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Constipation can be a significant clinical challenge that can compromise management plans and prolong hospital stays. Our goal was to examine the effects of constipation on mechanically ventilated patients, with outcomes related to inpatient stays. We retrospectively analyzed critically ill patients hospitalized with constipation in the 2016 to 2019 National Inpatient Sample (NIS) database. Constipation was defined using Rome IV criteria. Critically ill patients were defined as mechanically ventilated from admission day 1. Our primary outcome was length of stay (LOS) and total hospital charge. Secondary outcomes included predictors of mortality in critically ill patients with constipation. The study included 2,351,119 weighted discharges of mechanically ventilated patients in the NIS database. Of these, 3.7% had constipation. The adjusted LOS was 3.4 days longer in patients with constipation vs those without it (P < 0.001). The adjusted inpatient hospital cost was $31,762 higher in patients with constipation (P < 0.001). Men had higher LOS and inpatient costs. Constipation was not associated with increased inpatient mortality (P < 0.001). Several conditions increased mortality in critically ill patients with constipation, including peritonitis, fecal impaction, and bowel obstruction.

INTRODUCTION: Wünderlich syndrome (WS) is a rare presentation of hypovolemic hemorrhagic shock. It is a fatal disease described as a syndrome of spontaneous non-traumatic subcapsular and retroperitoneal hemorrhage. The etiology of WS is varied, with renal causes including malignancy being the most common, followed by renal vasculature abnormalities, vasculitis, cystic rupture, pyelonephritis, and idiopathic. The appropriate treatment depends on the accuracy of diagnosis and precise determination of its cause. To our knowledge, this is the first case report of WS due to acute pyelonephritis in a patient with congenital solitary kidney and Jehovah's Witness religious beliefs which impacted his care.

Cryotherapy probe biopsy should be considered a safe and effective approach to diagnose carcinoid tumors.

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