Background. The distribution of postoperative orthopedic infection and their susceptibility pattern to antibiotics vary regionally and change over time. The incidence of methicillin-resistant Staphylococcus aureus infection is rising worldwide. Therefore, knowledge of the frequency of the causative microorganisms and their susceptibility to antibiotics are necessary for an improved therapeutic outcome. This study aims to study the frequency and distribution of postoperative orthopedic infection and their resistance pattern to antibiotics. Methods. The study utilized a retrospective design that took place over a period of 5 years from 2016 and 2020 at a tertiary care hospital. The bacterial culture testing was performed by a recommended method. Descriptive statistics were used to analyze the data. Results. A total of 158 patients (100 males and 58 females) with positive cultures of postoperative orthopedic infection were included. The most common infective organism was Staphylococcus aureus, 64 patients (38.1); coagulase-negative staphylococci, 40 patients (23.8); Klebsiella species, 14 patients (8.3); and Enterococcus species, Escherichia coli, and Pseudomonas aeruginosa in 10 patients (6). Data also showed that gram-positive bacteria were detected in 118 patients (70.8), while gram-negative microorganisms were found in 50 patients (29.8). Among Staphylococcus aureus, 79.7 were MRSA, and vancomycin was the most effective antibiotic in staphylococcus infections. The antibiotics with the greatest sensitivity to gram-positive bacteria were vancomycin, linezolid, tigecycline, moxifloxacin, and nitrofurantoin, while the antibiotics for gram-negative bacteria with greater sensitivity were tigecycline, amikacin, ertapenem, imipenem, and cefotaxime. Conclusion. Staphylococcus aureus is the most common postoperative orthopedic infection, which was predominantly MRSA with vancomycin being the most effective antibiotic. In addition, the results showed a high resistance pattern to the commonly used antibiotics, leaving few choices. Antibiotic agents should be carefully selected according to specific drug sensitivity through routine monitoring of drug resistance patterns and to help formulate hospital antibiotic policy.

Biliary amputation neuroma is rare and difficult to diagnose preoperatively due to diversity of clinical presentation and a lack of awareness among healthcare providers. We present a case of biliary neuroma arising from a recent laparoscopic cholecystectomy, complicated by bile leak and recurrent cholangitis. An extensive review of the literature was performed, closely examining related etiology, trends in age, clinical symptomology, and time to presentation. The role of surgery compared to an endoscopic approach in diagnosis has been reviewed. Physicians are urged to remain mindful of malignant biliary strictures as they may easily mimic and misguide the diagnosis of a traumatic biliary neuroma.

Introduction: The prevalence of opioid use and its impact on healthcare outcomes among patients with Rome IV functional dyspepsia (FD) has not been reported in real‐world clinical practice in the United Kingdom (UK). The primary aim of this study was to study the prevalence of opioid intake among outpatients diagnosed with Rome IV FD. Secondary aims were to determine (A) the differences in phenotype and healthcare resource utilization between patients who consumed opioids versus non‐users, and (B) whether a combination of opioid cessation and a neuromodulator prescription could improve gastrointestinal (GI) symptoms.Methodology: Data were collected from consecutive patients diagnosed with FD according to the Rome IV clinical criteria in a single tertiary care neurogastroenterology outpatient clinic in the UK between January 2016 and December 2021. Patients who consumed opioids were provided with opioid cessation advice and prescribed a neuromodulator (the intervention).Results: One hundred and fifty‐six patients were diagnosed with FD and 48 (31%) were taking opioids. In a multivariate logistic regression model (OR, [95% CI]), older age (1.03 [1.004–1.059], p = 0.03), depression and/or anxiety (4.2 [1.4–12.5], p = 0.01), and chronic pain (4.0 [1.8–8.9], p < 0.001) were independently associated with opioid consumption at baseline. At least 44% of patients adhered to opioid cessation advice and, among these persons, 29% reported symptom improvement in response to a neuromodulator. The intervention had a number needed to treat of 5.7 to achieve an improvement in clinical symptoms.Conclusion: Opioid intake in FD is independently associated with older age, depression and/or anxiety, and chronic pain. Encouraging opioid cessation may be an important strategy in the management of FD.

Background: Esophageal perforation (EP) is a rare but life-threatening condition with an incidence of approximately 3.1 per million annually. While iatrogenic injury during endoscopy is the leading cause, other etiologies include spontaneous rupture, trauma, and malignancy. EP can present with nonspecific symptoms, most commonly chest pain or dysphagia, and diagnostic delays are associated with worse outcomes. Multiple non-operative strategies exist, including primary closure, stenting (bypass), combination therapy, and conservative management. However, data guiding the optimal approach remain limited. The aim of this study was to evaluate outcomes of different non-operative management strategies for EP and identify predictors of successful repair. Methods: We retrospectively analyzed adult patients with EP across three Mayo Clinic sites between 2007 and 2023. Patients were categorized into four groups based on treatment modality. Demographics, clinical features, imaging, endoscopic intervention, and outcomes were recorded. The primary outcome was clinical success, defined as avoidance of surgical intervention. Logistic regression was used to identify predictors of success. Results: A total of 72 patients were included (mean age 63.7 years, 65.3% male). The most common cause was iatrogenic injury (58.3%), and the distal esophagus was the most frequent site (67.6%). Non-operative success was 100% in the primary closure and combination groups, and 42.9% in the conservative group (p < 0.001). On multivariate analysis, non-conservative therapy significantly predicted success (aOR 22.4, 95% CI [1.2–407.4], p = 0.036). Conclusion: Primary closure and combination endoscopic approaches offer superior outcomes in managing EP. Early intervention with appropriate modality selection is critical to avoid surgical escalation and improve prognosis. Graphical