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Purpose We compared oncologic outcomes of laparoscopic surgery following self-expandable metallic stent (SEMS) insertion with one-stage emergency surgical treatment of obstructive left-sided colon and rectal cancers. Methods From April 1996 to October 2007, 95 consecutive patients with left-sided obstructive colorectal cancers were included: 25 underwent preoperative stenting and elective laparoscopic surgery (SLAP) and 70 underwent emergency open surgery with intraoperative colon lavage (OLAV). Long-term oncologic outcomes were analyzed on an intention-to-treat basis. Results There were no significant differences in baseline characteristics of patients between groups. Perineural invasion of the primary tumor was more frequent with SLAP (76 vs. 51.4 %, p  = 0.033). The median follow-up was 51 months (range, 4–139 months). There were no significant differences between groups in 5-year overall survival rates (SLAP vs. OLAV, 67.2 vs. 61.6 %, p  = 0.385). Five-year disease-free survival rates were also similar between groups (SLAP vs. OLAV, 61.2 vs. 60.0 %, p  = 0.932). Conclusions Laparoscopic surgery after SEMS was feasible and safe for patients with obstructive left-sided colorectal cancer, and oncologic outcomes were comparable to emergency open surgery with intraoperative colon lavage. These results support the continued use of SLAP in this setting. Further large-scale study is needed to investigate any clinical impact attached to the higher rates of perineural invasion observed in SLAP.

Background This analysis aims to evaluate health-related quality of life (HrQoL) (primary outcome for this analysis), nausea and vomiting, and pain in patients with inoperable malignant bowel obstruction (IMBO) due to cancer or its treatments randomised to standardised therapies plus octreotide or placebo over a maximum of 72 h in a double-blind clinical trial. Methods Adults with IMBO and vomiting recruited through 12 services spanning inpatient, consultative and community settings in Australia were randomised to subcutaneous octreotide infusion or saline. HrQoL was measured at baseline and treatment cessation (EORTC QLQ-C15-PAL). Mean within-group paired differences between baseline and post-treatment scores were analysed using Wilcoxon Signed Rank test and between group differences estimated using linear mixed models, adjusted for baseline score, sex, age, time, and study arm. Results One hundred six of the 112 randomised participants were included in the analysis ( n  = 52 octreotide, n  = 54 placebo); 6 participants were excluded due to major protocol violations. Mean baseline HrQoL scores were low (octreotide 22.1, 95% CI 14.3, 29.9; placebo 31.5, 95% CI 22.3, 40.7). There was no statistically significant within-group improvement in the mean HrQoL scores in the octreotide ( p  = 0.21) or placebo groups ( p  = 0.78), although both groups reported reductions in mean nausea and vomiting (octreotide p  < 0.01; placebo p  = 0.02) and pain scores (octreotide p  < 0.01; placebo p  = 0.03). Although no statistically significant difference in changes in HrQoL scores between octreotide and placebo were seen, an adequately powered study is required to fully assess any differences in HrQoL scores. Conclusion The HrQoL of patients with IMBO and vomiting is poor. Further research to formally evaluate the effects of standard therapies for IMBO is therefore warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000211369 (date registered 18/04/2008)

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is characterized by marked dilatation of the bladder and microcolon and decreased intestinal peristalsis. Recent studies indicate that heterozygous variants in ACTG2, which codes for a smooth muscle actin, cause MMIHS. However, such variants do not explain MMIHS cases that show an autosomal recessive mode of inheritance. We performed exome sequencing in a newborn with MMIHS and prune belly phenotype whose parents are consanguineous and identified a homozygous variant (c.3598A>T: p.Lys1200Ter) in MYH11, which codes for the smooth muscle myosin heavy chain. Previous studies showed that loss of Myh11 function in mice causes a bladder and intestinal phenotype that is highly reminiscent of MMIHS. All together, these observations strongly suggest that loss-of-function variants in MYH11 cause MMIHS. The documentation of variants in ACTG2 and MYH11 thus points to the involvement of the contractile apparatus of the smooth muscle in MMIHS. Interestingly, dominant-negative variants in MYH11 have previously been shown to cause thoracic aortic aneurism and dilatation. Different mechanisms of MYH11 disruption may thus lead to distinct patterns of smooth muscle dysfunction.

Patients with Crohn’s disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.

Background Loop ileostomy is widely employed as a defunctioning procedure for left-sided colonic anastomoses. Closure of the stoma carries a risk of morbidity and even mortality. The aim of this prospective trial was to evaluate the ability of stapled stoma closure to decrease the rates of perioperative morbidity. Methods One hundred and nineteen patients (mean age 56.2 ± 5.4 years) underwent two-stage operations for rectal carcinoma with protective loop ileostomy between 2005 and 2008. All patients were randomly divided into two groups: 56 patients had conventional ileostomy takedown, while in the other 63, a functional end-to-end anastomosis was created using a linear stapler. Groups were comparable in terms of age, gender, body mass index, and other parameters. Results Mean time of stoma closure using functional end-to-end anastomosis was 68 ± 7, when compared to 92 ± 11 min ( P  = 0.01) for conventional stoma closure. The overall morbidity rate after ileostomy closure using a stapler was 3.2%: one patient (1.6%) developed a wound infection and self-limited bleeding from the anastomotic line, while another patient (1.6%) had an ileal obstruction caused by adhesions and required additional intervention. Conventional ileostomy closure resulted in a 14.3% morbidity rate: six patients (10.7%) had prolonged ileus, 2 (3.6%) had small bowel obstruction, and 2 (3.6%) had wound infections ( P  = 0.04). Conclusion Functional end-to-end anastomosis reduces operating time and morbidity compared to conventional ileostomy takedown.

ObjectiveEffective medical therapy and validated trial outcomes are lacking for small bowel Crohn’s disease (CD) strictures. Histopathology of surgically resected specimens is the gold standard for correlation with imaging techniques. However, no validated histopathological scoring systems are currently available for small bowel stricturing disease. We convened an expert panel to evaluate the appropriateness of histopathology scoring systems and items generated based on panel opinion.DesignModified RAND/University of California Los Angeles methodology was used to determine the appropriateness of 313 candidate items related to assessment of CD small bowel strictures.ResultsIn this exercise, diagnosis of naïve and anastomotic strictures required increased bowel wall thickness, decreased luminal diameter or internal circumference, and fibrosis of the submucosa. Specific definitions for stricture features and technical sampling parameters were also identified. Histopathologically, a stricture was defined as increased thickness of all layers of the bowel wall, fibrosis of the submucosa and bowel wall, and muscularisation of the submucosa. Active mucosal inflammatory disease was defined as neutrophilic inflammation in the lamina propria and any crypt or intact surface epithelium, erosion, ulcer and fistula. Chronic mucosal inflammatory disease was defined as crypt architectural distortion and loss, pyloric gland metaplasia, Paneth cell hyperplasia, basal lymphoplasmacytosis, plasmacytosis and fibrosis, or prominent lymphoid aggregates at the mucosa/submucosa interface. None of the scoring systems used to assess CD strictures were considered appropriate for clinical trials.ConclusionStandardised assessment of gross pathology and histopathology of CD small bowel strictures will improve clinical trial efficiency and aid drug development.

This study aimed to develop a deep learning model to recognize cell interaction patterns in pathological slides of malignant bowel obstruction. The model classifies lesions into four categories—normal mucosa, serrated lesions, adenomas, and adenocarcinomas—and evaluates its diagnostic utility in tumor-associated obstruction. Pathological slides from patients with tumor-induced intestinal obstruction (TICO) were retrospectively collected from First Affiliated Hospital of Bengbu Medical University and annotated into four histological categories: normal, serrated lesions, adenomas, and adenocarcinomas. The proposed deep learning framework combines a residual convolutional network with a bidirectional state-space module (SSM), enabling multiscale feature extraction through convolution and down-sampling, while modeling the spatiotemporal dynamics of cellular interactions. The model was designed to learn spatial and structural characteristics of cell interactions—such as glandular organization, intercellular spacing, and nuclear density—across different lesion types. Grad-CAM was used to visualize attention regions and assess consistency between model focus and pathological features. However, Grad-CAM was used solely for interpretability and not clinical validation; no expert verification of the visualizations has been performed. On an independent Chaoyang test set, the model achieved a validation accuracy of 85% and a macro-F1 score of 0.843 (95% CI: 0.829–0.857), showing only a 3% decline from training accuracy (88%), thus demonstrating strong generalizability. In addition, we calculated 95% confidence intervals using 1,000 bootstrap resamples and applied both the DeLong test and McNemar test to compare the performance of our model with baseline methods. The results demonstrated statistically significant improvements ( P  < 0.05) in Accuracy, Macro-F1, and ROC-AUC, thereby further strengthening the reliability of our conclusions. The recall for adenocarcinoma (Class 3) reached 88%, while Classes 0–2 (normal, serrated lesions, and adenomas) ranged from 78% to 83%. These results highlight the impact of sample imbalance and morphological similarity, which will be addressed in future work through Focal Loss reweighting and detailed error analysis. Grad-CAM visualizations identified regions of glandular disruption and abnormal nuclear density, aligning with WHO-2022 diagnostic criteria and enhancing model interpretability. Overall performance is comparable to state-of-the-art gastrointestinal pathology AI systems from recent years, offering rapid and quantitative diagnostic support in emergency pathology settings. The proposed deep learning model effectively distinguishes four categories of tumor-associated colorectal lesions, demonstrating strong diagnostic potential. Limitations include: (i) all data were retrospectively collected from a single center, without external multicenter validation. Differences in population composition, scanning platforms, and staining batches may affect the model’s external generalizability; future studies will prioritize the inclusion of multicenter datasets to systematically evaluate the robustness and applicability of the model under diverse clinical conditions; (ii) the model has so far been assessed only in an offline environment, lacking prospective clinical validation within real-world workflows. Nonetheless, this model provides an important foundation for the early diagnosis of TICO, the formulation of personalized treatment strategies, and the advancement of pathological image analysis technologies.

Background Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery. Methods Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared. Results There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay. Conclusions Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.

To perform a systematic review and meta-analysis evaluating the diagnostic performance of computed tomography (CT) for small bowel obstruction (SBO), including diagnostic accuracy, ischemia, predicting surgical intervention, etiology and transition point. PubMed/MEDLINE and related databases were searched for research articles published from their inception through August 2018. Findings were pooled using bivariate random-effects and summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, patient age, enhanced CT, slice thickness and pathogenesis affected classification accuracy. In total, 45 studies with a total of 4004 patients were included in the analysis. The pooled sensitivity and specificity of CT for SBO were 91% (95% confidence interval [CI]: 84%, 95%) and 89% (95% CI: 81%, 94%), respectively, and there were no differences in the subgroup analyses of age, publication year, enhanced CT and slice thickness. For ischemia, the pooled sensitivity and specificity was 82% (95% CI: 67%, 91%) and 92% (95% CI: 86%, 95%), respectively. No difference was found between enhanced and unenhanced CT based on subgroup analysis; however, high sensitivity was found in adhesive SBO compared with routine causes (96% vs. 78%, P = 0.03). The pooled sensitivity and specificity for predicting surgical intervention were 87% and 73%, respectively. The accuracy for etiology of adhesions, hernia and tumor was 95%, 70% and 82%, respectively. In addition, the pooled sensitivity and specificity for transition point was 92% and 77%, respectively. CT has considerable accuracy in diagnosis of SBO, ischemia, predicting surgical intervention, etiology and transition point.

To develop and validate a nomogram model for discriminating simple intestinal obstruction and strangulated intestinal obstruction, thus providing objective evidence for clinical decision-making. Following pre-established inclusion and exclusion criteria, a retrospective analysis was conducted on the clinical data of 560 patients diagnosed with intestinal obstruction who were admitted to the Emergency Surgery Department of the First Affiliated Hospital of Anhui Medical University between January 1, 2020, and December 31, 2022. The data was subsequently split into a training cohort ( n  = 393) and a validation cohort ( n  = 167) using a 7:3 ratio. To identify independent risk and protective factors associated with strangulated intestinal obstruction, a multivariate logistic regression analysis was employed. Based on the identified factors, a nomogram prediction model was constructed. The model’s discriminatory ability was assessed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and the corrected C-index. The Hosmer-Lemeshow test was utilized to evaluate the model’s goodness of fit in both the training and validation cohorts. Calibration curves were generated to assess the model’s accuracy in predicting the probability of strangulated intestinal obstruction. Finally, decision curve analysis (DCA) was performed to evaluate the model’s potential clinical utility. Multivariate logistic regression analysis identified neutrophil percentage, peritoneal irritation sign, and abdominal fluid as independent risk factors for strangulated intestinal obstruction, while albumin emerged as an independent protective factor. These factors were incorporated into the nomogram, demonstrating high discrimination (AUC of 0.842[95%CI: 0.787–0.897] in the training set and 0.839 [95%CI: 0.742–0.937] in the validation set) and good calibration. The corrected C-index further supported the model’s performance in the training (0.833) and validation (0.813) cohorts. The Hosmer-Lemeshow test results ( p  = 0.759 and p  = 0.505, respectively) indicated a good model fit in both cohorts. Calibration curves confirmed the close agreement between the nomogram predictions and actual observations. Finally, DCA corroborated the model’s net clinical benefit. The comprehensive nomogram developed in this study emerged as a promising and convenient tool for evaluating the risk of strangulated intestinal obstruction, thereby aiding clinicians in screening the high-risk population.