Background: Short Bowel Syndrome (SBS) results from extensive bowel resection. Patients with SBS require Total Parenteral Nutrition (TPN) for survival. Understanding mechanisms contributing to TPN-associated liver injury and gut atrophy are critical in developing SBS therapies. Existing SBS models using tethered animals have significant limitations and are unlike ambulatory human SBS patients. We hypothesized that we could induce SBS in piglets and develop an ambulatory TPN-SBS model. Material and Methods: 18 neonatal pigs received duodenal and jugular catheters. They were fitted with a jacket holding TPN and a miniaturized pump. 6 piglets had 90% small bowel resection and catheter placement (SBS group). Non-SBS piglets were randomized into enteral nutrition (EN) or TPN. Results: Bowel resection was successfully accomplished in SBS animals. Weight gain was similar in all groups. SBS animals had increased serum bilirubin compared to EN. Mean conjugated bilirubin ± SD was 0.045 ± 0.01 for EN, (p=0.03 EN vs TPN and p=0.03 SBS vs EN) and 1.09 ± 1.25 for TPN, (p=0.62 TPN vs SBS). Gut density was reduced in the TPN group compared to EN and SBS groups. Mean gut density ± SD was 0.11 ± 0.04 for TPN (p=0.0004 TPN vs SBS and p=0.00007 TPN vs EN) and not statistically different for EN vs SBS (p=0.32). Conclusion: We created a novel, ambulatory TPN-SBS model using piglets, mimicking longterm TPN delivery in human SBS patients. Our model demonstrated TPN-related conjugated
Highlights
This is the first ever reported case of sterile granulomas in a patient with PTLD.
PTLD is a disease that could potentially be diagnosed with minimally invasive biopsy rather than diagnostic splenectomy.
This report is to create awareness regarding potential presence of sterile granulomas and discuss use of biopsy before splenectomy.
Neonates requiring peritoneal dialysis (PD) catheters have been shown to have complication rates up to 70%. The presence of a concurrent stoma significantly increases the risk of peritonitis, exit-site infection, and catheter failure. As such, multiple techniques have been proposed to reduce these risks, including a chest wall exit site. In this case, the patient was born with bilateral hypoplastic kidneys and an anorectal malformation, requiring a colostomy soon after birth. At 4 weeks of life, he required placement of a PD catheter for dialysis. Given the high risk of infection, a laparoscopic-assisted PD catheter placement with a chest wall exit remote from the colostomy was performed. This report describes the operative technique including omentectomy, placement of a percutaneous stitch between the catheter cuffs, and fibrin glue injection around the catheter. The patient had no catheter-related infections. Laparoscopic-assisted PD catheter placement with chest wall exit site is a safe alternative in patients with any type of abdominal stoma.
Laparoscopic-assisted colostomy in the management of anorectal malformations is a safe and effective technique. It offers similar advantages of the open technique, with the added benefits of avoiding wound-related complications and improved cosmetic results.
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