Benign blockage: gastric outlet obstruction due to a prolapsing gastric pedunculated polyp. Case report and literature review

NO ABSTRACT AVAILABLEAn 89-year-old woman was admitted to the emergency department at “Ospedale Civile Umberto I” in Lugo (Ravenna) for 1 month of vomiting, mild epigastric pain, and postprandial diarrhea without fever. Main comorbidities included chronic atrial fbrillation treated with a direct-acting oral anticoagulant, previous MI, hypertension, diabetes, and hypercholesterolemia, though despite her age the patient was autonomous in her daily activities. On admission, laboratory tests included normal WBC count, Hgb, and CRP. Abdominal X-ray demonstrated a stomach flled by ingested food (Fig. 1a) and difuse air–fuid levels accompanied by abdominal distension (Fig. 1b). A surgical consultation was requested; a CT scan was performed confrming gastric distension by ingested food (Fig. 2). Since gastric outlet obstruction was suspected, the patient was hospitalized in a medical unit, treated with NPO and IV fuids. After 2 weeks, a second surgical consultation was requested due to the recurrence of clinical symptoms with unchanged laboratory tests. An upper GI series reported normal gastric and duodenal transit (Fig. 3) while colonoscopy was negative. The patient underwent EGD that showed a 4-cm pedunculated polyp situated in the gastric antrum; the polyp prolapsed into the duodenal bulb creating a “ball valve”-type intermittent obstruction. Biopsy was consistent with a hyperplastic polyp which was endoscopically resected (Fig. 4a–c). The fnal histological report confrmed a benign lesion; the patient was discharged from the hospital without any further invasive treatment in good general condition

Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy.

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease

Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases

Transanal evisceration in a patient with rectal perforation and full thickness rectal prolapse: what has prolapsed into what?

These images show a 72-year-old female with full thickness rectal prolapse scheduled for surgery. She presented in the Emergency Room with irreducible prolapse, abdominal pain and signs of shock. Examination revealed the presence of small intestine prolapsing from the anus. Due to the presence of hemodynamic instability, the patient underwent emergency surgery without further diagnostic testing. At laparotomy, a perforation of the superior rectal wall was found with a 120 cm loop of small intestine prolapsing through it. The ileum was reduced in the abdomen with rapid resumption of perfusion and motility and a Hartmann procedure was performed. The postoperative course was uneventful and the patient was discharged after 6 day