Case Report
Rethinking Intra-operative Management of Crohn’s Disease: Intestinal Ultrasound Detects Microscopic Disease Unidentified at Ileal Margin Resection
Issue:
Volume 9, Issue 2, December 2025
Pages:
90-93
Received:
4 June 2025
Accepted:
18 June 2025
Published:
23 July 2025
Abstract: Crohn’s disease is a chronic and relapsing inflammatory condition that often requires surgical intervention. Post-operative recurrence of Crohn’s disease remains common after surgery occurring in up to 75% of patients. The role of disease-free surgical margins in post-operative recurrence has been debated, however, it has been identified as an independent risk factor for recurrence. We present a case of a woman with obstructive Crohn’s disease who underwent ileocecectomy and was maintained on uninterrupted infliximab therapy. Despite operative and pathology reports describing grossly normal surgical margins, three months post-operation the patient was experiencing new intermittent lower abdominal pain and intestinal ultrasound revealed active ileitis involving a 10cm segment immediately proximal to the ileocolonic anastomosis. Due to concern of incomplete resection, microscopic re-evaluation of the margins was conducted and confirmed histologically positive margins of active Crohn’s disease. Current guidelines have called for additional studies to examine the role of disease-free margins. Our case demonstrates the limitations of gross evaluation of disease-free margins and suggests a potential application of intestinal ultrasound intraoperatively for such assessment. While intestinal ultrasound has been utilized intraoperatively for colonic malignant margin identification, it has not yet been studied in inflammatory bowel disease and requires further evaluation.
Abstract: Crohn’s disease is a chronic and relapsing inflammatory condition that often requires surgical intervention. Post-operative recurrence of Crohn’s disease remains common after surgery occurring in up to 75% of patients. The role of disease-free surgical margins in post-operative recurrence has been debated, however, it has been identified as an inde...
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Research Article
Caregiver Burden and Work Productivity Loss in Caregivers of Young Patients with Inflammatory Bowel Disease
Issue:
Volume 9, Issue 2, December 2025
Pages:
94-102
Received:
8 July 2025
Accepted:
21 July 2025
Published:
11 August 2025
DOI:
10.11648/j.ijg.20250902.12
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Abstract: Background: Inflammatory bowel disease (IBD) is associated with frequent hospitalizations, significant disability and impairment of quality of life. This can affect the physical, mental and overall wellbeing of not just the patients, but also the people caring for them. The aim of this study was to estimate the prevalence of burden among caregivers of young IBD patients, assess their work productivity impairment and identify the factors affecting caregiver burden. Methods: Design: This was a cross-sectional study conducted over a 16 month period at a tertiary care centre in north Kerala. Participants: 78 caregivers corresponding to 78 consecutive young IBD patients (aged 10- 24 years) were included. Two sets of questionnaires, the Zarit Burden Interview and the Work Productivity and Activity Impairment questionnaires tailored to suit IBD were used to assess burden and work productivity losses respectively. The study was approved by the institutional ethical committee. Results: A total of 78 caregivers, corresponding to 78 young IBD patients (aged 10- 24 years) were included in the study. 61 patients had Crohn’s disease and 17 patients had ulcerative colitis. Of the total number of caregivers, 47 caregivers (60.3%) experienced clinically significant caregiver burden. The mean ZBI score was 21.74± 10.3. The mean percentage work time missed (absenteeism) was 22.39%, the mean percentage impairment while working (presenteeism) was 40.0% and the mean percentage overall work impairment (loss of productivity) was 48.62%. Disease activity at the time of diagnosis (p=0.008 for Crohn’s p=0.002 for ulcerative colitis), absenteeism, presenteeism, work productivity loss and percentage activity impairment were significantly associated with caregiver burden Conclusion: Caregivers of young IBD patients experience significant burden and work productivity loss and this needs urgent attention to improve overall patient management.
Abstract: Background: Inflammatory bowel disease (IBD) is associated with frequent hospitalizations, significant disability and impairment of quality of life. This can affect the physical, mental and overall wellbeing of not just the patients, but also the people caring for them. The aim of this study was to estimate the prevalence of burden among caregivers...
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Research Article
Enhanced Spontaneous Bacterial Peritonitis Management in Cirrhosis: Peritoneal Lavage with Targeted Antibiotic
Shi Heng
,
Peng Qin*
Issue:
Volume 9, Issue 2, December 2025
Pages:
103-110
Received:
9 July 2025
Accepted:
21 July 2025
Published:
12 August 2025
DOI:
10.11648/j.ijg.20250902.13
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Views:
Abstract: Spontaneous bacterial peritonitis (SBP) is a severe complication of decompensated cirrhosis, associated with high mortality and poor prognosis. This study aimed to evaluate the efficacy of a combined therapeutic approach-peritoneal catheter lavage, intraperitoneal antibiotic injection, and oral rifaximin-on top of standard intravenous antibiotics for SBP in cirrhotic patients. A total of 90 cirrhotic patients with SBP were randomly assigned to either the treatment group (n=45) or the control group (n=45). Both groups received basic care including hepatoprotective therapy, albumin supplementation, and electrolyte correction. The control group was treated with intravenous ceftriaxone (2 g/day for 14 days), while the treatment group was added peritoneal lavage (daily cycles of draining ascites, infusing warm saline, and injecting intraperitoneal ceftriaxone) plus oral rifaximin (200 mg three times daily) to the same intravenous regimen. Baseline characteristics, including demographic data, cirrhosis severity (Child-Pugh grade), and comorbidities, were comparable between the two groups (all P>0.05). After 14 days of treatment, the treatment group showed significantly greater improvements in clinical symptoms (fever, abdominal pain, tenderness) and laboratory markers: liver function parameters (ALT, AST, TBil) decreased more markedly, and inflammatory indicators (WBC, CRP, PCT) were reduced to a larger extent compared to the control group (all P<0.05). Notably, the ascitic fluid polymorphonuclear leukocyte count, a key marker of SBP resolution, dropped from 1200±350×106/L to 150±50×106/L in the treatment group, versus 1180±320×106/L to 450±120×106/L in the control group (P<0.001). The total effective rate was significantly higher in the treatment group (88.9%) than in the control group (62.3%, P<0.01). These findings suggest that combining peritoneal lavage, intraperitoneal antibiotics, and oral rifaximin with standard intravenous therapy enhances SBP control, improves liver function, and reduces systemic inflammation in cirrhotic patients, thereby offering a more effective strategy for managing this life-threatening complication.
Abstract: Spontaneous bacterial peritonitis (SBP) is a severe complication of decompensated cirrhosis, associated with high mortality and poor prognosis. This study aimed to evaluate the efficacy of a combined therapeutic approach-peritoneal catheter lavage, intraperitoneal antibiotic injection, and oral rifaximin-on top of standard intravenous antibiotics f...
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