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Background/Objectives: Pre-eruptive intracoronal resorption (PEIR) in impacted or unerupted teeth often remains undiagnosed. The aim of this study was to investigate the prevalence of PEIR with the aid of cone beam computed tomography (CBCT) and propose a new three-dimensional (3D) classification for the analysis of the lesions. Methods: A total of 164 unerupted teeth diagnosed in CBCT scans, derived from an equivalent number of patients, were examined for the presence of PEIR, tooth type, angulation and position. A novel 3D classification system was proposed and all PEIR lesions were further classified. The classification system was used to stage PEIR lesions according to their extend from the enamel level apically, the circumferential spread and their proximity to the pulp chamber. Descriptive statistics were used to assess the prevalence and type of resorption. The association between PEIR, demographics, tooth type, position and angulation were studied. The estimation of the multivariate relationship between PEIR, patient’s demographics and tooth characteristics was conducted with the multiple binary logistic regression model. Results: The prevalence of PEIR was 33.5%, affecting mostly maxillary canines, and maxillary and mandibular molars. The prevalence of PEIR in ages over 45 years was significantly higher (p < 0.001). The presence of PEIR was significantly associated with buccal position (p = 0.002) and buccal angulation (p = 0.016) of the tooth. Conclusions: Due to the high prevalence of PEIR, CBCT may improve detection and 3D characterization when imaging is already clinically indicated, and influence treatment planning in selected cases.

Background Fecal impaction (FI) causes serious complications and has a high mortality rate, particularly among older individuals. However, there have been few large-scale studies on FI, and understanding of FI is incomplete. In this study, we aimed to elucidate the characteristics, mortality rates, and healthcare costs of patients hospitalized for FI. Methods This retrospective observational study used data from the Japanese national administrative database and included patients hospitalized for FI between April 2016 and March 2023. The characteristics, treatment, outcomes, and healthcare costs of patients were evaluated. The risks for in-hospital mortality were examined using a Fine and Gray model as an exploratory analysis. Results In total, 30,439 patients were eligible for the study. The median (interquartile range) age was 79 (69–86) years. In total, 4,093 (13.4%) patients were admitted from nursing homes. On admission, 10,734 patients (35.3%) had a history of constipation. The in-hospital mortality rate was 8.4%, increasing with age and reaching 13.5% in patients aged 85 years or older. Total healthcare costs also increased with age, with more than 18 billion JPY spent cumulatively on patients aged 65 years or older across the study period, accounting for 85.9% of the total costs. Total annual healthcare costs exceeded 2700 million JPY and gradually increased over time. In an exploratory analysis, sepsis was the most significant risk factor for mortality, followed by emergency ambulance transportation and admission from a nursing home. Conclusions The mortality rate of fecal impaction was 8.4% in our study of a large Japanese national dataset, with the rate approaching 13.5% in those aged 85 years or older. Inpatient healthcare costs increased with age and over time.

Background Fecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis. Methods A PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases. Results 188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5 % were over 65 years old, 49 % suffered from chronic constipation, 29 % had an underlying neuropsychiatric disease and 15 % were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4 %), on the intestinal lumen (14 %) and on adjacent structures (12.6 %). Conclusions FI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

BackgroundFecal impaction (FI) is defined as a large mass of stool in the rectum and/or colon that is unable to be evacuated. No study to date details demographics and outcomes in a sizeable sample of FI patients in the USA.AimsThe present study aims to develop knowledge of FI by reporting descriptive measures and outcomes of patients presenting to a US emergency department (ED) with FI.MethodsMedical charts coded with FI at Beth Israel Deaconess Medical Center from 2016 or 2017 were identified retrospectively. Patients diagnosed with FI in the ED or subsequent to direct hospital admission from the ED were included. Patient-specific demographics, visit-specific details, medical and medication histories, and hospital treatment and outcome measures were included in a database and analyzed.ResultsThirty-two patients (mean age of 72.9 years, 62.5% female) had a total of 42 ED visits with FI. Patients had an average of 8.7 diagnoses and 11.2 medications listed in their charts. 54.8% of patients were taking at least one commonly prescribed constipating medication. The median total length of stay for admitted patients was 3 days, with nearly 90% of the ED visits with FI requiring hospital admission. 40.6% of patients experienced serious FI-related morbidities, and 21.9% of patients with FI died in the hospital.ConclusionPatients presenting with FI had high risk of morbidity and mortality, complex medical histories, and large numbers of active treatment regimens. Patients with FI should receive immediate treatment and close monitoring for morbidities and complications.

Non-operative treatment of uncomplicated appendicitis in children is gaining ground. Pending definitive evidence regarding its effectiveness, there is a call to evaluate clinical recovery after non-operative treatment. In this study, we analyzed data collected during initial admission of a multicenter prospective cohort in which children, 7–17 year, were treated non-operatively for uncomplicated appendicitis. During admission clinical parameters (pain and gastro-intestinal symptoms), inflammation parameters and sequential abdominal ultrasound were recorded. In total, 45 children were included, 42(93%) were discharged without the need for appendectomy; median [IQR] pain scores on admission were 5 [4–7], decreasing to 2 [0–3] after 1 day of treatment. Initially, 28/42 (67%) reported nausea and 19/42 (45%) vomiting; after 1 day, this was 3/42 (7%) and 1/42 (2%), respectively. White blood cell count declined from a median [IQR] of 12.9 [10.7–16.7] 10E9/L on admission to 7.0 [5.8–9.9] 10E9/L on day 1. Median [IQR] C-reactive protein levels increased from 27.5 [9–69] mg/L on admission to 48 [22–80] mg/L on day 1, declining to 21.5 [11–42] mg/L on day 2. Follow-up ultrasound showed no signs of complicated appendicitis in any of the patients.Conclusion: Clinical symptoms resolved in most children after 1 day of non-operative treatment. This suggests that non-operative treatment is a viable alternative to appendectomy regarding clinical recovery.Trail registration: NCT01356641What is Known:• Non-operative treatment of uncomplicated appendicitis in children is safe and its use around the world is gaining ground, however high quality evidence from adequately designed randomized trials is still lacking.• Concerns have been raised regarding the potentially prolonged clinical recovery associated with non-operative treatment.What is New:• Most clinical symptoms resolve after 1 day of non-operative treatment in the majority of children.

Stercoral colitis is a rare but serious diagnosis which is associated with a high rate of morbidity. This review highlights the pearls and pitfalls of stercoral colitis, including presentation, diagnosis, and emergency department (ED) management based on the available evidence. Stercoral colitis is an uncommon inflammatory condition of the distal large bowel and rectum resulting from accumulation of impacted stool and is associated with several complications including bowel ulceration, ischemia, perforation, peritonitis, and sepsis. Though most commonly present with abdominal pain and constipation, many patients present without typical symptoms requiring emergency clinicians to maintain high clinical suspicion, especially in patients at high risk for developing severe constipation. The diagnosis can be secured with cross-sectional radiography, including computed tomography of the abdomen and pelvis. ED management includes fluid resuscitation, initiation of a multimodal bowel regimen, and if indicated, initiation of parenteral antibiotics and consultation with a surgical specialist. Admission to the hospital should be considered for all patients with stercoral colitis. An understanding of stercoral colitis can assist emergency clinicians in diagnosing and appropriately managing this high risk disease.

Introduction: The aim of this study was to compare the reliability and the agreement of the Pederson and Pernambuco difficulty indexes in predicting the surgical extraction difficulty of the impacted mandibular third molars. Materials and methods: A prospective observational cohort study was conducted on 83 patients who had undergone surgical removal of impacted mandibular third molar. The difficulty of extraction was determined preoperatively according to the total scores obtained from the Pederson and Pernambuco difficulty indexes, the operative difficulty was determined by the surgical technique and the duration of extraction. The accuracy of prediction of the surgical difficulty and the degree of agreement of the two indexes were calculated. Results: The accuracy of Pederson and Pernambuco indexes in predicting the operative difficulty measured by duration of surgery was 36.1% and 55.4% respectively, and with operative difficulty measured by the technique was 21.7% and 37.3% respectively with statistically significant differences. The agreement between the 2 indexes was poor. Conclusion: Both indexes were limited in predicting the surgical difficulty of impacted mandibular third molars although the Pernambuco index was better than the Pederson index and the agreement between the two indexes was poor.

Introduction: An attempt at medical management is often the initial step in addressing esophageal obstruction from an impacted food bolus. Medical management, however, has limited success and often requires urgent endoscopy. We present a case in which standard medical treatment failed, but a swallowing augmentation maneuver resolved the obstruction. Case Report: A 67-year-old female presented with esophageal obstruction after eating steak. Transfer to higher level of care for endoscopy was initiated; however, the receiving gastroenterologist suggested an “upright posture, chin tuck, double swallow” maneuver. This immediately resolved the patient’s symptoms, and she was discharged home. Conclusion: This case suggests a novel, non-endoscopic technique for esophageal obstruction from food bolus impaction.