Globally, at the time of writing (20 March 2021), 121.759.109 confirmed COVID-19 cases have been reported to the WHO, including 2.690.731 deaths. Globally, on 18 March 2021, a total of 364.184.603 vaccine doses have been administered. In Italy, 3.306.711 confirmed COVID-19 cases with 103.855 deaths have been reported to WHO. In Italy, on 9 March 2021, a total of 6.634.450 vaccine doses have been administered. On 15 March 2021, Italian Medicines Agency (AIFA) decided to temporarily suspend the use of the AstraZeneca COVID-19 vaccine throughout the country as a precaution, pending the rulings of the European Medicines Agency (EMA). This decision was taken in line with similar measures adopted by other European countries due to the death of vaccinated people. On 18 March 2021, EMA’s safety committee concluded its preliminary review about thromboembolic events in people vaccinated with COVID-19 Vaccine AstraZeneca at its extraordinary meeting, confirming the benefits of the vaccine continue to outweigh the risk of side effects, however, the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e., low levels of blood platelets with or without bleeding, including rare cases of cerebral venous thrombosis (CVT). We report the case of a 54-year-old woman who developed disseminated intravascular coagulation (DIC) with multi-district thrombosis 12 days after the AstraZeneca COVID-19 vaccine administration. A brain computed tomography (CT) scan showed multiple subacute intra-axial hemorrhages in atypical locations, including the right frontal and the temporal lobes. A plain old balloon angioplasty (POBA) of the right coronary artery was performed, without stent implantation, with restoration of distal flow, but with persistence of extensive thrombosis of the vessel. A successive thorax angio-CT added the findings of multiple contrast filling defects with multi-vessel involvement: at the level of the left upper lobe segmental branches, of left interlobar artery, of the right middle lobe segmental branches and of the right interlobar artery. A brain magnetic resonance imaging (MRI) in the same day showed the presence of an acute basilar thrombosis associated with the superior sagittal sinus thrombosis. An abdomen angio-CT showed filling defects at the level of left portal branch and at the level of right suprahepatic vein. Bilaterally, it was adrenal hemorrhage and blood in the pelvis. An evaluation of coagulation factors did not show genetic alterations so as the nasopharyngeal swab ruled out a COVID-19 infection. The patient died after 5 days of hospitalization in intensive care.

The use of endorectal stapling devices can lead to focal weakness at the point of surgical suture on the rectal wall and predispose to the development of rectal diverticula.

Introduction: Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). This study aimed to analyze the accuracy of ultrasound (US) in diagnosing and staging SBO. Objectives: The main object of this study was to analyze the accuracy of ultrasound in diagnosing and staging SBO compared to CT. Methods: Retrospectively, stable patients with an ultrasonographic diagnosis of SBO who underwent abdominal CT immediately after US and before receiving naso-intestinal decompression, were included. US criteria for the diagnosis of SBO were related to morphological and functional findings. US diagnosis of obstruction was made if fluid-filled dilated small bowel loops were detected, peristalsis was abnormal and parietal abnormalities were present. Morphologic and functional sonographic findings were assigned to three categories: simple SBO, compensated SBO and decompensated SBO. US findings were compared with the results of CT examinations: Morphologic CT findings (divided into loop, vascular, mesenteric and peritoneal signs) allowed the classification of SBO in simple, decompensated and complicated. Results: US diagnostic accuracy rates in relation to CT results were calculated: ultrasound compared to CT imaging, had a sensitivity of 92.31% (95% CI, 74.87% to 99.05%) and a specificity of 94.12% (95% CI, 71.31% to 99.85%) in the diagnosis of SBO. Conclusions: This study, similarly to the existing literature, suggests that ultrasound is highly accurate in the diagnosis of SBO, and that the most valuable sonographic signs are the presence of dilated bowel loops ad abnormal peristalsis.

Ultrasound (US) is highly accurate in the diagnosis of small bowel obstruction (SBO). Because the indications for and timing of surgical intervention for SBO have changed over the past several decades, there is a widespread assumption that the majority of patients with simple SBO may be conservatively managed; in this scenario, staging SBO is crucial. This study evaluated the association between morphological and functional US signs in the diagnosis and staging (simple, decompensated and complicated), and the associations and prevalence of US signs correlated with clinical or surgical outcome. The US signs were divided into diagnostic (dilated bowel loops and altered kinesis) and staging criteria (extraluminal free fluid, parietal and villi alterations). We performed a retrospective, single-center cohort, observational study examining the prevalence of morphologic and functional US signs in the staging of simple, decompensated and complicated SBO. The most significant US signs were dilated bowel loops (100%), hypokinesis (90.46%), thickened walls (82.54%) and free fluid (74.60%). By linear regression, free fluid was positively correlated to US staging in both univariate and multivariate analysis; that is, the more advanced the stage of SBO, the more probable the presence of free fluid between the bowel loops. In univariate analysis only, we found a positive correlation between US staging/thickened walls and the prominence of valvulae conniventes. Additionally, the multivariate analysis indicated that parietal stratification and bowel jump kinesis were negative predictors for US staging in comparison to other US signs. In addition, we found significant associations between conservative treatment or surgery and hypokinesis (p = 0.0326), akinesis (p = 0.0326), free fluid (p = 0.0013) and prominence of valvulae conniventes (p = 0.011). Free fluid in particular was significantly less present in patients that were conservatively treated (p = 0.040). We conclude that the US staging of SBO may be crucial, with a valuable role in the initial diagnosis and staging of the pathology, saving time and reducing total radiation exposure to the patient.

MR-D shows lower sensitivity than ECCD in the detection of MPH development. The less-invasive MR-D may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery.