When Nature Strikes Back: Understanding Intestinal Perforations Caused by Vegetable and Animal Bodies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study conducted by Suárez-Gómez et al. offers valuable insights into the challenges of diagnosing and treating foreign body intestinal perforations in rural populations with limited healthcare resources. By presenting a series of cases, the authors highlight the diagnostic complexities, resource limitations, and socioeconomic factors that adversely impact patient outcomes. The research is commendable for its detailed patient characterizations and surgical outcomes, supported by illustrative photographs that enhance the study's relevance. However, there are several areas for improvement:

 

Introduction:

 

The study's objectives should be explicitly stated to provide a clearer context for the research.

 

Methods:

 

It is essential to detail the ethical approval process, particularly regarding patients’ consent for the publication of their data and surgical images.

 

Results:

 

Given that the study's primary focus is on describing five cases of perforation, it would be beneficial to include more photographs and imaging results to better illustrate the case series.

 

Conclusion:

 

The conclusions drawn are overly broad and not supported by the descriptive nature of the study. For instance, the authors should avoid attributing delayed medical presentation solely to geographical and socioeconomic barriers without an analytical assessment of these social determinants (the study is descriptive and not analytical). Additionally, the conclusion is overly lengthy and tends to discuss rather than conclude. I recommend reformulating the conclusion to focus on key takeaways and actionable lessons.

                                                       

Comments on the Quality of English Language

The manuscript's English requires significant revisions to correct numerous misspellings and clarify some ambiguous sentences.

Author Response

Comment 1: The study's objectives should be explicitly stated to provide a clearer context for the research.

Response: We modified the las paragraph of the introduction and added this "The objective of this study is to report and characterize patients presenting with foreign body intestinal perforation in the rural jungle region of Caquetá, Colombia. Sociodemographic factors, clinical signs and symptoms, surgical approaches, antibiotic coverage, and patient outcomes are detailed. One case involved a patient who voluntarily withdrew from the healthcare facility, resulting in delayed treatment and eventual mortality. Another patient did not present with leukocytosis in blood tests, complicating the diagnostic process."

Comment 2: It is essential to detail the ethical approval process, particularly regarding patients’ consent for the publication of their data and surgical images.

Response: We clarified and added this statement in the Materials and Methods section

"Ethical approval was waived due to the retrospective nature of the study, which relied on clinical record data. All patients provided signed consent for the use of their data. This study falls under the category of "research with no risk" as outlined by Resolution 8430 of 1993 in Colombian legislation. According to Article 11 of this regulation, such research involves the retrospective review of clinical records without intervention or modification of the participants' biological, physiological, psychological, or social variables and does not involve sensitive aspects of behaviour."

Comment 3: The conclusions drawn are overly broad and not supported by the descriptive nature of the study. For instance, the authors should avoid attributing delayed medical presentation solely to geographical and socioeconomic barriers without an analytical assessment of these social determinants (the study is descriptive and not analytical). Additionally, the conclusion is overly lengthy and tends to discuss rather than conclude. I recommend reformulating the conclusion to focus on key takeaways and actionable lessons.

Response: We shortened the conclusion and modified it to emphasise only on geographical and socio-economic barriers. 

Comment 4: The manuscript's English requires significant revisions to correct numerous misspellings and clarify some ambiguous sentences.

Response: We made the paper checked and corrected it overall to improve grammar and redaction

 

We would like to thank you for your time reading, correcting and giving feedback about this paper. 

 

 

Reviewer 2 Report

Comments and Suggestions for Authors

The authors present a series of patients who underwent surgery in various hospitals due to intestinal perforations caused by vegetable or animal foreign bodies. It is not clear the origin of the foreign bodies, nor the cause that provoked them to be eaten. Is it part of the diet of the local population?

Regarding grammar, I recommend a thorough review of the manuscript by a native speaker, as it has numerous typographical errors. Also, sentences should not begin with numbers written with numbers, but with letters (in the discussion this typo is seen repeatedly).

The images are adequate, and the table is of sufficient quality to describe the data of the case series presented.

The conclusions are too long. They should be more concise, so that the reader is left with few, but important, ideas. The rest of the sentences can be relocated to the Discussion.

Comments on the Quality of English Language

Regarding grammar, I recommend a thorough review of the manuscript by a native speaker, as it has numerous typographical errors. Also, sentences should not begin with numbers written with numbers, but with letters (in the discussion this typo is seen repeatedly).

Author Response

Comment 1: It is not clear the origin of the foreign bodies, nor the cause that provoked them to be eaten. Is it part of the diet of the local population

Response: We agree the origin of foreign body consumption in this context can use clarification so we added this phrase in the discussion "The rural landscape, characterised by adjacent rivers, makes the consumption of animals such as fish, chicken, and hen more common in the area. Additionally, the use of toothpicks and chewable straws, typical of rural life, is prevalent".

 

Comment 2: Regarding grammar, I recommend a thorough review of the manuscript by a native speaker, as it has numerous typographical errors. Also, sentences should not begin with numbers written with numbers, but with letters (in the discussion this typo is seen repeatedly). 

Response: We had the paper checked and corrected. Various modifications were made to improve overall grammar and redaction

 

Comment 3: The conclusions are too long. They should be more concise, so that the reader is left with few, but important, ideas. The rest of the sentences can be relocated to the Discussion.

Response: The conclusion was shortened and made more concise. 

Comment 4:The images are adequate, and the table is of sufficient quality to describe the data of the case series presented.

Response: We appreciate all kinds of comments. Negative comments are used as feedback to further improve the paper. Positive comments like this one reassure we made a good work and make our day. Thank you!

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the authors' efforts in addressing the concerns raised in the previous review. The revisions submitted as author responses provided a more coherent manuscript, and the quality has improved. I recommend accepting the manuscript for publication, provided minor typographical errors are corrected.

Thank you again for your revisions and contributions.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have responded satisfactorily to the reviewers' requests. In my view, the manuscript is ready for publication in the current version.