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Wei S, Zhang Y, Luo F, Duan K, Li M, Lv G. Tissue-engineered tracheal implants: Advancements, challenges, and clinical considerations. Bioeng Transl Med 2024; 9:e10671. [PMID: 39036086 PMCID: PMC11256149 DOI: 10.1002/btm2.10671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 07/23/2024] Open
Abstract
Restoration of extensive tracheal damage remains a significant challenge in respiratory medicine, particularly in instances stemming from conditions like infection, congenital anomalies, or stenosis. The trachea, an essential element of the lower respiratory tract, constitutes a fibrocartilaginous tube spanning approximately 10-12 cm in length. It is characterized by 18 ± 2 tracheal cartilages distributed anterolaterally with the dynamic trachealis muscle located posteriorly. While tracheotomy is a common approach for patients with short-length defects, situations requiring replacement arise when the extent of lesion exceeds 1/2 of the length in adults (or 1/3 in children). Tissue engineering (TE) holds promise in developing biocompatible airway grafts for addressing challenges in tracheal regeneration. Despite the potential, the extensive clinical application of tissue-engineered tracheal substitutes encounters obstacles, including insufficient revascularization, inadequate re-epithelialization, suboptimal mechanical properties, and insufficient durability. These limitations have led to limited success in implementing tissue-engineered tracheal implants in clinical settings. This review provides a comprehensive exploration of historical attempts and lessons learned in the field of tracheal TE, contextualizing the clinical prerequisites and vital criteria for effective tracheal grafts. The manufacturing approaches employed in TE, along with the clinical application of both tissue-engineered and non-tissue-engineered approaches for tracheal reconstruction, are discussed in detail. By offering a holistic view on TE substitutes and their implications for the clinical management of long-segment tracheal lesions, this review aims to contribute to the understanding and advancement of strategies in this critical area of respiratory medicine.
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Affiliation(s)
- Shixiong Wei
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
- Department of Thoracic SurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Yiyuan Zhang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
- Department of Thoracic SurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Feixiang Luo
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Kexing Duan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Mingqian Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Guoyue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery CenterThe First Hospital of Jilin UniversityChangchunChina
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Kozyk M, Usenko OY, Kessler SA, Shkarban VP, Tereshkevych IS, Babii IV, Sanzharov OM, Strubchevska K. Successful Endoscopic Treatment of a Pancreatic Pseudocyst in a Patient with Situs Inversus Totalis and Upper GI Duplication. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942006. [PMID: 38451882 PMCID: PMC10932831 DOI: 10.12659/ajcr.942006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/19/2024] [Accepted: 11/09/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Duplication of the gastrointestinal tract is a rare congenital malformation that can develop in any part of the digestive tract. These duplications may be asymptomatic into adult age. Situs inversus totalis is a rare congenital anomaly characterized by a mirror transposition of thoracic and abdominal organs. We present a case of a pancreatic pseudocyst in a patient with a combination of situs inversus totalis and doubling of the esophagus, stomach, and first part of the duodenum. CASE REPORT A 64-year-old woman presented with epigastric pain. Abdominal computed tomography revealed a pancreatic pseudocyst and a previously identified duplication of the esophagus, stomach, and duodenum with situs inversus totalis. The patient underwent esophagogastroduodenoscopy (EGD) with endoscopic ultrasonography for pseudocyst drainage. During EGD, a bifurcation of the esophagus was found. Duplication of the esophagus, stomach, and first part of the duodenum was evident on further advancement. A week later, there was repeated filling of the pseudocyst with a liquid component, and the patient underwent cystogastrostomy with stenting. Five months after discharge, the stent was removed without complications. CONCLUSIONS Duplication of the gastrointestinal tract and situs inversus totalis are very rare congenital malformations that require early diagnosis. While situs inversus totalis does not represent any medical disadvantage, physicians should be aware of abnormal anatomy before procedures to prepare specialists for this in case of the need for special techniques. Endoscopic treatment of pancreatic pseudocysts is safe and effective even in such rare cases. The use of endoscopic methods also minimizes intervention and decreases the length of the patients' stays in the hospital.
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Affiliation(s)
- Marko Kozyk
- Department of Internal Medicine, Corewell Health William Beaumont UniversityHospital, Royal Oak, MI, USA
| | - Olexandr Y. Usenko
- Department of Thoracoabdominal Surgery, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Steven A. Kessler
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Viktor P. Shkarban
- Department of Pancreatic Surgery, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Ivan S. Tereshkevych
- Department of Endoscopy, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Ivan V. Babii
- Department of Endoscopy, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Oleksandr M. Sanzharov
- Department of Endoscopy, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Kateryna Strubchevska
- Department of Internal Medicine, Corewell Health William Beaumont UniversityHospital, Royal Oak, MI, USA
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Shetty N, Mantri S, Agarwal S, Potdukhe A, Wanjari MB, Taksande AB, Yelne S. Unraveling the Challenges: A Critical Review of Congenital Malformations in Low Socioeconomic Strata of Developing Countries. Cureus 2023; 15:e41800. [PMID: 37575853 PMCID: PMC10422057 DOI: 10.7759/cureus.41800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Congenital malformations pose significant challenges in the low socioeconomic strata of developing countries. This review critically examines the prevalence, patterns, and factors influencing congenital malformations in these settings. It explores the physical, psychological, and economic consequences for affected individuals and their families and the social stigma and discrimination they face. The review highlights the importance of equity and access to healthcare services, the role of environmental factors and nutritional deficiencies, and the ethical considerations and policy implications associated with congenital malformations. Existing interventions, challenges in implementation, and innovative approaches are discussed. Gaps in knowledge and areas for further research are identified. Addressing congenital malformations in low socioeconomic strata requires multidisciplinary collaboration, advocacy, and inclusive policies. By prioritizing preventive measures, early detection, and comprehensive care, the burden of congenital malformations can be reduced, improving the quality of life for affected individuals and their communities.
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Affiliation(s)
- Nidhi Shetty
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saket Mantri
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sristy Agarwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashwini Potdukhe
- Medical Surgical Nursing, Srimati Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Xu H, Liu W, Liu C, Zhai Y, Zhao H, Guo R, Lv L, Zhang S. Case report: Ileocecal preservation for multiple small intestinal duplications. Front Pediatr 2023; 11:1205155. [PMID: 37342532 PMCID: PMC10277474 DOI: 10.3389/fped.2023.1205155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Small-intestinal duplication is a rare congenital developmental anomaly that is mainly single; multiple small-intestinal duplications are rare. Most malformations are located in the ileocecal region. The primary surgical treatment is complete resection of the malformations and adjacent intestinal ducts. However, the ileocecal junction plays an important role in children, and it is difficult to preserve it; multiple intestinal repairs increase the risk of postoperative intestinal fistula, which is a challenge for pediatric surgeons. Herein, we report a case of ileocecal preservation surgery for the treatment of multiple small intestinal duplication malformations near the ileocecal area. The child underwent laparoscopically assisted cyst excision and multiple intestinal repairs and had good postoperative recovery and follow-up.
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Affiliation(s)
- Hongxiu Xu
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Weiqiang Liu
- Department of Pediatric Surgery, Zhucheng Maternal and Child Health Hospital, Weifang, China
| | - Chunqing Liu
- Zhucheng Longcheng Hospital of Traditional Chinese Medicine, Weifang, China
| | - Yunpeng Zhai
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Huashan Zhao
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Rui Guo
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Longfei Lv
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Shisong Zhang
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
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Shanmugalingam A, Duxbury H, Choi JDW, Kwik C, P'Ng CH, Kim L, Pathma-Nathan N. An unusual case of colonic duplication cyst in an adult with dysplasia. J Surg Case Rep 2023; 2023:rjad039. [PMID: 36824693 PMCID: PMC9943052 DOI: 10.1093/jscr/rjad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Duplication cysts are rare benign congenital malformations typically identified in children by the age of 2 years. We report a rare case of colonic duplication cyst with dysplasia in an adult. A 32-year-old male was diagnosed with non-specific abdominal symptoms. Abdominopelvic computed tomography scan demonstrated a submucosal cystic lesion in the right colon. He underwent laparoscopic right hemicolectomy. Histopathology showed colonic duplication cyst with low grade dysplasia. He is due for a surveillance colonoscopy in 3 years. Duplication cyst in an adult colon with dysplasia is extremely rare. They are usually present in the terminal ileum. They have non-specific abdominal symptoms or can be asymptomatic. They are often identified incidentally or intraoperatively. Imaging may demonstrate a cystic lesion. Histopathology is required for definitive diagnosis. There are no guidelines or consensus on managing duplication cysts in adults. We recommend an oncological resection of the involved colon. Surveillance with routine colonoscopy is advisable.
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Affiliation(s)
- Aswin Shanmugalingam
- Department of Colorectal Surgery, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Hayley Duxbury
- Department of Tissue Pathology and Diagnostic Oncology, ICPMR, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Joseph Do Woong Choi
- Department of Colorectal Surgery, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Charlotte Kwik
- Department of Colorectal Surgery, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Chow Heok P'Ng
- Department of Tissue Pathology and Diagnostic Oncology, ICPMR, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Lauren Kim
- Department of Tissue Pathology and Diagnostic Oncology, ICPMR, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
| | - Nimalan Pathma-Nathan
- Department of Colorectal Surgery, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia
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Ludwig K, Santoro L, Ingravallo G, Cazzato G, Giacometti C, Dall’Igna P. Congenital anomalies of the gastrointestinal tract: the liver, extrahepatic biliary tree and pancreas. Pathologica 2022; 114:55-63. [PMID: 35212316 PMCID: PMC9040543 DOI: 10.32074/1591-951x-709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 02/08/2023] Open
Abstract
Congenital anomalies of the liver, biliary tree and pancreas are rare birth defects, some of which are characterized by a marked variation in geographical incidence. Morphogenesis of the hepatobiliary and pancreatic structures initiates from two tubular endodermal evaginations of the most distal portion of the foregut. The pancreas develops from a larger dorsal and a smaller ventral outpouching; emergence of the two buds will eventually lead to the fusion of the duct system. A small part of the remaining ventral diverticulum divides into a "pars cystica" and "pars hepatica", giving rise to the cystic duct and gallbladder and the liver lobes, respectively. Disruption or malfunctioning of the complex mechanisms leading to the development of liver, gallbladder, biliary tree and pancreas can result in numerous, albeit fortunately relatively rare, congenital anomalies in these organs. The type and severity of anomalies often depend on the exact moment in which disruption or alteration of the embryological mechanisms takes place. Many theories have been brought forward to explain their embryological basis; however, no agreement has yet been reached for most of them. While in some cases pathological evaluation might be more centered on macroscopic evaluation, in other instances small biopsies will be the keystone to understanding organ function and treatment results in the context of congenital anomalies. Thus, knowledge of the existence and histopathological characteristics of some of the more common conditions is mandatory for every pathologist working in the field of gastrointestinal pathology.
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Affiliation(s)
- Kathrin Ludwig
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Luisa Santoro
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Giuseppe Ingravallo
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Cinzia Giacometti
- Department if Services, Pathology Unit, ULSS 6 “Euganea”, Camposampiero, Italy
| | - Patrizia Dall’Igna
- Department of Emergencies and Organ Transplantation, Pediatric Surgery, University of Bari, Bari, Italy
- Correspondence Patrizia Dall’Igna Department of Emergencies and Organ Transplantation, Azienda Ospedaliero-Universitaria Consorziale, Ospedale Pediatrico Giovanni XXIII, via Giovanni Amendola 207, 70126 Bari, Italy E-mail:
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