described, including cystic lesions (simple unilocular or serous microcystic or macro/micro-cystic adenomas), neuroendocrine tumors (NET), renal cell cancer metastasis and adenocarcinoma. 14 Jun, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-117.php Aim: To show if there is any connection between the activity of inflammatory bowel disease (IBD), infection with Clostridium difficile (C. difficile) and thrombocytosis in our hospitalized patients. Methods: We performed a retrospective observational study to determine the incidence of C. difficile infection (CDI) and thrombocytosis in our patients with IBD hospitalized from January 1, 2007- December 31, 2012. 02 Jun, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-116.php We report two cases of gastric trichobezoar, recorded in the last 3 years in our Hospital. Both cases presented abdominal pain and epigastric mass, as well as upper obstructive symptoms. The cases were surgically treated with satisfactory evolution. the clinician has to consider this diagnosis. Surgery is a successful treatment for these cases. 24 May, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-114.php Incisional hernias are the most frequent “late complications” after laparotomy. They develop in more than 10% of patients and their incidence is related to numerous risk factors (Table 1). 30 Apr, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-113.php Aims and Objectives: To prospectively evaluate and compare effectiveness of topical 0.2% glyceryl trinitrate ointment vs lateral internal sphincterotomy in treatment of patients with chronic anal fissure. Material and Methods: The study included a total of 50 patients presented with chronic anal fissure, divided into two groups by computer generated randomization. Group A included 25 patients with chronic anal fissure treated with local glyceryl trinitrate ointment 0.2% whereas Group B included 25 patients managed by lateral internal sphincterotomy. 30 Apr, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-112.php Anaphylaxis and severe allergic transfusion reactions (ATR) are uncommon complications after blood transfusion. Nevertheless, these complications are associated with very severe outcomes, such as dyspnea, shock, and death. Patients with end-stage liver disease who require liver transplantation have a high tendency for bleeding because of splenomegaly-induced thrombocytopenia and decreased production of coagulation factors in the liver. Liver transplantation is a very long procedure and a significant perioperative blood loss is highly likely. Therefore, transfusion of platelets and other blood products is often necessary. We report a successful ABO-incompatible living donor liver transplantation in a patient with hepatitis B virus-related liver cirrhosis and hepatocellular carcinoma who had a history of platelet transfusion-related anaphylaxis. 07 Mar, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-111.php Background: Gastric adenocarcinoma is the fourth most common malignancy worldwide and is globally the second leading cause of cancer-related deaths each year. Salted foods and exposure to H. pyloriinfection during the infancy have been considered the most important environment risk factors for gastric cancer. Despites increased access to electric energy, allowing the use of refrigerators to better conserve foods, many people keep consuming salted food, by washing them before eating with the intention of reducing salted flavor and also supposing to decrease or avoid risk of diseases. The aim of this study was to investigate the efficacy of reducing nitrites levels in salted fish by washing the fish before consuming, to find if washing salted food should be an efficient measure to reduce, or even avoid, the nitrites related gastric cancer risk. 25 Feb, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-110.php Obesity is a large and growing health problem in the UK with high associated costs to the NHS. Bariatric surgery is proven as an effective treatment for obesity associated with long term weight loss and a reduction in obesity related comorbidities [1]. The NICE guidance highlights the importance of follow-up post-surgery [2]. The guidelines state that in order to be eligible for surgery the patient must commit to long term follow-up and that in order for a centre to offer bariatric surgery it must ensure that it can provide regular MDT post-op assessment and support for at least two years [2]. This should be followed by lifelong follow-up at least annually in the community [2]. 09 Jan, 2016 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-2-109.php Background: Appendix tumours present an incidence of 0.2 to 0.3% among all appendectomies. It is a rare condition, commonly found as an incidental diagnosis by imaging studies due to his lack of symptoms; nevertheless it is associated with many complications when undiagnosed like pseudomixoma peritonei a condition with high morbidity and mortality. This is the importance of recognize it to establish an opportune diagnose and treatment. 14 Oct, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-108.php Tuberculosis is described during the use of monoclonal antibodies against tumour necrosis factor (TNF) for Crohn's disease treatment. We report a case of a 44 year old man that developed fever, night sweats and weight loss during immunosuppressive and anti-TNF therapy for Crohn's disease. After extensive investigation we performed mediastinoscopy with biopsy of the paratracheal lymph node. A histopathological study revealed caseous necrosis. The patient improved after therapy against tuberculosis. During anti-TNF therapy, the diagnosis of tuberculosis may be mainly difficult when an atypical location is present. Clinical skills are important mainly in countries where tuberculosis is endemic. 09 Sep, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-107.php One of the most important events on gastroenterology certainly was the isolation of Helicobacter pylori (H. pylori) by Barry Marshall and Robin Warren in 1983 [1], occurrence which redirected our understanding of the pathophysiology of gastrointestinal diseases. The production of urease as well as the mobility of these bacteria promoted by flagella were identified as essential factors for colonization of the gastric epithelium and, from there, within a few years, the list of H. pylori virulence factors for colonizing and persisting on the gastric surface epithelium besides some factors damaging the mucosa expanded greatly. 28 Aug, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-106.php The current therapeutic goal in the management of chronic hepatitis B (CHB) infection is to persistently suppress hepatitis B virus (HBV) replication and prevent its progression to liver failure and the development of hepatocellular carcinoma (HCC). At present, the therapeutic strategies for CHB includes either a short course of pegylated-interferon-alfa (PEG-IFNa) and/or a long term course of nucleos(t)ide analogues (NA's). NA's are more preferable to PEG-IFNa, majorly for its easier route of administration and excellent tolerance and safety profiles. Entecavir (ETV) and tenofovir (TDF) are the current first line options for its potency to maintain sustained virological response (SVR) in almost 100% of the adherent individuals along with minimal to no long-term resistance. 28 Aug, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-105.php Portal hypertension can result in the reopening of collapsed embryonic channels within existing adult veins [11. Walsh G, Williams MP (1995) Case report: Giant pararectal varices-computed tomographic appearances. Br J Radiol 68: 203-204. ]. Ectopic varices are defined by portosystemic venous collaterals occurring anywhere in the gastrointestinal tract other than the esophagogastric region. Therapeutic options for bleeding stomal varices include surgical ligation, stoma revision, portosystemic shunt, and liver transplantation. We present a case with bleeding stomal varices which were successfully treated by percutaneous injection sclerotherapy. 30 Jul, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-104.php Benign lesions of the colon are infrequent and with a low percentage of appearance. Colon lipomas are in the third place of benign tumors after adenomas and smooth muscle [11. Goligher JC (1980) Cirugía de Ano Recto y Colon. 2a ed. Barcelona: Salvat.,55. Thonet G, Setton J, García M, et al. (2003) Lipomas de colon, a propósito de 2 casos. Rev Chil de Cirugía 55: 274-276.]. Colonic lipomas are benign non epithelial tumors of soft texture and mesenchymal origin; generally they grow from mature adipocytes. Lipomas can appear in the entire gastrointestinal tract. They are generally asymptomatic, but when symptomatically, bleeding and obstruction can appear [22. Barrera A, Bannura G (1998) Lipoma de colon transverso como causa de intususcepción colónica. Rev Chil Cir 50: 669-673.,44. Notaro JR, Masser PA (1991) Annular colon lipoma: a case report and review of the literature. Surgery 110: 570-572.]. Its clinical diagnosis is difficult, signs and symptoms include abdominal pain, obstruction, lower gastrointestinal bleeding, diarrhea, constipation, and intussusception [55. Thonet G, Setton J, García M, et al. (2003) Lipomas de colon, a propósito de 2 casos. Rev Chil de Cirugía 55: 274-276.]. These tumors are found in endoscopies, radiological exams, surgical interventions, and autopsies. We present 2 cases of colon lipoma. 27 Jul, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-103.php Aim: We evaluated food intake in telaprevir-based triple therapy (telaprevir, pegylated-interferon, and ribavirin) and its relation to Gastric Emptying (GE). Methods: 17 patients received telaprevir combined with pegylated interferon plus ribavirin. The GE study was carried out using the 13C-acetate breath test and GE time was expressed as the peak time of 13CO2 excretion (Tmax). 26 Jun, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-102.php Background: Secondary intercurrent infections in patients with inflammatory bowel disease (IBD) represent a very important problem in daily clinical practice because of their significant contribution to quality of life and work ability. Beta-glucans are known to act as non-specific immunomodulators that exhibit an anti-inflammatory effect as evident in animal and human studies. Imunoglukan P4H® capsules are nutritional supplement containing 100 mg of beta-(1,3/1,6)-D-glucan pleuran isolated from oyster mushroom Pleurotus ostreatus and 100 mg of vitamin C. 11 May, 2015 https://www.clinsurggroup.us/Clinical-Gastroenterology/ACG-1-101.php Background and Aim: CT colonography has promoted a new paradigm, that up-to 2 polyps ≤5mm can be left in-situ and followed. In contrast, endoscopists identify and remove all colorectal polyps, regardless of size. We evaluated whether and how endoscopists might implement a plan of ignoring small polyps in clinical practice.