Systemic sclerosis (SSc) is a rare systemic autoimmune rheumatic disease frequently associated with gastrointestinal (GI) involvement. GI manifestations are heterogeneous, may occur throughout the entire tract from the very early stages of the disease and are often associated with a significant burden of symptoms and complications, leading to high morbidity and mortality. Diagnosis often remains challenging due to the lack of sensitive instruments for early detection and the reliance on invasive or expensive diagnostic tools. In recent years, ultrasound (US) has become an increasingly important tool for GI evaluation across a wide range of conditions, including chronic inflammatory bowel diseases, appendicitis and diverticulitis as well as rarer diseases and functional conditions. The aim of this scoping review is to provide an updated overview of the role of gastrointestinal ultrasound (GIUS) in the assessment and monitoring of GI involvement in SSc. A systematic search of MEDLINE and Scopus identified 25 eligible studies. The available evidence is unevenly distributed across the GI tract: thirteen studies addressed the upper GI tract, seven the anorectum, six the gallbladder and five the mesenteric vessels. For each segment, we summarize how US can detect changes in wall structure, vascularization and motility. The evidence base is limited by small, predominantly single-center and cross-sectional studies, heterogeneous acquisition protocols and reference standards and a scarcity of reproducibility data. Further prospective and multicenter studies are therefore needed to validate the role of GIUS, standardize protocols and establish its integration into the clinical management of SSc patients.

While colonic diverticulosis affects approximately half of adults over 60 years of age in Western populations, jejunal diverticulosis are rare with a reported prevalence of 0.2%-1.9% associated with high mortality rate (up to 40%) when presented as complicated. Performing lifesaving surgery while respecting patient's autonomy and informed refusal of blood transfusion represents a challenge on its own for the medical team. We present a case of a 74-year-old Jehovah's Witness man who was diagnosed intraoperatively with perforated jejunal diverticulitis. Emergency laparotomy with segmental jejunal resection and primary anastomosis was performed. On the fifth postoperative day the patient developed post-operative haemorrhage secondary to laparotomy disruption with omental tearing, requiring urgent reoperation. Despite refusing allogenic blood transfusion, blood loss was successfully managed without transfusion. Post-operative anemia was treated with intravenous iron, vitamin B12, Folic acid, and supportive care which resulted in gradual improvement. The patient was discharged on post-operative Day 11. This case highlights that successful management of perforated jejunal diverticulitis and post-operative haemorrhage is feasible in Jehovah's Witness patient through prompt surgical intervention, meticulous haemostasis, and bloodless postoperative anaemia treatment. To our knowledge, this is the first reported case of perforated jejunal diverticulitis in a Jehovah's Witness patient.

Background: Morbidity associated with anastomotic leak (AL) can be reduced by timely detection. Local electrophysiological parameters are highly sensitive to pathophysiological processes (inflammation/ischemia) underlying AL and may enable early post-op monitoring ahead of clinical signs. A new approach to early leak detection includes post-operative measurement of bioelectric activity of the GI tract. The method has been implemented in a medical device that uses electrodes embedded in a standard surgical drain to continuously monitor local bowel myoelectric activity following GI surgery. Methods: A multicenter pilot study evaluated the performance of the device to support detection of clinically recognizable anastomotic leaks on post-operative day 3. The device's technology collected data that an algorithm classified to predict AL. Data were collected for a duration of 3-10 days, while the surgical drain was in place (without affecting routine care). Pilot endpoints were safety and performance analyses: sensitivity and specificity. Results: Fifty patients from 6 medical centers (mean age: 63.6 ± 13.3 years; 38% male) undergoing elective anterior resection (laparoscopic (N = 26), robotic (N = 16), open (N = 8)) for cancer (N = 44), diverticulitis (N = 4), and rectal prolapse (N = 2) were included. Average anastomotic height was 9 ± 5 cm from the anal verge. Grade C ALs were observed in 6.0% (N = 3) of the patients, resulting in increased hospitalization time (6.4 ± 2.4 days with no leak vs. 15.0 ± 7.9 days with Grade C leak). In this N = 50 cohort, the device had 100% sensitivity and 100% specificity at POD3 in prediction of Grade C leaks. Given the small number of events (three Grade C leaks, seven leaks overall), these results are preliminary. No device-related serious adverse events were observed, and the standard drain form factor contributed to positive usability feedback. Conclusions: Pilot data suggest that the bioelectric sensing drain device is safe and warrants further evaluation as a potential adjunct for AL detection. The small study sample size and wide confidence intervals for key outcomes require confirmation in a pivotal diagnostic accuracy study with a fixed thresholding algorithm.

Atraumatic splenic rupture is an extremely rare cause of deterioration in the context of concurrent abdominal pathology. This case report describes rapid deterioration and shock in a mid-50s-year-old man with acute complicated sigmoid diverticulitis 3 days into admission without history of abdominal trauma. This was associated with a rapid haemoglobin (Hb) drop from 119 to 37 g/L, which necessitated activation of the massive transfusion protocol. An atraumatic splenic rupture was subsequently diagnosed on urgent exploratory laparotomy. The patient underwent splenectomy followed by a Hartmann's procedure for treatment of perforated sigmoid diverticulitis. This case highlights the importance of maintaining a broad differential diagnosis and consideration of concurrent pathologies for deteriorating patients with common acute infectious abdominal pathologies, including appendicitis or diverticulitis, as missed diagnosis of atraumatic splenic rupture may be fatal due to profound haemorrhage.

Epiploic appendagitis is a rare and often overlooked cause of acute abdominal pain that can mimic more common surgical conditions such as acute appendicitis or diverticulitis. Most reported cases involve the sigmoid or descending colon, whereas epiploic appendagitis occurring near the vermiform appendix is extremely rare. We report the case of a 57-year-old woman who presented with acute right lower quadrant pain initially suspected to be acute appendicitis. Computed tomography revealed inflammation of the epiploic appendage adjacent to the base of the appendix, with mild reactive appendicitis. The patient underwent surgery successfully, which confirmed torsion and necrosis of the appendiceal epiploic appendage. Early and accurate diagnosis of this condition is crucial to guide appropriate management.

Anti-p200 pemphigoid is a rare autoimmune subepidermal blistering disease with limited evidence guiding its management. We report a 49-year-old woman with refractory anti-p200 pemphigoid who failed treatment with high-dose prednisone and dapsone and developed significant corticosteroid-related toxicity, including hypertension, hypertrichosis, steroid-induced myopathy, and psychological distress. Given her history of complicated diverticulitis requiring bowel resection, dupilumab was initiated as a steroid-sparing therapeutic option. Pruritus improved within two weeks, near-complete remission was achieved after two months, and sustained disease control was maintained for six months, allowing substantial corticosteroid tapering without treatment-related adverse events.

Laparoscopic surgery is increasingly used to treat colonic diverticulitis; however, its role in emergency, perforated, high-risk, and procedure-specific settings remains uncertain. This structured narrative review evaluated and synthesized comparative evidence by clinical setting, operative strategy, and patient risk profile to provide a clinical decision-making framework for identifying settings in which laparoscopy may offer meaningful benefits and those in which its role remains uncertain. In elective settings, randomized trials and observational studies generally demonstrated short-term advantages of laparoscopy, including reduced postoperative morbidity, less pain, faster recovery, and shorter hospitalization, although clear mid- or long-term superiority has not been established. In emergency, perforated, and high-risk settings, observational and nationwide database studies reported favorable short-term outcomes of laparoscopy; however, these findings were strongly influenced by patient selection, disease severity, and institutional expertise. Benefits were most consistent for resection-based procedures but were less clear for laparoscopic Hartmann procedures and inconsistent for lavage- or drainage-based strategies. Stoma creation rates tended to be lower after laparoscopy in selected cohorts, although this finding depended on disease severity and operative strategy. Evidence regarding intraoperative complications remains limited. Overall, laparoscopic surgery is associated with favorable short-term outcomes, with the most consistent evidence arising from elective diverticular surgery. In emergency surgery and perforated disease, however, the available evidence remains predominantly observational and susceptible to selection bias. These findings support a selective, context-dependent approach based on disease severity, patient condition, operative strategy, and institutional expertise, with careful surgical planning and timely conversion when necessary.