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Sample records for adhesive small bowel

  1. Laparoscopic Management of Adhesive Small Bowel Obstruction

    PubMed Central

    Konjic, Ferid; Idrizovic, Enes; Hasukic, Ismar; Jahic, Alen

    2016-01-01

    Introduction: Adhesions are the reason for bowel obstruction in 80% of the cases. In well selected patients the adhesive ileus laparoscopic treatment has multiple advantages which include the shorter hospitalization period, earlier food taking, and less postoperative morbidity rate. Case report: Here we have a patient in the age of 35 hospitalized at the clinic due to occlusive symptoms. Two years before an opened appendectomy had been performed on him. He underwent the treatment of exploration laparoscopy and laparoscopic adhesiolysis. Dilated small bowel loops connected with the anterior abdominal wall in the ileocecal region by adhesions were found intraoperatively and then resected harmonically with scalpel. One strangulation around which a small bowel loop was wrapped around was found and dissected. Postoperative course was normal. PMID:27041815

  2. Small-bowel enema in the diagnosis of adhesive obstructions.

    PubMed

    Caroline, D F; Herlinger, H; Laufer, I; Kressel, H Y; Levine, M S

    1984-06-01

    The small-bowel enema was evaluated in 60 patients in whom a final diagnosis of adhesive obstruction was made by surgery or on the basis of clinical findings. Distinctive radiographic and clinical features were found with single versus multiple bands. While 72% of 32 single-band obstructions were graded as severe, this grading was given to only 34% of 18 obstructions by multiple bands. Extensive adhesions were demonstrated in 10 patients and presented varied radiographic features. The radiographic diagnosis of adhesive obstruction was found to be correct in 36 (87.8%) of 41 patients in whom a surgical diagnosis could subsequently be made. However, an incorrect radiologic diagnosis of obstruction by metastases was made in five patients. They form the basis for a discussion of the differential diagnosis. PMID:6609596

  3. Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention

    PubMed Central

    Catena, Fausto; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; De Simone, Belinda; Sartelli, Massimo; Van Goor, Harry

    2016-01-01

    Intra-abdominal adhesions following abdominal surgery represent a major unsolved problem. They are the first cause of small bowel obstruction. Diagnosis is based on clinical evaluation, water-soluble contrast follow-through and computed tomography scan. For patients presenting no signs of strangulation, peritonitis or severe intestinal impairment there is good evidence to support non-operative management. Open surgery is the preferred method for the surgical treatment of adhesive small bowel obstruction, in case of suspected strangulation or after failed conservative management, but laparoscopy is gaining widespread acceptance especially in selected group of patients. "Good" surgical technique and anti-adhesive barriers are the main current concepts of adhesion prevention. We discuss current knowledge in modern diagnosis and evolving strategies for management and prevention that are leading to stratified care for patients. PMID:27022449

  4. [Post-operative bowel obstruction. Part 2: Mechanical post-operative small bowel obstruction by bands and adhesions].

    PubMed

    Duron, J J

    2003-12-01

    Small Bowel obstruction due to post-operative adhesions is a common problem in a general surgical practice. Any laparotomy initiates the lifelong risk of this complication. Mortality rates have improved dramatically in the last three decades. The basic evaluation and treatment of small bowel obstruction is well defined but many individual strategies may result from the variety of clinical presentations and from techniques and equipment available to a local surgical practice. Recent advances in surgical techniques and preventive strategies may improve overall results. Results will remain linked to the continuous aging of the populations of Western countries. PMID:14978440

  5. Manual Physical Therapy for Non-Surgical Treatment of Adhesion-Related Small Bowel Obstructions: Two Case Reports

    PubMed Central

    Rice, Amanda D.; King, Richard; Reed, Evette D’Avy; Patterson, Kimberley; Wurn, Belinda F.; Wurn, Lawrence J.

    2013-01-01

    Background: Adhesion formation is a widely acknowledged risk following abdominal or pelvic surgery. Adhesions in the abdomen or pelvis can cause or contribute to partial or total small bowel obstruction (SBO). These adhesions deter or prevent the passage of nutrients through the digestive tract, and may bind the bowel to the peritoneum, or other organs. Small bowel obstructions can quickly become life-threatening, requiring immediate surgery to resect the bowel, or lyse any adhesions the surgeon can safely access. Bowel repair is an invasive surgery, with risks including bowel rupture, infection, and peritonitis. An additional risk includes the formation of new adhesions during the healing process, creating the potential for subsequent adhesiolysis or SBO surgeries. Objective: Report the use of manual soft tissue physical therapy for the reversal of adhesion-related partial SBOs, and create an initial inquiry into the possibility of nonsurgical lysis of adhesions. Case Reports: Two patients presenting with SBO symptoms due to abdominal adhesions secondary to abdominal and pelvic surgery were treated with manual soft tissue physical therapy focused on decreasing adhesions. Conclusions: Successful treatment with resolution of symptom presentation of partial SBO and sustained results were observed in both patients treated. PMID:26237678

  6. [Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery].

    PubMed

    Timofeev, M E; Breusenko, V G; Shapoval'iants, S G; Fedorov, E D; Larichev, S E; Kretsu, V N

    2015-01-01

    It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient. PMID:26031952

  7. Small bowel radiology

    SciTech Connect

    Antes, G.; Eggemann, F.

    1987-01-01

    This book deals mainly with technique, experiences and results of the biphasic small bowel enema (enteroclysis) with barium and methyl cellulose. The method allows the evaluation of both morphology and function of the small bowel. The introduction describes the examination technique, basic patterns, interpretation and indications, while the atlas shows a broad spectrum of small bowel diseases (Crohn's disease, other inflammatory diseases, tumors, motility disorders, obstructions and malformations). The possibilities of small bowel radiology are demonstrated with reference to clinical findings and differential diagnoses.

  8. Small bowel resection

    MedlinePlus

    Small intestine surgery; Bowel resection - small intestine; Resection of part of the small intestine; Enterectomy ... her hand inside your belly to feel the intestine or remove the diseased segment. Your belly is ...

  9. Small bowel bacterial overgrowth

    MedlinePlus

    ... Surgical procedures that create a loop of small intestine where excess bacteria can grow. An example is a Billroth II type of stomach removal ( gastrectomy ). Some cases of irritable bowel syndrome (IBS) Symptoms The most common symptoms are: Abdominal ...

  10. [Small-Bowel Cancer].

    PubMed

    Kagaya, Yuka; Sakamoto, Hirotsugu; Yamamoto, Hironori

    2016-05-01

    Diagnosis of small-bowel cancer has become easier thanks to the development of both balloon-assisted endoscopy and capsule endoscopy. Balloon-assisted endoscopy allows not only for observation of the deep intestine but also for biopsies and for establishing a histological diagnosis. Although endoscopic diagnosis is reported to improve the prognosis of small-bowel cancer by early detection, it is still difficult and the prognosis in general is poor. Surgery and chemotherapy protocols for this disease are similar to those for colon cancer. At present, the response rate to chemotherapy for small-bowel cancer is low. There is an urgent need in this patient population to establish a new diagnostic and therapeutic algorithm using balloon-assisted endoscopy and capsule endoscopy. PMID:27210079

  11. Benign small bowel tumor.

    PubMed Central

    Wilson, J M; Melvin, D B; Gray, G; Thorbjarnarson, B

    1975-01-01

    The clinical record and histologic sections of 84 cases of benign small bowel tumor are reviewed. Manifestations of systemic diseases, congenital anomalies, and lesions of either the ileocecal valve or periampullary region were excluded. In the same time span there were 96 small bowel malignancies. Clinical presentation, pathologic findings, management and result are compared to the collected published experience of about 2000 cases. There were 36 leiomyomas, 22 lipomas, 9 angiomas, 6 neurofibromas and 4 fibromas. Thirty-six men and 48 women were affected; the majority in their fifth and sixth decade. Seventy-eight were operative and 6 autopsy diagnoses. The most common symptom was obstruction (42%) followed by hemorrhage (34%) and pain (22%), relative frequency differing for the various specific tumors. There were rarely significant physical findings. A diagnosis of small bowel tumor was made radiologically in 30 patients. Because of the nonspecificity of other signs and symptoms, an acute awareness of the possibility of small bowel tumor is mandatory for preoperative anticipation of the diagnosis. Local resection was performed in all with no deaths or significant postoperative complications. PMID:1078626

  12. Large bowel obstruction secondary to adhesive bands.

    PubMed

    El-Masry, Nabil S; Geevarghese, Ruben

    2015-01-01

    Large bowel obstruction (LBO) is most commonly due to malignancy, volvulus, hernia, diverticular disease and inflammatory bowel disease. LBO due to adhesions is unusual. A literature review was conducted which revealed that only a few such cases have been reported. We report two cases of LBO secondary to adhesions in patients, one with and one without a past abdominal surgical history. We highlight that while rare, the aetiology of LBO secondary to adhesions must be considered in the differential diagnosis in patients presenting with obstructive symptoms. PMID:25650387

  13. Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital

    PubMed Central

    Haule, Caspar; Ongom, Peter A; Kimuli, Timothy

    2013-01-01

    Introduction The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin®) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. Methods An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital’s emergency and general surgical wards were included. Randomisation was to Gastrografin® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. Results All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance (P = 0.67). Average time to relief of obstruction was shorter in the Gastrografin® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference (P = 0.023). The average length of hospital stay was shorter in the Gastrografin® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference (P = 0.04). Conclusion The use of Gastrografin® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and

  14. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

    PubMed Central

    2011-01-01

    Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and

  15. Adhesion molecules in inflammatory bowel disease.

    PubMed Central

    Jones, S C; Banks, R E; Haidar, A; Gearing, A J; Hemingway, I K; Ibbotson, S H; Dixon, M F; Axon, A T

    1995-01-01

    The ability of leucocytes to adhere to endothelium is essential for leucocyte migration into inflammatory sites. Some of these adhesion molecules are released from the cell surface and can be detected in serum. The soluble adhesion molecules intercellular adhesion molecule 1 (ICAM-1), E selectin, and vascular cell adhesion molecule 1 (VCAM-1) were studied in the serum of patients with Crohn's disease, ulcerative colitis, and healthy controls. A second blood sample was taken from patients with active disease after one month of treatment and a third two months after remission was achieved. Tissue expression of the same adhesion molecules was studied by immunohistology. Circulating VCAM-1 concentrations were significantly higher in patients with active ulcerative colitis (n = 11, median = 165 U/ml) compared with patients with inactive ulcerative colitis (n = 10, median = 117 U/ml, p < 0.005), active Crohn's disease (n = 12, median = 124 U/ml, p < 0.02), and controls (n = 90, median = 50 U/ml, p < 0.0001). Within each disease group there were no significant differences in E selectin or ICAM-1 concentrations between the active and inactive states, however, patients with active Crohn's disease had significantly higher ICAM-1 concentrations (n = 12, median = 273 ng/ml) than controls (n = 28, median = 168, p < 0.003). VCAM-1 concentrations fell significantly from pretreatment values to remission in active ulcerative colitis (p < 0.01). In Crohn's disease there was a significant fall in ICAM-1 both during treatment (p < 0.01) and two months after remission (p < 0.02). Vascular expression of ICAM-1 occurred more often and was more intense in inflamed tissue sections from patients with ulcerative colitis and Crohn's disease than from controls. Vascular labelling with antibody to E selectin also occurred more often in patients with active inflammatory bowel disease. In conclusion, increased circulating concentrations of selected adhesion molecules are associated with

  16. An Unusual Case of Small Bowel Volvulus

    PubMed Central

    Manjunath, Srinidhi; Balasubramanya, Kanakapura Srinivasamurthy; Nanjaiah, Basavaraju

    2015-01-01

    Small bowel volvulus is a rare and life threatening surgical emergency. Nearly 75% of volvulus occurs in colon and 25% occurs in small bowel. Small bowel volvulus is abnormal twisting of bowel loops around the axis of its own mesentry leading to twisting and occlusion of mesenteric vessels causing intestinal obstruction, venous engorgement, gangrene and perforation. Small bowel volvulus is more common in neonates and young adults and very rare in adults. We are reporting a first case of small bowel volvulus and gangrene caused by herniation of ovarian cyst through mesenteric defect and twisting of small bowel around the axis of ovarian cyst leading to closed loop obstruction, small bowel volvulus and gangrene. Outcome of the disease is mainly based on the early diagnosis and intervention. Mortality is about 5.8 - 8% in nongangrenous SBV which increases drastically to 20 – 100% in gangrenous bowel. PMID:26676224

  17. Neoplasms of the Small Bowel

    PubMed Central

    Silberman, Howard; Crichlow, Robert W.; Caplan, Howard S.

    1974-01-01

    Small bowel tumors are unusual lesions exhibiting nonspecific clinical features often diagnosed at an advanced stage. In the cases studied at the Hospital of the University of Pennsylvania nearly all the 32 patients with malignancies were symptomatic whereas in the 34 patients with benign lesions the condition was discovered as an incidental finding in about half of the patients. Weight loss, palpable mass or anemia usually indicated malignancy. Small bowel radiography was the most useful diagnostic aid in the present series. While the etiology of these lesions is unknown, villous adenomas probably bear a relationship to carcinoma. The association between chronic regional enteritis and small bowel tumors is unestablished but suggestive. An analysis of reported series reveals a disproportionate incidence of additional primary tumors in patients with small bowel neoplasms. Surgical extirpation is indicated for curative treatment. In the present series, resection in hope of cure was carried out in 25 of 32 malignant tumors resulting in eight five-year survivals. One of these latter lived nine years with disseminated malignant carcinoid reflecting the occasional indolent course of this tumor. PMID:4842978

  18. Small Bowel Imaging: an Update.

    PubMed

    Rimola, Jordi; Panés, Julián

    2016-07-01

    Bowel imaging had experienced relevant technical advances during the last decade. The developments in the field of cross-sectional imaging had a particular impact on the assessment of Crohn's disease. The purpose of this manuscript is to provide a review of the main progress of cross-sectional imaging in the assessment of Crohn's disease and other small bowel diseases with relevance in clinical practice and in research. Also, we outline the technical advances, trends, and potential contributions of new technological cross-sectional imaging improvements that may have potential impact and contribution in the near future. PMID:27315216

  19. Small bowel resection

    MedlinePlus

    ... cause inflammation include regional ileitis , regional enteritis , and Crohn disease . Cancer Carcinoid tumor Injuries to the small intestine ... you have a chronic condition, such as cancer, Crohn disease or ulcerative colitis, you may need ongoing medical ...

  20. Small bowel bacterial overgrowth

    MedlinePlus

    Overgrowth - intestinal bacteria; Bacterial overgrowth - intestine ... Unlike the large intestine, the small intestine does not have a high number of bacteria. When there are too many bacteria in the ...

  1. Perforation from endoscopic small bowel biopsy.

    PubMed Central

    Scott, B; Holmes, G

    1993-01-01

    Two patients, having undergone an apparently straightforward endoscopy with small bowel biopsy, developed a perforation. One, who proved to have normal small bowel mucosa, needed laparotomy and suturing of the duodenal perforation. The other, who had coeliac disease, settled with conservative management. PMID:8432444

  2. Laparoscopic Surgery is Useful for Preventing Recurrence of Small Bowel Obstruction After Surgery for Postoperative Small Bowel Obstruction

    PubMed Central

    Nakamura, Takatoshi; Sato, Takeo; Naito, Masanori; Ogura, Naoto; Yamanashi, Takahiro; Miura, Hirohisa; Tsutsui, Atsuko; Yamashita, Keishi

    2016-01-01

    Introduction: Risk factors for recurrence postoperative small bowel obstruction in patients who have postoperative abdominal surgery remain unclear. Materials and Methods: The study group comprised 123 patients who underwent surgery for ileus that developed after abdominal surgery from 1999 through 2013. There were 58 men (47%) and 65 women (53%), with a mean age of 63 years (range, 17 to 92 y). The following surgical procedures were performed: lower gastrointestinal surgery in 47 patients (39%), gynecologic surgery in 39 (32%), upper gastrointestinal surgery in 15 (12%), appendectomy in 9 (7%), cholecystectomy in 5 (4%), urologic surgery in 5 (4%), and repair of injuries caused by traffic accidents in 3 (2%). Laparoscopic surgery was performed in 75 patients (61%), and open surgery was done in 48 (39%). We examined the following 11 potential risk factors for recurrence of small bowel obstruction after surgery for ileus: sex, age, body mass index, the number of episodes of ileus, the number of previously performed operations, the presence or absence of radiotherapy, the previously used surgical technique, the current surgical technique (laparoscopic surgery, open surgery), operation time, bleeding volume, and the presence or absence of enterectomy. Results: The median follow-up was 57 months (range, 7 to 185 mo). Laparoscopic surgery was switched to open surgery in 11 patients (18%). The reason for surgery for postoperative small bowel obstruction was adhesion to the midline incision in 36 patients (29%), band formation in 30 (24%), intrapelvic adhesion in 23 (19%), internal hernia in 13 (11%), small bowel adhesion in 20 (16%), and others in 1 (1%). Postoperative complications developed in 35 patients (28%): wound infection in 12 (10%), recurrence of postoperative small bowel obstruction in 12 (10%), paralytic ileus in 4 (3%), intra-abdominal abscess in 3 (2%), suture failure in 1 (1%), anastomotic bleeding in 1 (1%), enteritis in 1 (1%), and dysuria in 1 (1

  3. Small bowel obstruction caused by dried apple

    PubMed Central

    Ooi, Sally; Hong, Khiem

    2015-01-01

    Introduction Small bowel obstruction in a virgin abdomen is an uncommon surgical condition. While malignancy, inflammatory bowel disease and foreign body are the main reported causes, undigested food bezoar causing bowel obstruction is a rare entity. We report a case of small bowel obstruction secondary to dried preserved apple having re-expanded within the gastrointestinal tract. Presentation of case A 69 year old male presented with severe abdominal distension, generalized abdominal tenderness and obstipation for 1 week. Small bowel obstruction (SBO) was confirmed on plain abdominal X-ray and CT imaging. An emergency explorative laparatomy identified a sausage-shaped intra-luminal foreign body obstructing the distal ileum. An enterotomy was performed which revealed a rehydrated, donut-shaped piece of dried apple. Discussion Swallowed items that pass through the pylorus rarely cause obstruction as they are usually small enough to pass through the rest of the bowel without difficulty. We postulate that in our patient that the dried apple was originally small enough to pass through the pylorus. However during small bowel, its’ highly absorbable nature resulted in an increase in size that prevented its’ passage through the ileocecal valve. A simple in-vitro experiment discovered that dried apple has a potential to reabsorb fluid and expand up to 35% of its initial size within 72 h. Conclusion This report illustrates the potential for dried food substances to cause intra-luminal SBO after significant expansion with rehydration. PMID:25841159

  4. Bellyboard device reduces small bowel displacement

    SciTech Connect

    Bertelrud, K.; Mehta, M.; Shanahan, T.; Utrie, P.; Gehring, M. )

    1991-03-01

    The ability to cure several pelvic malignancies is hampered by the inability to deliver doses greater than 45 to 50 Gy, beyond which radiation enteritis becomes dose-limiting. The design and fabrication of a device that allows exclusion of small bowel from the pelvis during radiation therapy are described in this study. A prospective dose-volume analysis conducted on 30 patients reveals a 66 percent reduction in the volume of small bowel within the radiation portals.

  5. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

    PubMed Central

    2013-01-01

    Background In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not decrease recurrence rates or recurrences needing surgery. Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band

  6. Diagnosing small bowel malabsorption: a review.

    PubMed

    Papadia, Cinzia; Di Sabatino, Antonio; Corazza, Gino Roberto; Forbes, Alastair

    2014-02-01

    Malabsorption encompasses dysfunctions occurring during the digestion and absorption of nutrients. A small proportion of patients presents with chronic diarrhoea. A clinical history supportive of malabsorption may guide investigations toward either the small bowel or pancreas. Serological testing for coeliac disease will determine most cases without invasive investigations. In the clinical context of persisting weight loss and malnutrition, small bowel enteropathy may be investigated with small intestinal biopsies. Small bowel absorptive capacity and permeability might be measured by oral sugar-mix ingestion. Further, approaches to the investigation of malabsorption might also involve the detection in faeces of a substance that has not been absorbed. A variation of the latter is the use of breath testing which relies on the breakdown of the malabsorbed test substance by colonic flora. Measurement of protein absorption is difficult and unreliable; it is, therefore, rarely advocated in clinical settings. No single biological marker confirming a diagnosis of small bowel malabsorption or small bowel integrity is presently available in clinical practice. Plasma citrulline concentration, an amino acid not incorporated into endogenous or exogenous proteins, has been extensively used in research studies and supportive results are establishing its concentration as a reliable quantitative biomarker of enterocyte absorptive capacity. PMID:23179329

  7. Current Role of Ultrasound in Small Bowel Imaging.

    PubMed

    Wale, Anita; Pilcher, James

    2016-08-01

    Bowel ultrasound is cheap, relatively quick, allows dynamic evaluation of the bowel, has no radiation burden, is well tolerated by patients, and allows repeat imaging. Bowel ultrasound requires a systematic assessment of the entire bowel using high-frequency probes. In addition, hydrosonography and contrast-enhanced ultrasound may be performed. We present the normal sonographic appearances of large and small bowel and the sonographic appearances of acute appendicitis, Crohn's disease, celiac disease, intussusception, infectious enteritis, intestinal tuberculosis, small bowel ileus and obstruction, small bowel ischemia, and malignant tumors. PMID:27342894

  8. Changes of smooth muscle contractile filaments in small bowel atresia

    PubMed Central

    Gfroerer, Stefan; Fiegel, Henning; Ramachandran, Priya; Rolle, Udo; Metzger, Roman

    2012-01-01

    AIM: To investigate morphological changes of intestinal smooth muscle contractile fibres in small bowel atresia patients. METHODS: Resected small bowel specimens from small bowel atresia patients (n = 12) were divided into three sections (proximal, atretic and distal). Standard histology hematoxylin-eosin staining and enzyme immunohistochemistry was performed to visualize smooth muscle contractile markers α-smooth muscle actin (SMA) and desmin using conventional paraffin sections of the proximal and distal bowel. Small bowel from age-matched patients (n = 2) undergoing Meckel’s diverticulum resection served as controls. RESULTS: The smooth muscle coat in the proximal bowel of small bowel atresia patients was thickened compared with control tissue, but the distal bowel was unchanged. Expression of smooth muscle contractile fibres SMA and desmin within the proximal bowel was slightly reduced compared with the distal bowel and control tissue. There were no major differences in the architecture of the smooth muscle within the proximal bowel and the distal bowel. The proximal and distal bowel in small bowel atresia patients revealed only minimal differences regarding smooth muscle morphology and the presence of smooth muscle contractile filament markers. CONCLUSION: Changes in smooth muscle contractile filaments do not appear to play a major role in postoperative motility disorders in small bowel atresia. PMID:22791945

  9. Acute abdomen due to small bowel anisakiasis.

    PubMed

    Pellegrini, M; Occhini, R; Tordini, G; Vindigni, C; Russo, S; Marzocca, G

    2005-01-01

    The popularity in Western countries of dishes based on raw fish has led to an increased incidence of anisakiasis, a human parasitic disease caused by the ingestion of live anisakid larvae. The entire digestive tract may be involved, but the stomach and the small intestine are the most frequently affected sites. We report a case of acute abdomen due to Anisakis simplex infection that caused small bowel obstruction. PMID:15702863

  10. Small Bowel Imaging in Managing Crohn's Disease Patients

    PubMed Central

    Albert, Jörg G.

    2012-01-01

    The small bowel is essential to sustain alimentation and small bowel Crohn's disease (CD) may severely limit its function. Small bowel imaging is a crucial element in diagnosing small bowel CD, and treatment control with imaging is increasingly used to optimize the patients outcome. Thereby, capsule endoscopy, Balloon-assisted enteroscopy, and Magnetic resonance imaging have become key players to manage CD patients. In this review, role of small bowel imaging is detailed discussed for use in diagnosing and managing Crohn's disease patients. PMID:22474438

  11. Small Bowel Perforations: What the Radiologist Needs to Know.

    PubMed

    Lo Re, Giuseppe; Mantia, Francesca La; Picone, Dario; Salerno, Sergio; Vernuccio, Federica; Midiri, Massimo

    2016-02-01

    The incidence of small bowel perforation is low but can develop from a variety of causes including Crohn disease, ischemic or bacterial enteritis, diverticulitis, bowel obstruction, volvulus, intussusception, trauma, and ingested foreign bodies. In contrast to gastroduodenal perforation, the amount of extraluminal air in small bowel perforation is small or absent in most cases. This article will illustrate the main aspects of small bowel perforation, focusing on anatomical reasons of radiological findings and in the evaluation of the site of perforation using plain film, ultrasound, and multidetector computed tomography equipments. In particular, the authors highlight the anatomic key notes and the different direct and indirect imaging signs of small bowel perforation. PMID:26827735

  12. Postoperative small bowel obstruction in infants and children.

    PubMed Central

    Festen, C

    1982-01-01

    In the Pediatric Surgical Department of The St Radboud Hospital, Nijmegen, The Netherlands, between January 1970 and December 1980, 1476 laparotomies were performed on neonates, infants, and children. In 33 of these patient the abdominal surgery was complicated by a postoperative small bowel obstruction (SBO), for which a second laparotomy had to be performed. In 80% of patients this SBO developed within three months of the prior operation. The risk of developing an adhesive SBO was greater when there was more than one prior peritoneal procedure, and when, during this prior procedure, there was already a peritonitis. There was no obvious relation with the nature of the original operation. In more than 70% of patients a single adhesion caused the obstruction, while in many of these cases there were already circulatory disturbances, even by early reintervention. The mortality was 6%. PMID:7125744

  13. Collagen dynamics of partial small bowel obstruction

    SciTech Connect

    Stromberg, B.V.; Klein, L.

    1984-08-01

    The response of intestinal collagen to obstruction and stress was studied in the rat. Partial small bowel obstructions were created. Preobstruction collagen was measured by injection of tritium labeled proline. New collagen formation after obstruction occurred was followed by injection of carbon-14 labeled proline. At 3 weeks, collagen fractions were identified. Throughout the study, preexisting preobstruction intestinal collagen was metabolically stable with no breakdown or remodeling demonstrable. New collagen formation was rapid and occurred to the largest degree close to the obstruction.

  14. Phytobezoar: A Rare Cause of Small Bowel Obstruction

    PubMed Central

    Pujar K., Anupama; Pai A., Sreekar; Hiremath V., Bharati

    2013-01-01

    Phytobezoar is an unusual cause of small bowel obstruction. It accounts for about 0.4%-4% of all mechanical bowel obstruction. However, the symptoms are not very different from those caused by usual aetiologies of small bowel obstruction. The commonest site of obstruction is terminal ileum. Treatment of small bowel obstruction due to Phytobezoar is surgery. Prevention includes avoidance of high fibre diet, prokinetics particularly in patients who have undergone gastric surgery. A 57-year-old male presented with symptoms and signs of small bowel obstruction. On exploratory laparotomy Phytobezoar in the ileum was found to be the cause of obstruction. Diagnosis was confirmed by histopathology. PMID:24298509

  15. Small Bowel Obstruction Due to Suprapubic Catheter Placement.

    PubMed

    Bonasso, Patrick C; Lucke-Wold, Brandon; Khan, Uzer

    2016-07-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection. PMID:27335801

  16. Small bowel bleeding: a comprehensive review

    PubMed Central

    Gunjan, Deepak; Sharma, Vishal; Bhasin, Deepak K

    2014-01-01

    The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician. PMID:24874805

  17. Treating Small Bowel Obstruction with a Manual Physical Therapy: A Prospective Efficacy Study

    PubMed Central

    Rice, Amanda D.; Patterson, Kimberley; Reed, Evette D.; Wurn, Belinda F.; Klingenberg, Bernhard; King, C. Richard; Wurn, Lawrence J.

    2016-01-01

    Small bowel obstructions (SBOs) caused by adhesions are a common, often life-threatening postsurgical complication with few treatment options available for patients. This study examines the efficacy of a manual physical therapy treatment regimen on the pain and quality of life of subjects with a history of bowel obstructions due to adhesions in a prospective, controlled survey based study. Changes in six domains of quality of life were measured via ratings reported before and after treatment using the validated Small Bowel Obstruction Questionnaire (SBO-Q). Improvements in the domains for pain (p = 0.0087), overall quality of life (p = 0.0016), and pain severity (p = 0.0006) were significant when average scores before treatment were compared with scores after treatment. The gastrointestinal symptoms (p = 0.0258) domain was marginally significant. There was no statistically significant improvement identified in the diet or medication domains in the SBO-Q for this population. Significant improvements in range of motion in the trunk (p ≤ 0.001), often limited by adhesions, were also observed for all measures. This study demonstrates in a small number of subjects that this manual physical therapy protocol is an effective treatment option for patients with adhesive small bowel obstructions as measured by subject reported symptoms and quality of life. PMID:26989690

  18. Dietitians and small bowel feeding tube placement.

    PubMed

    Marsland, Cheryl

    2010-06-01

    Some advanced practice nutrition support dietitians have added small bowel feeding tube placement to their scope of responsibility. This is due, in part, to the challenges of gaining early enteral access in patients with functioning GI tracts. Emerging literature supports the practice of skilled practitioners placing feeding tubes at bedside. A variety of methods can be used to place tubes at the bedside. The nutrition support dietitian must understand licensure and liability considerations to perform this invasive procedure. This article will review literature reports of dietitians placing feeding tubes and provide information on the methods used, training and competencies required, and legal issues involved. PMID:20581321

  19. Optimal Diagnostic Approaches for Patients with Suspected Small Bowel Disease

    PubMed Central

    Kim, Jae Hyun; Moon, Won

    2016-01-01

    While the domain of gastrointestinal endoscopy has made great strides over the last several decades, endoscopic assessment of the small bowel continues to be challenging. Recently, with the development of new technology including video capsule endoscopy, device-assisted enteroscopy, and computed tomography/magnetic resonance enterography, a more thorough investigation of the small bowel is possible. In this article, we review the systematic approach for patients with suspected small bowel disease based on these advanced endoscopic and imaging systems. PMID:27334413

  20. Where are we at with short bowel syndrome and small bowel transplant

    PubMed Central

    Yildiz, Baris Dogu

    2012-01-01

    Intestinal failure can be defined as the critical reduction of functional gut mass below the minimal amount necessary for adequate digestion and absorption to satisfy body nutrient and fluid requirements in adults or children. Short bowel syndrome (SBS) is characterized by a state of malabsorption following extensive resection of the small bowel. SBS may occur after resection of more than 50% and is certain after resection of more than 70% of the small intestine, or if less than 100 cm of small bowel is left. Several treatment modalities other than total parenteral nutrition, including hormones (recombinant human growth hormone, glucagon-like peptide-2) and tailoring surgeries (Bianchi procedure, serial transverse enteroplasty), had been proposed, however these were either experimental or inefficient. Small bowel transplant is a rather new approach for SBS. The once feared field of solid organ transplantation is nowadays becoming more and more popular, even in developing countries. This is partially secondary to the developments in immunosuppressive strategy. In this regard, alemtuzumab deserves special attention. There are more complex surgeries, such as multivisceral transplantation, for multi-organ involvement including small bowel. This latter technique is relatively new when compared to small bowel transplant, and is performed in certain centers worldwide. In this review, an attempt is made to give an insight into small bowel syndrome, small bowel transplantation, and related issues. PMID:24175201

  1. Primary neoplasms of the small bowel.

    PubMed

    Serour, F; Dona, G; Birkenfeld, S; Balassiano, M; Krispin, M

    1992-01-01

    Primary neoplasms of the small bowel are unusual and constitute 1-5% of all gastrointestinal tract neoplasms. Preoperative diagnostic difficulties, frequent dissemination at the time of the diagnosis, and poor prognosis are characteristic of this pathology. During a period of 26 years we treated 61 patients with tumors of the small bowel, 44 malignant and 18 benign (1 patient had both). The most common symptoms were abdominal pain (62%), weight loss (41%), and gastro-intestinal bleeding (31%). More than half of the patients were treated as emergencies and among the remaining, the most useful diagnostic test was the small intestinal barium study. Seventeen patients were operated on for intestinal obstruction, 6 of them due to intussusception of the tumor, while 8 other patients presented with perforation and 7 with massive gastrointestinal bleeding. Leiomyoma was the most frequent benign lesion. Among malignancies lymphoma was encountered in 38.6%, followed by adenocarcinoma (29.6%) and leiomyosarcoma (22.8%). Lymphoma was predominant among Sephardic Jews. Curative procedures were attempted in all but one of the benign cases and in 21 of the malignant cases. At the time of surgery metastases were present in 23 patients. The postoperative mortality was high (20% and 14% in the benign and malignant groups, respectively) most probably due to the high incidence of emergency surgery in a high risk population. The prognosis of the malignant tumors was poor with a 5-year survival of 18%. Their disappointing course seems to be related to late diagnosis because of nonspecific symptoms and difficulty in bringing the tumor to the fore. Hopefully, a greater awareness will lead to an earlier diagnosis and improve the prognosis. PMID:1548877

  2. The Usefulness of Capsule Endoscopy for Small Bowel Tumors.

    PubMed

    Cheung, Dae Young; Kim, Jin Su; Shim, Ki-Nam; Choi, Myung-Gyu

    2016-01-01

    Video capsule endoscopy (VCE) has expanded the range of endoscopic examination of the small bowel. The clinical application of VCE is mainly for obscure gastrointestinal bleeding (OGIB) and small bowel tumor is one of the clinically significant diagnoses of VCE, often requiring subsequent invasive interventions. Small bowel tumors are detected with a frequency of around 4% with VCE in indications of OGIB, iron deficiency anemia, unexplained abdominal pain, and others. Protruding mass with bleeding, mucosal disruption, irregular surface, discolored area, and white villi are suggested as the VCE findings of small bowel tumor. Device assisted enteroscopy (DAE), computed tomography enteroclysis/enterography and magnetic resonance enteroclysis/enterography also have clinical value in small bowel examination and tumor detection, and they can be used with VCE, sequentially or complementarily. Familial adenomatous polyposis, Peutz-Jeghers syndrome, melanoma, lymphoma, and neuroendocrine tumor with hepatic metastasis are the high risk groups for small bowel tumors, and surveillance programs for small bowel tumors are needed. VCE and radiological imaging have value in screening, and in selected cases, DAE can provide more accurate diagnosis and endoscopic treatment. This review describes the usefulness and clinical impact of VCE on small bowel tumors. PMID:26855919

  3. The Usefulness of Capsule Endoscopy for Small Bowel Tumors

    PubMed Central

    Cheung, Dae Young; Kim, Jin Su; Shim, Ki-Nam; Choi, Myung-Gyu

    2016-01-01

    Video capsule endoscopy (VCE) has expanded the range of endoscopic examination of the small bowel. The clinical application of VCE is mainly for obscure gastrointestinal bleeding (OGIB) and small bowel tumor is one of the clinically significant diagnoses of VCE, often requiring subsequent invasive interventions. Small bowel tumors are detected with a frequency of around 4% with VCE in indications of OGIB, iron deficiency anemia, unexplained abdominal pain, and others. Protruding mass with bleeding, mucosal disruption, irregular surface, discolored area, and white villi are suggested as the VCE findings of small bowel tumor. Device assisted enteroscopy (DAE), computed tomography enteroclysis/enterography and magnetic resonance enteroclysis/enterography also have clinical value in small bowel examination and tumor detection, and they can be used with VCE, sequentially or complementarily. Familial adenomatous polyposis, Peutz-Jeghers syndrome, melanoma, lymphoma, and neuroendocrine tumor with hepatic metastasis are the high risk groups for small bowel tumors, and surveillance programs for small bowel tumors are needed. VCE and radiological imaging have value in screening, and in selected cases, DAE can provide more accurate diagnosis and endoscopic treatment. This review describes the usefulness and clinical impact of VCE on small bowel tumors. PMID:26855919

  4. Acute appendicitis presenting as small bowel obstruction: two case reports

    PubMed Central

    2009-01-01

    Acute appendicitis is a common surgical problem however the diagnosis is often overlooked when it presents as a small bowel obstruction. In this report we present two cases of elderly patients who presented with small bowel obstruction and raised inflammatory markers. Both patients were successfully treated with a laparotomy, adhesiolysis and appendicectomy and went on to make a good recovery. PMID:20062683

  5. Obscure Overt Gastrointestinal Bleeding Due To Isolated Small Bowel Angiomatosis

    PubMed Central

    Martinez, Melissa; Chiorean, Michael V.; Cote, Gregory A.

    2016-01-01

    Isolated small bowel angiomatosis is a rare entity with a distinctive endoscopic appearance. A multidisciplinary approach is often required to diagnose and treat these complex lesions. We present 2 cases of isolated small bowel angiomatosis, and illustrate the endoscopic findings that may guide similar diagnoses. PMID:27144197

  6. Small bowel wall thickening: MDCT evaluation in the emergency room.

    PubMed

    Akcalar, Seray; Turkbey, Baris; Karcaaltincaba, Musturay; Akpinar, Erhan; Akhan, Okan

    2011-10-01

    Small bowel wall thickening detected on computed tomography is a frequent finding in patients referring to emergency room with acute abdominal pain. In this pictorial review, we aim to discuss patterns of small bowel wall thickening and to explain hints for differential diagnosis with imaging findings. PMID:21681404

  7. Primary malignant small bowel tumors: an atypical abdominal emergency.

    PubMed Central

    Mitchell, K. J.; Williams, E. S.; Leffall, L. D.

    1995-01-01

    Primary malignant tumors of the small bowel are uncommon in the United States. They comprise less than 1% of all gastrointestinal malignancies, with an incidence of 2200 cases per year. The clinical presentation of small bowel tumors is frequently insidious and often overlooked by physicians. The low incidence and lack of pathognomonic symptoms are the reasons that the early diagnosis of malignant small bowel tumor is uncommon. To better understand the clinical presentation, diagnostic evaluation, management, and outcome, a review of Howard University patients with primary malignant small bowel tumors between 1970 and 1990 was conducted. Our experience concurs with the reported literature and supports the conclusion that a high index of suspicion is necessary. The diagnosis of a malignant small bowel tumor should be considered in patients with vague chronic abdominal complaints. Images Figure 1 Figure 2 PMID:7752280

  8. Factors Associated With Small Bowel Obstruction Following Appendectomy

    PubMed Central

    Tseng, Chien-Jen; Sun, Ding-Ping; Lee, I-Chen; Weng, Shih-Feng; Chou, Chia-Lin

    2016-01-01

    Abstract Postoperative small bowel obstruction (SBO) is a common complication of appendectomy. This study aimed to assess risk factors for SBO following appendectomy. This retrospective cohort study used the 2006 to 2008 Taiwan National Health Insurance Research Database. We evaluated adult patients with acute appendicitis who underwent open (OA) or laparoscopic appendectomy (LA) between January 1, 2006 and December 31, 2008. Excluded were patients with a history of abdominal surgery and SBO before the index operation, or abdominal surgery between the appendectomy and initial diagnosis of bowel obstruction as an identifiable cause of SBO. Factors thought to influence postoperative SBO were highlighted. The OA and LA cohorts were matched by propensity score, and the hazard ratios (HRs) and 95% confidence interval (CIs) of SBO were calculated. We enrolled 11,289 patients who underwent OA, and 11,289 matched controls who underwent LA. OA patients had significant risk of adhesive SBO compared with the LA group (adjusted HR: 1.7, 95% CI: 1.11–2.63). Further analysis revealed that that female sex (adjusted HR: 1.79, 95% CI: 1.17–2.72), CCI score of 1 or ≥2 (adjusted HR: 3.16, 95% CI: 1.76–5.67; adjusted HR: 4.03, 95% CI: 1.57–10.34), complicated appendicitis (adjusted HR: 1.68, 95% CI: 1.05–2.69), treatment in district hospitals increased risk of adhesive SBO. Female sex, complicated appendicitis, more comorbidities, and treatment in district hospitals are factors associated with a risk of SBO after appendectomy. Our findings confirmed that a laparoscopic approach is better than an open approach. PMID:27149462

  9. Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction

    PubMed Central

    Harvin, Glenn; Graham, Adam

    2016-01-01

    Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction. PMID:27403104

  10. Jejunitis and brown bowel syndrome with multifocal carcinogenesis of the small bowel

    PubMed Central

    Raithel, Martin; Rau, Tilman T; Hagel, Alexander F; Albrecht, Heinz; de Rossi, Thomas; Kirchner, Thomas; Hahn, Eckhart G

    2015-01-01

    This is the first report describing a case where prolonged, severe malabsorption from brown bowel syndrome progressed to multifocally spread small bowel adenocarcinoma. This case involves a female patient who was initially diagnosed with chronic jejunitis associated with primary diffuse lymphangiectasia at the age of 26 years. The course of the disease was clinically, endoscopically, and histologically followed for 21 years until her death at the age 47 due to multifocal, metastasizing adenocarcinoma of the small bowel. Multiple lipofuscin deposits (so-called brown bowel syndrome) and severe jejunitis were observed microscopically, and sections of the small bowel showed dense lymphoplasmacytic infiltration of the lamina propria as well as blocked lymphatic vessels. After several decades, multifocal nests of adenocarcinoma cells and extensive, flat, neoplastic mucosal proliferations were found only in the small bowel, along with a loss of the mismatch repair protein MLH1 as a long-term consequence of chronic jejunitis with malabsorption. No evidence was found for hereditary nonpolyposis colon carcinoma syndrome. This article demonstrates for the first time multifocal carcinogenesis in the small bowel in a malabsorption syndrome in an enteritis-dysplasia-carcinoma sequence. PMID:26420973

  11. Jejunitis and brown bowel syndrome with multifocal carcinogenesis of the small bowel.

    PubMed

    Raithel, Martin; Rau, Tilman T; Hagel, Alexander F; Albrecht, Heinz; de Rossi, Thomas; Kirchner, Thomas; Hahn, Eckhart G

    2015-09-28

    This is the first report describing a case where prolonged, severe malabsorption from brown bowel syndrome progressed to multifocally spread small bowel adenocarcinoma. This case involves a female patient who was initially diagnosed with chronic jejunitis associated with primary diffuse lymphangiectasia at the age of 26 years. The course of the disease was clinically, endoscopically, and histologically followed for 21 years until her death at the age 47 due to multifocal, metastasizing adenocarcinoma of the small bowel. Multiple lipofuscin deposits (so-called brown bowel syndrome) and severe jejunitis were observed microscopically, and sections of the small bowel showed dense lymphoplasmacytic infiltration of the lamina propria as well as blocked lymphatic vessels. After several decades, multifocal nests of adenocarcinoma cells and extensive, flat, neoplastic mucosal proliferations were found only in the small bowel, along with a loss of the mismatch repair protein MLH1 as a long-term consequence of chronic jejunitis with malabsorption. No evidence was found for hereditary nonpolyposis colon carcinoma syndrome. This article demonstrates for the first time multifocal carcinogenesis in the small bowel in a malabsorption syndrome in an enteritis-dysplasia-carcinoma sequence. PMID:26420973

  12. The role of small bowel endoscopy in small bowel Crohn's disease: when and how?

    PubMed

    Kim, Mikang; Jang, Hyun Joo

    2016-07-01

    Endoscopy has a crucial role in the diagnosis, management, and surveillance of inflammatory bowel disease (IBD). It contributes in supporting the diagnosis of IBD with the clinical history, physical examination, laboratory findings, and targeted biopsies. Furthermore, endoscopy has a significant role in assessing disease activity and distribution in treatment efficacy evaluation, post-surgical recurrence risk, and cancer surveillance in patients with long-lasting illness. Endoscopy also provides therapeutic potential for the treatment of IBD, especially with stricture dilatation and treatment of bleeding. Small bowel (SB) endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become important diagnostic options to diagnose and treat patients with SB Crohn's disease. We reviewed the present role of SB endoscopy in patients with SB Crohn's disease. PMID:27433142

  13. The role of small bowel endoscopy in small bowel Crohn's disease: when and how?

    PubMed Central

    Kim, Mikang

    2016-01-01

    Endoscopy has a crucial role in the diagnosis, management, and surveillance of inflammatory bowel disease (IBD). It contributes in supporting the diagnosis of IBD with the clinical history, physical examination, laboratory findings, and targeted biopsies. Furthermore, endoscopy has a significant role in assessing disease activity and distribution in treatment efficacy evaluation, post-surgical recurrence risk, and cancer surveillance in patients with long-lasting illness. Endoscopy also provides therapeutic potential for the treatment of IBD, especially with stricture dilatation and treatment of bleeding. Small bowel (SB) endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become important diagnostic options to diagnose and treat patients with SB Crohn's disease. We reviewed the present role of SB endoscopy in patients with SB Crohn's disease. PMID:27433142

  14. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    PubMed

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  15. Computed Tomography Angiography of the Small Bowel and Mesentery.

    PubMed

    Raman, Siva P; Fishman, Elliot K

    2016-01-01

    Multidetector computed tomography (MDCT) has largely supplanted other available radiologic modalities in the evaluation of a wide variety of different vascular and inflammatory abnormalities of the small bowel, with computed tomography angiography (CTA) playing a major role in the diagnostic efficacy of MDCT for these diseases. Improvements in CTA imaging have proved particularly valuable in the evaluation of small bowel vascular and inflammatory disorders, diagnoses in which arterial phase images might be able to offer greater information than standard venous phase imaging. This article details the MDCT imaging findings of several small bowel vascular and inflammatory disorders. PMID:26654393

  16. Primary small bowel melanomas: fact or myth?

    PubMed Central

    Hadjittofi, Christopher; Athanasopoulos, Panagiotis G.; Shah, Rahul; Ala, Aftab A.

    2016-01-01

    Small bowel melanoma (SBM) is a rare entity, which often evades diagnosis and therefore presents late. Its origin, whether arising primarily or metastatically from an unidentified or regressed primary cutaneous melanoma, remains debatable. In this report, we present a rare case of primary SBM and review the current literature. A 60-year-old man presented with melena and microcytic anemia. A series of investigations including abdominal ultrasonography (US), esophago-gastro-duodenoscopy (EGD) and colonoscopy were normal. Abdominal computed tomography revealed no specific pathology. Subsequent capsule endoscopy identified a jejunal mass, which was confirmed on laparotomy, was resected, and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. This report discusses gastrointestinal (GI) malignant melanoma, and examines the evidence both for and against the existence of true primary vs. metastatic disease. Furthermore, this case highlights the capabilities of capsule endoscopy in identifying an extremely rare GI tumor, which evaded other diagnostic modalities. Finally, the origins and pathophysiology of this rare cancer are evaluated, with the aim of promoting early diagnosis and treatment, and therefore improving current poor outcomes. PMID:27127766

  17. Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding

    PubMed Central

    Akin, Fatma Ebru; Yurekli, Oyku Tayfur; Demirezer Bolat, Aylin; Tahtacı, Mustafa; Koseoglu, Huseyin; Selvi, Eyup; Buyukasik, Naciye Semnur; Ersoy, Osman

    2016-01-01

    Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas. PMID:27092029

  18. Exploring the Small Bowel: Update on Deep Enteroscopy.

    PubMed

    Riff, Brian P; DiMaio, Christopher J

    2016-06-01

    Deep enteroscopy allows for the diagnosis and treatment of small bowel disorders that historically required operative intervention. There are a variety of endoscopic platforms using balloons and rotational overtubes to facilitate small bowel intubation and even allow for total enteroscopy. Obscure gastrointestinal bleeding is the most common indication for deep enteroscopy. By visualizing segments of the small bowel not possible through standard EGD or push enteroscopy, deep enteroscopy has an established high rate of identification and treatment of bleeding sources. In addition to obscure bleeding, other common indications include diagnosis and staging of Crohn's disease, evaluation of findings on capsule endoscopy and investigation of possible small bowel tumors. Large endoscopy databases have shown deep enteroscopy to be not only effective but safe. Recent research has focused on comparing the diagnostic rates, efficacy, and total enteroscopy rates of the different endoscopic platforms. PMID:27098815

  19. Recent Advances in Imaging of Small and Large Bowel.

    PubMed

    Das, Chandan J; Manchanda, Smita; Panda, Ananya; Sharma, Anshul; Gupta, Arun K

    2016-01-01

    The diagnosis of bowel pathology is challenging in view of the nonspecific clinical presentation. Currently, there are various imaging modalities available to reach an accurate diagnosis. These modalities include conventional techniques (radiographs, small bowel follow-through, conventional enteroclysis), ultrasonography, and cross-sectional examinations (computed tomography [CT] and MR imaging) as well as functional imaging modalities, such as PET-CT or PET-MR imaging. Each modality has its own advantages and disadvantages and can be used in isolation or combination. This review discusses the role of CT, MR imaging, and PET-CT in the evaluation of small and large bowel diseases. PMID:26590441

  20. The influence of small bowel contamination on the pathogenesis of bowel obstruction.

    PubMed

    Schwöbel, M; Hirsig, J; Illi, O; Bättig, U

    1989-01-01

    Altered motility of the intestine after laparotomy, adynamic bowel segments, blind bowel loops following bypass operations, or diverticula may cause pathological growth of intestinal microflora and thus lead to contaminated small bowel syndrome (CSBS). As a result of malabsorption in the jejunum and ileum, loss of weight, growth arrest, diarrhea, steatorrhea, megaloblastic anemia, and hypoproteinemia may occur. In addition to these, the acute symptoms of small bowel contamination, intestinal obstruction and secretory diarrhea, are less well known. A stenosis in the terminal ileum was experimentally created in Göttingen minipigs and the bacterial flora of the small bowel assessed by quantitative cultures. After 3 months the number of aerobic and anaerobic bacteria in the pre- and poststenotic region had increased by a factor of 10(2)-10(5). The acute form of CSBS was diagnosed by microbiological examination of gastric samples in 14 children. After the children were treated with orally and intravenously administered antibiotics, the symptoms disappeared within 12-36 h. Reoperations for small bowel obstruction can be avoided by conservative treatment of CSBS with antibiotics. PMID:2513601

  1. Metastatic Adenocarcinoma of Unknown Origin Presenting as Small Bowel Perforation

    PubMed Central

    Alkabie, Samir; Bello, Brian; Martinez, Roberto F.; Geis, W. Peter

    2015-01-01

    Metastatic malignant tumors that originate from occult primaries are defined as “cancers of unknown origin.” We herein present the case of a 59-year-old man who presented with small bowel perforation secondary to metastatic adenocarcinoma of an unknown primary site. Imaging exhibited two pulmonary nodules, neither of which was dominant, along with mediastinal and retroperitoneal lymphadenopathy. Immunohistochemical profiling of the small bowel biopsy specimens revealed the tumor was most likely pulmonary in origin. PMID:26425638

  2. Relationship of small bowel motility to ileoanal reservoir function.

    PubMed Central

    Groom, J S; Kamm, M A; Nicholls, R J

    1994-01-01

    Some patients with an ileoanal reservoir have a high defecation frequency, despite a good anatomical result and the absence of pouchitis. This study aimed to determine whether variation in function is related to a difference in small bowel motility proximal to the reservoir and if small bowel motility is propagated into the reservoir. Ambulatory small bowel and reservoir motility was studied for 24 hours in five patients with good function (median bowel frequency 4 per day, range 3-6) and seven subjects with poor function (median bowel frequency 12 per day, range 10-20). Five solid state pressure sensors were positioned in the small bowel and one in the reservoir. During the fasting nocturnal period (2300-0800 h), patients with poor function had a median of 10 (range 5-13) migrating motor complexes (MMC), significantly greater (p = 0.03) than the corresponding median number of 3 (range 2-7) in patients with good function. A total of 120 MMCs were observed in the whole series of 12 patients. Of these only two were propagated from the small bowel into the reservoir. Discrete clustered contractions were not propagated into the reservoir, although prolonged propagated contractions did pass into the reservoir in one patient. Patients with poor function had similar 24 hour stool output and radiological reservoir size to those with good function, but the median maximum tolerated volume on reservoir distension was 290 ml (range 160-450) for patients with poor function compared with 475 ml (range 460-550) for patients with good function (p = 0.005). Small bowel motility proximal to the reservoir bears an important relationship to pouch function and defecation frequency. Propagation of coordinated proximal small intestinal motility into the reservoir is rare. PMID:8174992

  3. Small bowel perforation due to fish bone: A case report.

    PubMed

    Pulat, Huseyin; Karakose, Oktay; Benzin, Mehmet Fatih; Benzin, Seyma; Cetin, Recep

    2015-09-01

    Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen. PMID:27239615

  4. Laparoscopic surgery for small-bowel obstruction caused by Meckel’s diverticulum

    PubMed Central

    Matsumoto, Takatsugu; Nagai, Motoki; Koike, Daisuke; Nomura, Yukihiro; Tanaka, Nobutaka

    2016-01-01

    A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrast-enhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel, suggestive of Meckel’s diverticulum (MD) and a mesodiverticular band (MDB). After intestinal decompression, elective laparoscopic surgery was carried out. Using three 5-mm ports, MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel’s diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman. PMID:26981191

  5. An unusual cause of small bowel obstruction: dried apricots.

    PubMed

    Gümüs, Metehan; Kapan, Murat; Onder, Akin; Tekbas, Güven; Yagmur, Yusuf

    2011-11-01

    Small bowel obstruction is rarely caused by bezoars. An important cause of phytobezoars are dried fruits. A 56 year old man presented to our department with symptoms of acute intestinal obstruction. Abdomen was distended and tender at the right and left lower quadrants. Bowel movements were decreased, and rectum was empty on digital examination. Upright plain films of the abdomen revealed multiple air-fluid levels and patient was immediately operated on. Due to the ischaemia of short small bowel segment, resection and end to end anastomosis were performed. After resection, bowel was opened and an apricot was found in the small bowel lumen. Although the dried apricot was small enough to pass through the pylorus spontaneously, it became swollen in fluid and started to obstruct the small bowel lumen especially in the terminal ileum. Obstruction by undigested food is rare and mostly seen in children, edentulous older people and patients with mental disorders. In conclusion, dried fruits, when swallowed without chewing, may cause intestinal obstruction. PMID:22125996

  6. A case of small bowel mesenteric pneumatosis: A multidisciplinary approach to clinical interpretation and intervention

    PubMed Central

    Johnstone, Christopher; Salih, Tamir; Saha, Arin

    2016-01-01

    Introduction Pneumatosis of the small bowel mesentery is rare and the preserve of case reports. This case report describes the importance of a multi-disciplinary team (MDT) approach to rare pathologies. Case report A 78-year-old man presented to our unit with a two-day history of upper abdominal pain associated with nausea and intermittent vomiting. An urgent computed tomography (CT) scan was organised. The scan was grossly abnormal and difficult to interpret; it was reported as widespread intra-mural gas within the small bowel wall most likely secondary to extensive small bowel ischaemia. Although surgical intervention was very high risk (predicted P-possum mortality of over 60%) and there was a strong possibility that the patient would not recover from surgery, the disparity between clinical and radiological findings meant that a diagnostic laparoscopy was indicated. A diagnostic laparoscopy showed that the small bowel itself was normal but there was extensive gas within the mesentery, caused by a band adhesion which had eroded into the peritoneal layer of the small bowel mesentery. Discussion Pneumatosis of the small bowel mesentery is a pathological sign rather than a diagnosis and is characterised by gas within the mesenteric sleeves. It is likely associated with significant morbidity and therefore rarely observed as the majority with this sign would not be deemed suitable for surgical intervention. Conclusion The case highlights an unusual pathology, rare imaging findings, the importance of a multi-disciplinary approach and the value of clear communication and informed consent when considering major intervention or surgery. PMID:27082993

  7. Surgical aspects of radiation enteritis of the small bowel

    SciTech Connect

    Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.

    1984-02-01

    Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

  8. Early postoperative small bowel obstruction: open vs laparoscopic

    PubMed Central

    Goussous, Naeem; Kemp, Kevin M.; Bannon, Michael P.; Kendrick, Michael L.; Srvantstyan, Boris; Khasawneh, Mohammad A.; Zielinski, Martin D.

    2016-01-01

    BACKGROUND The window for safe reoperation in early postoperative (<6 weeks) small bowel obstruction (ESBO) is short and intimately dependent on elapsed time from the initial operation. Laparoscopic procedures create fewer inflammatory changes than open laparotomies. We hypothesize that it is safer to reoperate for ESBO after laparoscopic procedures than open. METHODS Review of patients who underwent re-exploration for ESBO from 2003 to 2009 was performed. Based on the initial operation, patients were classified as “open” or “laparoscopic.” The Revised Accordion Severity Grading System was used to define complications as minor (1 to 2) or severe (3 to 6). RESULTS There were 189 patients identified (age 55 years, 48% male): 130 open and 59 laparoscopic. Adhesive disease was more common (65% vs 42%, P <.01), while strictures were less frequent (5% vs 14% P = .03), in the open group. The open group had a greater rate of malignancy, days to re-exploration, and severity of complications. There was no difference in the rates of minor complications, enterotomy, and mortality. ESBO after laparoscopic surgery was more commonly caused by a focal source (85% vs 63%). Eighty-three patients (64 open, 19 laparoscopic) underwent re-exploration at or beyond 14 days. Within this subgroup, there were more severe complications (25% vs 5%) after open procedures with equivalent mortality (4% vs 0%). CONCLUSIONS Laparoscopic approaches confer a lower rate of adhesive disease and severity of complications in early SBO as compared with open surgery even if performed after 2 weeks of index procedure. PMID:25457244

  9. Small bowel double-contrast enema in stage III ovarian cancer.

    PubMed

    Wittich, G; Salomonowitz, E; Szepesi, T; Czembirek, H; Fruehwald, F

    1984-02-01

    The efficiency of small bowel double-contrast enema in the detection and localization of tumor- or therapy-induced lesions of the intestine was studied retrospectively in 43 patients with stage III ovarian carcinoma. The radiographic findings in 62 examinations were verified by operative and autopsy findings and by the clinical course. Postoperative changes in the small bowel were noted in 69% of the patients (63% moderate, 6% severe). Signs of acute radiation enteritis were found in 36% (all moderate). Signs of chronic radiation enteropathy were detected in 71% (53% moderate, 18% severe). Small bowel obstruction due to recurrent tumor was correctly identified in 9%. Nonobstructing peritoneal implants were detected in 27% of the patients. The small bowel double-contrast enema is accurate in localizing lesions resulting from adhesions, acute and chronic radiation enteritis, or obstructing tumor; it is less efficient in detecting nonobstructive peritoneal metastases. The major clinical value of this examination is its ability to differentiate "dysfunctional intestine," which is managed conservatively, from focal obstruction requiring surgery. The radiographic features of chronic radiation enteritis on double-contrast enema examination are discussed in detail. PMID:6607594

  10. Most small bowel cancers are revealed by a complication

    PubMed Central

    Negoi, Ionut; Paun, Sorin; Hostiuc, Sorin; Stoica, Bodgan; Tanase, Ioan; Negoi, Ruxandra Irina; Beuran, Mircea

    2015-01-01

    ABSTRACT Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates. PMID:26676271

  11. Small bowel injury in low-dose aspirin users.

    PubMed

    Endo, Hiroki; Sakai, Eiji; Kato, Takayuki; Umezawa, Shotaro; Higurashi, Takuma; Ohkubo, Hidenori; Nakajima, Atsushi

    2015-04-01

    The use of low-dose aspirin (LDA) is well known to be associated with an increased risk of serious upper gastrointestinal complications, such as peptic ulceration and bleeding. Until recently, attention was mainly focused on aspirin-induced damage of the stomach and duodenum. However, recently, there has been growing interest among gastroenterologists on the adverse effects of aspirin on the small bowel, especially as new endoscopic techniques, such as capsule endoscopy (CE) and balloon-assisted endoscopy, have become available for the evaluation of small bowel lesions. Preliminary CE studies conducted in healthy subjects have shown that short-term administration of LDA can induce mild mucosal inflammation of the small bowel. Furthermore, chronic use of LDA results in a variety of lesions in the small bowel, including multiple petechiae, loss of villi, erosions, and round, irregular, or punched-out ulcers. Some patients develop circumferential ulcers with stricture. In addition, to reduce the incidence of gastrointestinal lesions in LDA users, it is important for clinicians to confirm the differences in the gastrointestinal toxicity between different types of aspirin formulations in clinical use. Some studies suggest that enteric-coated aspirin may be more injurious to the small bowel mucosa than buffered aspirin. The ideal treatment for small bowel injury in patients taking LDA would be withdrawal of aspirin, however, LDA is used as an antiplatelet agent in the majority of patients, and its withdrawal could increase the risk of cardiovascular/cerebrovascular morbidity and mortality. Thus, novel means for the treatment of aspirin-induced enteropathy are urgently needed. PMID:25501289

  12. No difference in small bowel microbiota between patients with irritable bowel syndrome and healthy controls.

    PubMed

    Dlugosz, Aldona; Winckler, Björn; Lundin, Elin; Zakikhany, Katherina; Sandström, Gunnar; Ye, Weimin; Engstrand, Lars; Lindberg, Greger

    2015-01-01

    Several studies have indicated that colonic microbiota may exhibit important differences between patients with irritable bowel syndrome (IBS) and healthy controls. Less is known about the microbiota of the small bowel. We used massive parallel sequencing to explore the composition of small bowel mucosa-associated microbiota in patients with IBS and healthy controls. We analysed capsule biopsies from the jejunum of 35 patients (26 females) with IBS aged 18-(36)-57 years and 16 healthy volunteers (11 females) aged 20-(32)-48 years. Sequences were analysed based on taxonomic classification. The phyla with the highest total abundance across all samples were: Firmicutes (43%), Proteobacteria (23%), Bacteroidetes (15%), Actinobacteria (9.3%) and Fusobacteria (7.0%). The most abundant genera were: Streptococcus (19%), Veillonella (13%), Prevotella (12%), Rothia (6.4%), Haemophilus (5.7%), Actinobacillus (5.5%), Escherichia (4.6%) and Fusobacterium (4.3%). We found no difference among major phyla or genera between patients with IBS and controls. We identified a cluster of samples in the small bowel microbiota dominated by Prevotella, which may represent a common enterotype of the upper small intestine. The remaining samples formed a gradient, dominated by Streptococcus at one end and Escherichia at the other. PMID:25687743

  13. Gastric band connection tube results in small bowel obstruction: an acute emergency

    PubMed Central

    Suter, Katherine J. L.; Rajasagaram, Niruben; Nottle, Peter

    2016-01-01

    The laparoscopic adjustable gastric band (LAGB) is a widely performed procedure for the morbid obesity epidemic. Despite its low mortality compared with other mainstream bariatric surgeries, it is not without its complications. The authors report a late and rare complication of a small bowel obstruction in a 52-year-old woman from an LAGB placed for 2 years. She was diagnosed clinically and radiologically with a small bowel obstruction. However, in the setting of an LAGB, this became a closed-loop obstruction. She proceeded to an emergency laparoscopy, which revealed that the port connection tube had formed dense adhesions to the jejunum causing an obstructive band. This is only the fifth reported case in Australia; as bariatric surgery continues to rise, these patients may present unannounced to any emergency department and as such should be treated as a closed-loop obstruction with immediate resuscitative and surgical management instituted. PMID:27170704

  14. Gastric band connection tube results in small bowel obstruction: an acute emergency.

    PubMed

    Suter, Katherine J L; Rajasagaram, Niruben; Nottle, Peter

    2016-01-01

    The laparoscopic adjustable gastric band (LAGB) is a widely performed procedure for the morbid obesity epidemic. Despite its low mortality compared with other mainstream bariatric surgeries, it is not without its complications. The authors report a late and rare complication of a small bowel obstruction in a 52-year-old woman from an LAGB placed for 2 years. She was diagnosed clinically and radiologically with a small bowel obstruction. However, in the setting of an LAGB, this became a closed-loop obstruction. She proceeded to an emergency laparoscopy, which revealed that the port connection tube had formed dense adhesions to the jejunum causing an obstructive band. This is only the fifth reported case in Australia; as bariatric surgery continues to rise, these patients may present unannounced to any emergency department and as such should be treated as a closed-loop obstruction with immediate resuscitative and surgical management instituted. PMID:27170704

  15. Risk factors for small bowel cancer in Crohn's disease.

    PubMed

    Lashner, B A

    1992-08-01

    Suspected risk factors for adenocarcinoma of the small bowel in Crohn's disease include surgically excluded small bowel loops, chronic fistulous disease, and male sex. Review of all seven University of Chicago cases failed to confirm any suspected risk factor. A case-control study was performed to identify possible alternatives. Each case was matched to four randomly selected controls from an inflammatory bowel disease registry matched for year of birth, sex, and confirmed small bowel Crohn's disease. Three factors were significantly associated with the development of cancer: (1) Four cancers developed in the jejunum, and jejunal Crohn's disease was associated with the development of cancer [odds ratio (OR) 8.0, 95% confidence interval (CI) 1.6-39.3]. (2) There was an association between the development of cancer and occupations known to be associated with an increased colorectal cancer risk (OR 20.3, CI 2.7-150.5). Three cases (a chemist with exposure to halogenated aromatic compounds and aliphatic amines, a pipefitter with exposure to asbestos, and a machinist with exposures to cutting oils, solvents, and abrasives) and one of 28 controls (a fireman with multiple hazardous exposures) had an occupational risk factor. (3) Among medications taken for at least six months, only 6-mercaptopurine use was associated with cancer (OR 10.8, CI 1.1-108.7). In conclusion, proximal small bowel disease, 6-mercaptopurine use, and hazardous occupations are associated with cancer of the small bowel in patients with Crohn's disease and can be added to the list of suspected risk factors. PMID:1499440

  16. Delayed small bowel obstruction after robotic-assisted sacrocolpopexy.

    PubMed

    Vahanian, Sevan A; Finamore, Peter S; Lazarou, George

    2015-01-01

    We report 2 unusual cases of partial bowel obstruction resulting from adherence to a barbed suture presenting 3 to 4 weeks after robotic-assisted sacrocolpopexy for uterovaginal prolapse. Both patients underwent an uncomplicated robotic-assisted supracervical hysterectomy and sacrocolpopexy. Immediate postoperative recovery was uncomplicated. Three to four weeks after surgery, both patients presented with symptoms of nausea, vomiting, and abdominal pain and were found to have small bowel obstructions requiring a return to the operating room. Upon surgical exploration, a loop of small bowel was found to be adhered to a segment of the barbed suture at the sacral promontory, which had been used to close the peritoneum over the mesh. Subsequent to release, both patients had an uneventful recovery. PMID:25185609

  17. Solitary fibrous tumor of small bowel mesentery with postoperative bowel obstruction: a case report and review of literature.

    PubMed

    Zhang, Guo-Jing; Li, Ruo-Tong; Zhou, Yang; Huang, Fei; Zhao, Zhi-Cheng; Li, Wei-Dong; Fu, Wei-Hua

    2015-01-01

    Solitary fibrous tumor (SFT) which is an extremely rare clinical entity has been reported infrequently. Most commonly it is distinguished into pleural and extrapleural forms, with same morphological resemblance. There has been many literatures reported regarding extrapleural form of SFT but few cases of SFT originating from small bowel mesentery have been reported till now. We here report one case of SFT of small bowel mesentery with some eventful postoperative bowel obstruction and literature review. PMID:26617912

  18. Early and delayed presentation of traumatic small bowel injury.

    PubMed

    McGuigan, Andrew; Brown, Robin

    2016-01-01

    Traumatic small bowel injury (TSBI) is rare and presents in only 1% of patients following blunt trauma. Delay in diagnosis can result in significant morbidity so a high index of suspicion is required in patients with abdominal injuries and a significant mechanism of injury. We discuss three cases of TSBI with varying presentations, and discuss their investigation and treatment. PMID:26961562

  19. Gastric Versus Small Bowel Feeding in Critically Ill Adults.

    PubMed

    Schlein, Kirsten

    2016-08-01

    Critically ill patients often require enteral feedings as a primary supply of nutrition. Whether enteral nutrition (EN) should be delivered as a gastric versus small bowel feeding in the critically ill patient population remains a contentious topic. The Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on this topic. No research to date demonstrates a significant difference between the two feeding routes in terms of patient mortality, ventilator days, or length of stay in the intensive care unit (ICU); however, studies provide some evidence that there may be other benefits to using a small bowel feeding route in critically ill patients. The purpose of this paper is to examine both sides of this debate and review advantages and disadvantages of both small bowel and gastric routes of EN. Practical issues and challenges to small bowel feeding tube placement are also addressed. Finally, recommendations are provided to help guide the clinician when selecting a feeding route, and suggestions are made for future research. PMID:26920643

  20. Acute small bowel obstruction due to chicken bone bezoar

    PubMed Central

    Vetpillai, Preadeepan; Oshowo, Ayo

    2012-01-01

    Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted undigested chicken bone. PMID:23754931

  1. Bowel preparation in “real-life” small bowel capsule endoscopy: a two-center experience

    PubMed Central

    Klein, Amir; Dashkovsky, Marianna; Gralnek, Ian; Peled, Ravit; Chowers, Yehuda; Khamaysi, Iyad; Har-Noy, Ofir; Levi, Idan; Nadler, Moshe; Eliakim, Rami; Kopylov, Uri

    2016-01-01

    Background Video capsule endoscopy (VCE) is an established diagnostic tool for the investigation of small bowel (SB) pathology. Bowel preparation prior to VCE may improve visualization, transit time, and diagnostic yield. We aimed to evaluate the “real-life” experience comparing two different preparation protocols in patients undergoing SB VCE. Methods We performed a retrospective analysis of prospectively collected data from SB VCE procedures, performed in two tertiary care medical centers in Israel. VCE procedures performed at “Sheba Medical Center” used a 2-L polyethylene glycol (PEG) bowel preparation (n=360) while VCEs performed at “Rambam Health Care campus” used a clear liquid diet plus 12-h fast protocol (n=500). A dichotomous preparation scale (adequate, inadequate) was used to classify cleansing quality. Data collection included patient and procedural details. The proportion of VCE procedures with adequate bowel preparation and the overall positive SB findings in the two different bowel preparation protocols were evaluated. Results SB completion rates were higher in the PEG protocol (96% vs. 83%, P<0.001) and SB passage time was significantly faster in the PEG protocol (mean 217±73 vs. 238±77 min, P<0.001). Bowel preparation quality was similar between groups (8% vs. 7% inadequate preparation, P=0.591). Overall positive SB findings were similar between the two groups (57% clear liquid fasting only vs. 51% PEG protocol, P=0.119). Conclusion In this large cohort, a 2-L PEG protocol had similar preparation quality and diagnostic yield compared with clear liquid fasting. PMID:27064840

  2. The Vomiting Patient: Small Bowel Obstruction, Cyclic Vomiting, and Gastroparesis.

    PubMed

    Nagarwala, Jumana; Dev, Sharmistha; Markin, Abraham

    2016-05-01

    Vomiting and abdominal pain are common in patients in the emergency department. This article focuses on small bowel obstruction (SBO), cyclic vomiting, and gastroparesis. Through early diagnosis and appropriate management, the morbidity and mortality associated with SBOs can be significantly reduced. Management of SBOs involves correction of physiologic and electrolyte disturbances, bowel rest and removing the source of the obstruction. Treatment of acute cyclic vomiting is primarily directed at symptom control, volume and electrolyte repletion, and appropriate specialist follow-up. The mainstay of therapy for gastroparesis is metoclopramide. PMID:27133244

  3. Multivisceral and Small Bowel Transplantation at Shiraz Organ Transplant Center

    PubMed Central

    Nikeghbalian, S.; Mehdi, S. H.; Aliakbarian, M.; Kazemi, K.; Shamsaeefar, A.; Bahreini, A.; Mansoorian, M. R.; Malekhosseini, S. A.

    2014-01-01

    Background: Multivisceral transplantations were initially done in animal models to understand the immunological effects. Later on, in human beings, it has been considered a salvage procedure for unresectable complex abdominal malignancies. With advancement in surgical techniques, availability of better immunosuppressive drugs, and development of better post-operative management protocols, outcomes have been improved after these complex surgical procedures. Objective: To analyze and report results of multivisceral, modified multivisceral, and small bowel transplantations done at Shiraz Organ Transplant Center, Shiraz, southern Iran. Methods: Medical records of all patients who underwent multivisceral, modified multivisceral, and small bowel transplants were retrospectively analyzed. Results: There were 18 patients. The most common indications for the procedure in our series were unresectable carcinoma of pancreas followed by short bowel syndrome. 10 patients were alive after a median follow-up of 8.7 (range: 3–32) months. The remaining 8 patients died post-operatively, mostly from septicemia. Conclusion: Multivisceral and small bowel transplantations are promising treatments for complex abdominal pathologies. PMID:25013680

  4. Small bowel adenocarcinoma in Lynch syndrome: A case report

    PubMed Central

    Sun, Ke-Kang; Liu, Gang; Shen, Xiaojun; Wu, Xiaoyang

    2016-01-01

    Small bowel adenocarcinoma is part of the tumor spectrum of Lynch syndrome, which is caused by germline mutations in the mismatch repair genes. The present study describes the case of a 51-year-old man fulfilling the Amsterdam II criteria for Lynch syndrome, who had a 15-mm early-stage colorectal cancer resected endoscopically from the ascending colon. Due to upper abdominal discomfort after eating and consequent anorexia, a computed tomography scan performed 1 month later showed a tumoral mass of the upper jejunum with local lymphadenopathy. The laparotomy revealed a completely obstructing mass. Intraoperative frozen section showed a small bowel adenocarcinoma. Subsequent genetic testing confirmed the germline mutation of mutL homolog 1. The patient received 6 cycles of an adjuvant folinic acid, fluorouracil and ocaliplatin chemotherapy regimen. The latest CT scan, 16 months after the chemotherapy, did not show any recurrence. This case highlights the importance of considering the possibility of small bowel adenocarcinoma in patients with upper bowel obstruction, particularly for patients with Lynch syndrome. PMID:27446478

  5. Electrostimulation to move endoscopes in the small bowel

    NASA Astrophysics Data System (ADS)

    Mosse, Charles A.; Mills, Timothy N.; Appleyard, Mark; Swain, Paul

    2001-01-01

    Background: Methods are required for propulsion of endoscopes through the small bowel and for propelling capsule endoscopes without cables. Aim: To test the hypothesis that electrical stimulation could propel an endoscope by stimulating muscular contraction. Methods: Prototype acrylic devices of ovoid shape were constructed with two stainless steel electrodes mounted on the tapered section. Five devices of 13 to 23 mm diameter with a taper of 16 degree(s) to 20 degree(s) (half angle) were tested. When in contact with the bowel wall electrostimulation was applied causing circular muscle contraction which when applied to the taper of the ovoid resulted in forward propulsion of the device. The method does not induce peristalsis but works by stimulating local contraction. The device was tested in small bowel and oesophagus of anaesthetized pigs. Results: Electrostimulation caused the ovoid to advance rapidly (6 mm/sec) up and down the oesophagus by inducing circular esophageal muscle contraction. When stimulated at 15 Hz with 30 ms pulses the threshold for movement was 12 mA; at 20 mA the device moved reliably in both directions in the small bowel at speeds of up to 4.5 mm/s, negotiating tight curves.

  6. Small-Bowel Neoplasms: Role of MRI Enteroclysis

    PubMed Central

    Faggian, Angela; Fracella, Maria Rosaria; D'Alesio, Grazia; Alabiso, Maria Eleonora; Feragalli, Beatrice; Miele, Vittorio; Iasiello, Francesca

    2016-01-01

    Small-bowel neoplasms are the 3%–6% of all gastrointestinal tract neoplasms. Due to the rarity of these lesions, the low index of clinical suspicion, and the inadequate radiologic examinations or incorrect interpretation of radiologic findings, a delay in diagnosis of 6–8 months from the first symptoms often occurs. Even if conventional enteroclysis and capsule endoscopy are the most common procedures used to accurately depict the bowel lumen and mucosal surface, their use in evaluating the mural and extramural extents of small-bowel tumors is limited. Instead multidetector computed tomographic enteroclysis and magnetic resonance enteroclysis have the potential to simultaneously depict intraluminal, mural, and extraintestinal abnormalities. In particular MR enteroclysis has an excellent soft tissue contrast resolution and multiplanar imaging capability. It can provide anatomic, functional, and real time information without the need of ionizing radiation. MR findings, appearances of the lesions, combined with the contrast-enhancement behavior and characteristic of the stenosis are important to differentiate small-bowel neoplasm from other nonneoplastic diseases. PMID:26819616

  7. Integrins and adhesion molecules as targets to treat inflammatory bowel disease.

    PubMed

    Bravatà, Ivana; Allocca, Mariangela; Fiorino, Gionata; Danese, Silvio

    2015-12-01

    Inflammatory bowel diseases (IBD) present a typically relapsing-remitting behavior and are characterized by a disabling and progressive course. Anti-tumor necrosis factor (TNF)-α agents have drastically changed the therapeutic management of IBD. However, a significant proportion of patients does not have a primary response, some patients lose response overtime and/or experience side effects. Recently, anti-adhesion molecules were investigated and showed efficacy with a good safety profile. Vedolizumab was recently approved for both Crohn's disease (CD) and ulcerative colitis (UC) and several other molecules are under evaluation in this field. Anti-adhesion molecules could represent a potential therapeutic option for future therapy in IBD. In this review we report the efficacy and safety of major anti-adhesion drugs in active IBD patients. PMID:26687159

  8. Association between two single base polymorphisms of intercellular adhesion molecule 1 gene and inflammatory bowel disease

    PubMed Central

    Habibi, Manijeh; Naderi, Nosratllah; Farnood, Alma; Balaii, Hedieh; Dadaei, Tahereh; Almasi, Shohreh; Zojaji, Homayoun; Asadzadeh Aghdae, Hamid; Zali, Mohammad Reza

    2016-01-01

    Aim: The present study evaluated the association between G241R and K469E polymorphisms of intercellular adhesion molecule 1 gene and inflammatory bowel disease in Iranian population. Background: Inflammatory bowel disease including ulcerative colitis and Crohn’s disease, is a chronic idiopathic inflammatory disease of the gastrointestinal tract. There are two single base polymorphisms of intercellular adhesion molecule 1gene, G241R and K469E, reported to be associated with inflammatory disorders. Patients and methods: In this case-control study, 156 inflammatory bowel disease patients (110 ulcerative colitis and 46 Crohn’s disease patients) and 131 healthy controls were enrolled. Two polymorphisms of intercellular adhesion molecule 1 gene, including G241R and K469E, were assessed by polymerase chain reaction followed by restriction fragment length polymorphism. Results: The E469 allele of K469E polymorphism was significantly more frequent in Crohn’s disease patients compared to controls (P< 0.05, OR= 1.83; 95% CI: 1.13 to 2.96). The mutant homozygote genotype of K469E polymorphism (E/E) was also significantly more frequent in Crohn’s disease patients compared to controls (P< 0.05, OR= 4.23; 95% CI: 1.42 to 12.59). No difference was observed in the frequency of K469E polymorphism among ulcerative colitis patients compared to controls. There were no significant differences in genotype and allele frequencies of G241R polymorphism among ulcerative colitis and Crohn’s disease patients compared to control subjects. Conclusion: According to our findings, K469E polymorphism of intercellular adhesion molecule 1 gene may probably participate in the pathogenesis of Crohn’s disease in Iran. PMID:27099667

  9. Early solitary small bowel metastasis from stage I cutaneous melanoma

    PubMed Central

    Gavriilidis, Paschalis; Efthimiopoulos, Georgios; Zafiriou, Georgios

    2013-01-01

    Patient Male, 63 Final Diagnosis: Melanoma Symptoms: Gastrointesinal haemorrhage Medication: — Clinical Procedure: Enterectomy Specialty: Oncology Objective: Unusual clinical course Background: It is reported that the time interval between the initial diagnosis of malignant melanoma and the diagnosis of the gastrointestinal metastases is 43.8±11.3 months. Case Report: We present the case of a 63-year-old Caucasian man who was operated on for superficial spreading Stage IB melanoma and 8 months later was diagnosed with solitary small bowel metastasis without other systemic metastases. Conclusions: Small bowel melanoma metastasis should be suspected in any patient with previous history of malignant melanoma who develops symptoms of anemia, gastrointestinal hemorrhage, and non-specific abdominal pain. PMID:24367718

  10. [Prenatal discovery of Joubert syndrome associated with small bowel volvulus].

    PubMed

    Aurégan, C; Donciu, V; Millischer, A-E; Khen-Dunlop, N; Deloison, B; Sonigo, P; Magny, J-F

    2016-03-01

    Joubert syndrome and prenatal volvulus are difficult to diagnose during pregnancy. Joubert syndrome and related diseases should be considered in case of prenatal abnormal features of the fourth ventricle. Small bowel volvulus is also a surgical emergency because of the risk of intestinal necrosis before or after delivery. This type of condition justifies the transfer of pregnant women to a specialized hospital where the newborn may receive appropriate care. We report the case of a 31-week and 4-day gestational-age fetus in whom intrauterine growth retardation and small-bowel volvulus were diagnosed. Additional imaging revealed associated Joubert syndrome. This highlights the need for regular ultrasound monitoring during pregnancy and the comanagement of obstetricians and pediatricians to provide appropriate care before and after delivery. PMID:26850151

  11. Small Bowel Dose Tolerance for Stereotactic Body Radiation Therapy.

    PubMed

    LaCouture, Tamara A; Xue, Jinyu; Subedi, Gopal; Xu, Qianyi; Lee, Justin T; Kubicek, Gregory; Asbell, Sucha O

    2016-04-01

    Inconsistencies permeate the literature regarding small bowel dose tolerance limits for stereotactic body radiation therapy (SBRT) treatments. In this review, we organized these diverse published limits with MD Anderson at Cooper data into a unified framework, constructing the dose-volume histogram (DVH) Risk Map, demonstrating low-risk and high-risk SBRT dose tolerance limits for small bowel. Statistical models of clinical data from 2 institutions were used to assess the safety spectrum of doses used in the exposure of the gastrointestinal tract in SBRT; 30% of the analyzed cases had vascular endothelial growth factor inhibitors (VEGFI) or other biological agents within 2 years before or after SBRT. For every dose tolerance limit in the DVH Risk Map, the probit dose-response model was used to estimate the risk level from our clinical data. Using the current literature, 21Gy to 5cc of small bowel in 3 fractions has low toxicity and is reasonably safe, with 6.5% estimated risk of grade 3 or higher complications, per Common Terminology Criteria for Adverse Events version 4.0. In the same fractionation for the same volume, if lower risk is required, 16.2Gy has an estimated risk of only 2.5%. Other volumes and fractionations are also reviewed; for all analyzed high-risk small bowel limits, the risk is 8.2% or less, and the low-risk limits have 4% or lower estimated risk. The results support current clinical practice, with some possibility for dose escalation. PMID:27000513

  12. Recent advances in small bowel diseases: Part II

    PubMed Central

    Thomson, Alan BR; Chopra, Angeli; Clandinin, Michael Tom; Freeman, Hugh

    2012-01-01

    As is the case in all areas of gastroenterology and hepatology, in 2009 and 2010 there were many advances in our knowledge and understanding of small intestinal diseases. Over 1000 publications were reviewed, and the important advances in basic science as well as clinical applications were considered. In Part II we review six topics: absorption, short bowel syndrome, smooth muscle function and intestinal motility, tumors, diagnostic imaging, and cystic fibrosis. PMID:22807605

  13. Diospyrobezoar as a Cause of Small Bowel Obstruction

    PubMed Central

    de Toledo, Andréia Padilha; Rodrigues, Fernanda Hurtado; Rodrigues, Murilo Rocha; Sato, Daniela Tiemi; Nonose, Ronaldo; Nascimento, Enzo Fabrício; Martinez, Carlos Augusto Real

    2012-01-01

    Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery. PMID:23271989

  14. Small bowel neuroendocrine tumors: From pathophysiology to clinical approach.

    PubMed

    Xavier, Sofia; Rosa, Bruno; Cotter, José

    2016-02-15

    Neuroendocrine tumors (NETs), defined as epithelial tumors with predominant neuroendocrine differentiation, are among the most frequent types of small bowel neoplasm. They represent a rare, slow-growing neoplasm with some characteristics common to all forms and others attributable to the organ of origin. The diagnosis of this subgroup of neoplasia is not usually straight-forward for several reasons. Being a rare form of neoplasm they are frequently not readily considered in the differential diagnosis. Also, clinical manifestations are nonspecific lending the clinician no clue that points directly to this entity. However, the annual incidence of NETs has risen in the last years to 40 to 50 cases per million probably not due to a real increase in incidence but rather due to better diagnostic tools that have become progressively available. Being a rare malignancy, investigation regarding its pathophysiology and efforts toward better understanding and classification of these tumors has been limited until recently. Clinical societies dedicated to this matter are emerging (NANETS, ENETS and UKINETS) and several guidelines were published in an effort to standardize the nomenclature, grading and staging systems as well as diagnosis and management of NETs. Also, some investigation on the genetic behavior of small bowel NETs has been recently released, shedding some light on the pathophysiology of these tumors, and pointing some new directions on the possible treating options. In this review we focus on the current status of the overall knowledge about small bowel NETs, focusing on recent breakthroughs and its potential application on clinical practice. PMID:26909234

  15. Small bowel neuroendocrine tumors: From pathophysiology to clinical approach

    PubMed Central

    Xavier, Sofia; Rosa, Bruno; Cotter, José

    2016-01-01

    Neuroendocrine tumors (NETs), defined as epithelial tumors with predominant neuroendocrine differentiation, are among the most frequent types of small bowel neoplasm. They represent a rare, slow-growing neoplasm with some characteristics common to all forms and others attributable to the organ of origin. The diagnosis of this subgroup of neoplasia is not usually straight-forward for several reasons. Being a rare form of neoplasm they are frequently not readily considered in the differential diagnosis. Also, clinical manifestations are nonspecific lending the clinician no clue that points directly to this entity. However, the annual incidence of NETs has risen in the last years to 40 to 50 cases per million probably not due to a real increase in incidence but rather due to better diagnostic tools that have become progressively available. Being a rare malignancy, investigation regarding its pathophysiology and efforts toward better understanding and classification of these tumors has been limited until recently. Clinical societies dedicated to this matter are emerging (NANETS, ENETS and UKINETS) and several guidelines were published in an effort to standardize the nomenclature, grading and staging systems as well as diagnosis and management of NETs. Also, some investigation on the genetic behavior of small bowel NETs has been recently released, shedding some light on the pathophysiology of these tumors, and pointing some new directions on the possible treating options. In this review we focus on the current status of the overall knowledge about small bowel NETs, focusing on recent breakthroughs and its potential application on clinical practice. PMID:26909234

  16. Ileo-ileal Intussusception and Bowel Obstruction Caused by Plasmablastic Lymphoma of Small Bowel- A Rare Entity in Rare Location

    PubMed Central

    Thakur, Sanjiv S.

    2016-01-01

    Intussusception of small bowel is considered a rare cause of bowel obstruction in adults accounting for only about 1% of bowel obstruction in adults. Intussusception in adults is uncommon with 95% cases of intussusceptions occurring in children. Adult intussusception from small intestinal lymphoma is also rare with only 36 cases reported in the literature between 2000 and 2011. Plasmablastic lymphoma (PBL) is an aggressive lymphoid neoplasm usually seen in the oral cavity in the clinical setting of human immunodeficiency virus (HIV) infection. Plasmablastic lymphoma of the small intestine is extremely rare. Here, we report a case of plasmablastic lymphoma of small bowel with ileoileal intussusception in an HIV-negative immunocompetent male patient. PMID:27134931

  17. Segmental reversal of the small bowel as an alternative to intestinal transplantation in patients with short bowel syndrome.

    PubMed Central

    Panis, Y; Messing, B; Rivet, P; Coffin, B; Hautefeuille, P; Matuchansky, C; Rambaud, J C; Valleur, P

    1997-01-01

    OBJECTIVE: This article reports the results of segmental reversal of the small bowel on parenteral nutrition dependency in patients with very short bowel syndrome. SUMMARY BACKGROUND DATA: Segmental reversal of the small bowel could be seen as an acceptable alternative to intestinal transplantation in patients with very short bowel syndrome deemed to be dependent on home parenteral nutrition. METHODS: Eight patients with short bowel syndrome underwent, at the time of intestinal continuity restoration, a segmental reversal of the distal (n = 7) or proximal (n = 1) small bowel. The median length of the remnant small bowel was 40 cm (range, 25 to 70 cm), including a median length of reversed segment of 12 cm (range, 8 to 15 cm). Five patients presented with jejunotransverse anastomosis, and one each with jejunorectal, jejuno left colonic, or jejunocaecal anastomosis with left colostomy. RESULTS: There were no postoperative deaths. Three patients were reoperated early for wound dehiscence, acute cholecystitis, and sepsis of unknown origin. Three patients experienced transient intestinal obstruction, which was treated conservatively. Median follow-up was 35 months (range, 2 to 108 months). One patient died of pulmonary embolism 7 months postoperatively. By the end of follow-up, three patients were on 100% oral nutrition, one had fluid and electrolyte infusions only, and, in the four other patients, parenteral nutrition regimen was reduced to four (range of 3 to 5) cyclic nocturnal infusions per week. Parenteral nutrition cessation was obtained in 3 of 5 patients at 1 years and in 3 of 3 patients at 4 years. CONCLUSION: Segmental reversal of the small bowel could be proposed as an alternative to intestinal transplantation in patients with short bowel syndrome before the possible occurrence of parenteral nutrition-related complications, because weaning for parenteral nutrition (four patients) or reduction of the frequency of infusions (four patients) was observed in the

  18. Two way push videoenteroscopy in investigation of small bowel disease

    PubMed Central

    Bouhnik, Y; Bitoun, A; Coffin, B; Moussaoui, R; Oudghiri, A; Rambaud, J

    1998-01-01

    Aims—To evaluate the diagnostic yield and safety of a new push type videoenteroscope (PVE) for diagnosis of small bowel disease. 
Methods—Three hundred and thirteen patients were referred for one or two way PVE from December 1993 to June 1996. Indications for PVE were: an unexplained iron deficiency anaemia with or without clinically evident gastrointestinal bleeding; or a complementary investigation for suspected small bowel disease, after a small bowel barium follow through (SBBFT) considered as normal or abnormal, but without a definite diagnosis. 
Results—A jejunoscopy and a retrograde ileoscopy were carried out in 306 and 234 patients, respectively. In patients with isolated anaemia (n=131) and those with clinically evident gastrointestinal bleeding associated anaemia (n=72), PVE provided a diagnosis in 26 (19.8%) and 22 (30.5%) cases, respectively. Lesions found were located in the jejunoileum in 30 (14.7%) patients and in the gastroduodenum or the colon in 18 (8.8%) patients—that is, within the reach of the conventional gastroscope/colonoscope. In patients with normal (n=54) or abnormal (n=56) SBBFT, PVE provided a diagnosis in 17(31%) and 27 (48%) cases, respectively. In 25% of cases, the abnormal appearance of SBBFT was not confirmed. The site of the radiological abnormality was not reached in 27% of cases. Lesions were located at the jejunum and the ileum in 59 (64%) and 33 (36%) cases, respectively. 
Conclusions—PVE is useful in around 30% of cases of unexplained anaemia or after an SBBFT which failed to provide an accurate aetiological diagnosis. Use of retrograde videoenteroscopy increases diagnostic yield by one third. 

 Keywords: enteroscopy; small intestine; gastrointestinal bleeding; anaemia; chronic diarrhoea; intestinal tumour PMID:10189858

  19. An unusual cause of small bowel perforation: apricot pit.

    PubMed

    Atila, Koray; Güler, Sanem; Bora, Seymen; Gülay, Hüseyin

    2011-05-01

    Ingestion of foreign bodies can be a common problem, especially among children, alcoholics, and psychiatric and senile patients. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved immediately may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract uneventfully, and perforation occurs in less than 1%. In this study, we report a case of small bowel obstruction with perforation in a 73-year-old female due to the accidental swallowing of an apricot pit. PMID:21935813

  20. Small bowel bacterial overgrowth in patients with irritable bowel syndrome: the first study in iran.

    PubMed

    Abbasi, Mehdi HayatBakhsh; Zahedi, MohammadJavad; Darvish Moghadam, Sodaif; Shafieipour, Sara; HayatBakhsh Abbasi, Mahroo

    2015-01-01

    BACKGROUND Small intestinal bacterial overgrowth (SIBO) may have a role in the pathophysiology of irritable bowel syndrome (IBS). So, the aim of this study was to assess the association between SIBO and IBS by using glucose breath test (GBT) in Kerman city as the first study in Iranian population. METHODS 107 patients with IBS and 107 healthy individuals were enrolled in our study. All the participants underwent GBT. A peak of H2 values >20 p.p.m above the basal value after glucose ingestion was considered suggestive of SIBO. SPSS software version 17 was used for data analysis. P value < 0.05 was considered as statistically significant. RESULTS Of the 107 patients with IBS, 40 had positive GBT (37.4%) compared with 14 (12.1%) out of the 107 control participants(p< 0.001). Dominant symptoms in patients with IBS were diarrhea in 36(33.6%), constipation in 12(11.2%), abdominal pain in 22(20.6%), bloating in 28(26.2%), and change in bowel habit in 9(8.4%) patients. There was not statistically significant difference among any of this IBS subgroups and positive GBT (p=0.44). CONCLUSION There is a positive association between IBS and SIBO. We suggest a Placebo-controlled bacterial eradication study for identifying the role of SIBO in IBS. PMID:25628852

  1. Endoscopic band ligation for bleeding lesions in the small bowel

    PubMed Central

    Ikeya, Takashi; Ishii, Naoki; Shimamura, Yuto; Nakano, Kaoru; Ego, Mai; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2014-01-01

    AIM: To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel. METHODS: This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy’s lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. RESULTS: Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. CONCLUSION: EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel. PMID:25324920

  2. Small Bowel Obstruction due to Mesodiverticular Band of Meckel's Diverticulum: A Case Report

    PubMed Central

    Sumer, Aziz; Kemik, Ozgur; Olmez, Aydemir; Dulger, A. Cumhur; Hasirci, Ismail; Iliklerden, Umit; Kisli, Erol; Kotan, Cetin

    2010-01-01

    Meckel's diverticulum is the most common congenital anomaly of the small intestine. Common complications related to a Meckel's diverticulum include haemorrhage, intestinal obstruction, and inflammation. Small bowel obstruction due to mesodiverticular band of Meckel's diverticulum is a rare complication. Herein, we report the diagnosis and management of a small bowel obstruction occurring due to mesodiverticular band of a Meckel's diverticulum. PMID:20814563

  3. Huge simultaneous trichobezoars causing gastric and small-bowel obstruction

    PubMed Central

    Mansour-Ghanaei, Fariborz; Herfatkar, Mohammadrasoul; Sedigh-Rahimabadi, Massih; Lebani-Motlagh, Mohammad; Joukar, Farahnaz

    2011-01-01

    Bezoars are concretions of foreign materials that impair gastrointestinal motility or cause intestinal obstruction in the stomach, small intestine or bowel of humans or animals. There are many types of them such as phyto, lacto and trichobezoars. Although bezoars are not rare, multiple giant bezoars which totally fill the stomach lumen and have extension to the small intestine (Rapunzel syndrome) are very rare. This is a case report of a young girl who had a history of trichophagia and presented with partial gastric and intestinal obstructive signs. The patient was healthy, and her physical exam was almost normal and the only positive thing in her past medical history was trichophagia from several years ago. She had a big trapped bobble in her stomach and several air-fluid levels in abdominal radiograph and was investigated with endoscopy which confirmed the diagnosis of a huge gastric trichobezoar. PMID:22247733

  4. Small bowel obstruction caused by self-anchoring suture used for peritoneal closure following robotic inguinal hernia repair

    PubMed Central

    Khan, Faraz A.; Hashmi, Asra; Edelman, David A.

    2016-01-01

    Laparoscopic inguinal herniorraphy is a commonly performed procedure given the reported decrease in pain and earlier return to activity when compared with the open approach. Moreover, robotic assistance offers the operating surgeon considerable ergonomic advantages, making it an attractive alternative to conventional laparoscopic herniorraphy. Robotic herniorraphy utilizes the transabdominal preperitoneal approach where following repair peritoneal closure is necessary to avoid mesh exposure to the viscera. Self-anchoring sutures are frequently used to this end given the ease of use and knotless application. We present an unusual case of post-operative small bowel obstruction following robotic inguinal hernia repair caused by the self-anchoring suture used for peritoneal closure. This patient presented 3 days post-procedure with symptoms and cross-sectional imaging indicative of small bowel obstruction with a clear transition point. Underwent laparoscopic lysis of a single adhesive band originating from the loose intraperitoneal end of the suture leading to resolution of symptoms. PMID:27340230

  5. Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

    PubMed Central

    Tsibouris, Panagiotis; Kalantzis, Chissostomos; Apostolopoulos, Periklis; Zalonis, Antonios; Isaacs, Peter Edward Thomas; Hendrickse, Mark; Alexandrakis, Georgios

    2014-01-01

    AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration (cases) and 60 matched patients with a non-bleeding peptic ulcer (controls) underwent small bowel capsule endoscopy, after a negative colonoscopy (compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowel lesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy. RESULTS: Forty (67%) cases and 18 (30%) controls presented small bowel erosions (P = 0.0001), while 22 (37%) cases and 4 (8%) controls presented small bowel ulcers (P < 0.0001). Among non-steroidal anti-inflammatory drug (NSAID) consumers, 39 (95%) cases and 17 (33%) controls presented small bowel erosions (P < 0.0001), while 22 (55%) cases and 4 (10%) controls presented small bowel ulcers (P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3 (SD = 1.4) g/dL in cases with small bowel ulcerative lesions and 10.5 (SD = 1.3) g/dL in those without (P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6 (27%) cases with small bowel ulcers presented

  6. Novel strategies for the treatment of inflammatory bowel disease: Selective inhibition of cytokines and adhesion molecules

    PubMed Central

    Nakamura, Kazuhiko; Honda, Kuniomi; Mizutani, Takahiro; Akiho, Hirotada; Harada, Naohiko

    2006-01-01

    The etiology of inflammatory bowel disease (IBD) has not yet been clarified and immunosuppressive agents which non-specifically reduce inflammation and immunity have been used in the conventional therapies for IBD. Evidence indicates that a dysregulation of mucosal immunity in the gut of IBD causes an overproduction of inflammatory cytokines and trafficking of effector leukocytes into the bowel, thus leading to an uncontrolled intestinal inflammation. Such recent advances in the understanding of the pathogenesis of IBD created a recent trend of novel biological therapies which specifically inhibit the molecules involved in the inflammatory cascade. Major targets for such treatment are inflammatory cytokines and their receptors, and adhesion molecules. A chimeric anti-TNF-α monoclonal antibody, infliximab, has become a standard therapy for CD and it is also likely to be beneficial for UC. Several anti-TNF reagents have been developed but most of them seem to not be as efficacious as infliximab. A humanized anti-TNF monoclonal antibody, adalimumab may be useful for the treatment of patients who lost responsiveness or developed intolerance to infliximab. Antibodies against IL-12 p40 and IL-6 receptor could be alternative new anti-cytokine therapies for IBD. Anti-interferon-γ and anti-CD25 therapies were developed, but the benefit of these agents has not yet been established. The selective blocking of migration of leukocytes into intestine seems to be a nice approach. Antibodies against α4 integrin and α4β7 integrin showed benefit for IBD. Antisense oligonucleotide of intercellular adhesion molecule 1 (ICAM-1) may be efficacious for IBD. Clinical trials of such compounds have been either recently reported or are currently underway. In this article, we review the efficacy and safety of such novel biological therapies for IBD. PMID:16937430

  7. Ultrasonographic appearance of Ascaris lumbricoides in the small bowel.

    PubMed

    Mahmood, T; Mansoor, N; Quraishy, S; Ilyas, M; Hussain, S

    2001-03-01

    Roundworm infestation, one of the most common helminthic diseases worldwide, is caused by Ascaris lumbricoides, one of the largest parasites that infests the human bowel. A lumbricoides is virtually universal at some stage of childhood in semitropical and tropical regions. This study describes our experience with the ultrasonographic appearance of intestinal ascariasis in 84 patients, 2.5 to 42 years of age, examined over 2 years beginning October 1997. The patients' conditions ranged from acute intestinal obstruction to no clinical features pertaining to obstruction. Ultrasonographic examination was performed with an Echocee power Doppler real-time unit with a variable-frequency 3.7-MHz convex, 7.5-MHz linear probe. In longitudinal section the Ascaris worm presented as a linear intraluminal mass with 3 or 4 linear echogenic interfaces; in the cross section, it was round, sometimes appearing as a "target" sign. Some worms also showed serpentine movements. Sonographic examination of the patients in the left lateral decubitus position after ingestion of water improved detection and visualization of the worms in some cases. It is concluded that A lumbricoides in the small bowel has a sonographic appearance that can be recognized by the wary observer. PMID:11270532

  8. [Indications and results of small bowel transplantation in adults].

    PubMed

    Joly, Francisca; Panis, Yves

    2012-02-01

    immunosuppression to control rejection. By 1990, the development of tacrolimus-based immunosuppression, as well as improved surgical techniques, the increased array of potent immunosuppressive medications, infection prophylaxis, and better patient selection helped to improve actuarial graft and patient survival rates for all types of intestine transplantation. In adult intestinal transplantation, three kinds of graft can be proposed: isolated small bowel, combined liver and small bowel, and multivisceral transplantation. In isolated small bowel transplantation, the length of the graft ranges between 1.5 and 2 meters, but depends on the size of the recipient (and the abdominal cavity volume, which is reduced). The graft is anastomosed with the recipient's duodenum or remnant proximal jejunum. the distal part of the small bowel graft is on a temporary stoma, in order to allow biopsies for early detection of rejection. Vascular anastomoses are usually performed directly on the aorta for the superior mesenteric artery and either the recipient's portal vein or vena cava for the donor superior mesenteric vein. In combined liver and intestinal transplantation, one venous anastomosis is avoided because the graft is in one piece. Finally, one specificity of this transplantation is the fact that it usually concerns patients with numerous previous abdominal operations and with total or subtotal enterectomy. Thus, the residual abdominal cavity is usually very small, and this can be a major problem for graft insertion. For this reason, abdominal closure is performed with a temporary prosthesis, because even cutaneous closure remains impossible if a compartment syndrome is to be avoided. PMID:23420959

  9. Advances in small bowel neuroendocrine neoplasia Banck and Small intestine

    PubMed Central

    Banck, Michaela S.; Beutler, Andreas S.

    2015-01-01

    Purpose of review this review aims at summarizing progress in clinical trials and basic science redefining the diagnosis and treatment of well differentiated small intestine neuroendocrine tumors (SI-NET). Recent findings Two clinical trials demonstrated antitumor activity of the long-acting somatostatin analogues octreotide LAR and lanreotide for advanced SI-NET. The mTOR inhibitor everolimus is another treatment option for patients with SI-NET, but awaits definitive proof of benefit in the ongoing RADIANT-4 study. Two whole exome/genome-sequencing studies reported in the past year provided the first genome-wide analysis of large sets of SI-NET at nucleotide resolution. Candidate therapeutically relevant alterations were found to affect SRC, SMAD genes, AURKA, EGFR, HSP90, and PDGFR as well as mutually exclusive amplification of AKT1 or AKT2 and other alterations of PI3K/Akt/mTOR signaling genes. The gene CDKN1B is inactivated by small insertions/deletions in 8% of patients with SI-NET suggesting cell cycle inhibitors as new candidate drugs for SI-NET. Circulating tumor cells and tumor-derived RNA in the blood are promising clinical tests for SI-NET. Summary Clinical and genomic research may merge in the near future to re-shape clinical trials and to define the ‘personalized’ treatment options for patients with SI-NET. PMID:24441281

  10. Incarcerated Trocar Site Herniation of the Small Bowel following Laparoscopic Myomectomy

    PubMed Central

    Zomer, Monica Tessmann; de Azevedo, Rafael Menezes

    2013-01-01

    Small bowel herniation through the fascial defect created by the entry of trocars is one of the major complications of the laparoscopic surgery. In this paper, we describe a 42-year-old woman developing an incarcerated trocar site herniation of the small bowel following laparoscopic myomectomy and treated by laparoscopic approach. PMID:23956895

  11. Small bowel obstruction secondary to transport aircraft: coincidence or reality?

    PubMed

    Massalou, D; Fournier, M; Salucki, B; Baqué, P

    2013-09-01

    Small bowel obstructions (SBO) are a leading cause of admission to general surgery, posing the problem of the aetiology and treatment based on the diagnosis. More than 300 patients were admitted for SBO in 2011 in our institution. In our clinical practice, we have had to care for patients with SBO immediately after air travel, all of whom had an antecedent of abdominal surgery by laparotomy. The finding of episodes of acute SBO immediately following a commercial flight has never been reported in the literature. We report the cases of four patients for whom we offer several pathophysiological hypotheses, and we publish the first dietary rules for people with a history of intraperitoneal surgery to adopt during a flight. PMID:23806628

  12. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen.

    PubMed

    Colak, Tahsin; Olmez, Tolga; Turkmenoglu, Ozgur; Dag, Ahmet

    2013-01-01

    Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT). The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB) complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass. PMID:24288645

  13. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen

    PubMed Central

    Turkmenoglu, Ozgur; Dag, Ahmet

    2013-01-01

    Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT). The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB) complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass. PMID:24288645

  14. Wernicke-Korsakoff syndrome following small bowel obstruction.

    PubMed

    Deb, S; Law-Min, R; Fearnley, D

    We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention. PMID:12446948

  15. Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction

    PubMed Central

    Bray Madoué, Kaimba; Boniface, Moifo; Annick Laure, Edzimbi; Pierre, Herve

    2016-01-01

    Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil. PMID:27066288

  16. Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction.

    PubMed

    Bray Madoué, Kaimba; Boniface, Moifo; Annick Laure, Edzimbi; Pierre, Herve

    2016-01-01

    Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil. PMID:27066288

  17. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    PubMed

    Pennazio, Marco; Spada, Cristiano; Eliakim, Rami; Keuchel, Martin; May, Andrea; Mulder, Chris J; Rondonotti, Emanuele; Adler, Samuel N; Albert, Joerg; Baltes, Peter; Barbaro, Federico; Cellier, Christophe; Charton, Jean Pierre; Delvaux, Michel; Despott, Edward J; Domagk, Dirk; Klein, Amir; McAlindon, Mark; Rosa, Bruno; Rowse, Georgina; Sanders, David S; Saurin, Jean Christophe; Sidhu, Reena; Dumonceau, Jean-Marc; Hassan, Cesare; Gralnek, Ian M

    2015-04-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule

  18. Small bowel capsule endoscopy: Where are we after almost 15 years of use?

    PubMed Central

    Van de Bruaene, Cedric; De Looze, Danny; Hindryckx, Pieter

    2015-01-01

    The development of capsule endoscopy (CE) in 2001 has given gastroenterologists the opportunity to investigate the small bowel in a non-invasive way. CE is most commonly performed for obscure gastrointestinal bleeding, but other indications include diagnosis or follow-up of Crohn’s disease, suspicion of a small bowel tumor, diagnosis and surveillance of hereditary polyposis syndromes, Nonsteroidal anti-inflammatory drug-induced small bowel lesions and celiac disease. Almost fifteen years have passed since the release of the small bowel capsule. The purpose of this review is to offer the reader a brief but complete overview on small bowel CE anno 2014, including the technical and procedural aspects, the possible complications and the most important indications. We will end with some future perspectives of CE. PMID:25610531

  19. Pilot study of small bowel mucosal gene expression in patients with irritable bowel syndrome with diarrhea.

    PubMed

    Camilleri, Michael; Carlson, Paula; Valentin, Nelson; Acosta, Andres; O'Neill, Jessica; Eckert, Deborah; Dyer, Roy; Na, Jie; Klee, Eric W; Murray, Joseph A

    2016-09-01

    Prior studies in with irritable bowel syndrome with diarrhea (IBS-D) patients showed immune activation, secretion, and barrier dysfunction in jejunal or colorectal mucosa. We measured mRNA expression by RT-PCR of 91 genes reflecting tight junction proteins, chemokines, innate immunity, ion channels, transmitters, housekeeping genes, and controls for DNA contamination and PCR efficiency in small intestinal mucosa from 15 IBS-D and 7 controls (biopsies negative for celiac disease). Fold change was calculated using 2((-ΔΔCT)) formula. Nominal P values (P < 0.05) were interpreted with false detection rate (FDR) correction (q value). Cluster analysis with Lens for Enrichment and Network Studies (LENS) explored connectivity of mechanisms. Upregulated genes (uncorrected P < 0.05) were related to ion transport (INADL, MAGI1, and SONS1), barrier (TJP1, 2, and 3 and CLDN) or immune functions (TLR3, IL15, and MAPKAPK5), or histamine metabolism (HNMT); downregulated genes were related to immune function (IL-1β, TGF-β1, and CCL20) or antigen detection (TLR1 and 8). The following genes were significantly upregulated (q < 0.05) in IBS-D: INADL, MAGI1, PPP2R5C, MAPKAPK5, TLR3, and IL-15. Among the 14 nominally upregulated genes, there was clustering of barrier and PDZ domains (TJP1, TJP2, TJP3, CLDN4, INADL, and MAGI1) and clustering of downregulated genes (CCL20, TLR1, IL1B, and TLR8). Protein expression of PPP2R5C in nuclear lysates was greater in patients with IBS-D and controls. There was increase in INADL protein (median 9.4 ng/ml) in patients with IBS-D relative to controls (median 5.8 ng/ml, P > 0.05). In conclusion, altered transcriptome (and to lesser extent protein) expression of ion transport, barrier, immune, and mast cell mechanisms in small bowel may reflect different alterations in function and deserves further study in IBS-D. PMID:27445342

  20. Factors Associated With Small Bowel Obstruction Following Appendectomy: A Population-Based Study.

    PubMed

    Tseng, Chien-Jen; Sun, Ding-Ping; Lee, I-Chen; Weng, Shih-Feng; Chou, Chia-Lin

    2016-05-01

    Postoperative small bowel obstruction (SBO) is a common complication of appendectomy. This study aimed to assess risk factors for SBO following appendectomy.This retrospective cohort study used the 2006 to 2008 Taiwan National Health Insurance Research Database. We evaluated adult patients with acute appendicitis who underwent open (OA) or laparoscopic appendectomy (LA) between January 1, 2006 and December 31, 2008. Excluded were patients with a history of abdominal surgery and SBO before the index operation, or abdominal surgery between the appendectomy and initial diagnosis of bowel obstruction as an identifiable cause of SBO. Factors thought to influence postoperative SBO were highlighted. The OA and LA cohorts were matched by propensity score, and the hazard ratios (HRs) and 95% confidence interval (CIs) of SBO were calculated.We enrolled 11,289 patients who underwent OA, and 11,289 matched controls who underwent LA. OA patients had significant risk of adhesive SBO compared with the LA group (adjusted HR: 1.7, 95% CI: 1.11-2.63). Further analysis revealed that that female sex (adjusted HR: 1.79, 95% CI: 1.17-2.72), CCI score of 1 or ≥2 (adjusted HR: 3.16, 95% CI: 1.76-5.67; adjusted HR: 4.03, 95% CI: 1.57-10.34), complicated appendicitis (adjusted HR: 1.68, 95% CI: 1.05-2.69), treatment in district hospitals increased risk of adhesive SBO.Female sex, complicated appendicitis, more comorbidities, and treatment in district hospitals are factors associated with a risk of SBO after appendectomy. Our findings confirmed that a laparoscopic approach is better than an open approach. PMID:27149462

  1. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass

    PubMed Central

    Green, Jessica; Ikuine, Tomoko; Hacker, Shoshana; Urrego, Hernan; Tuggle, Karleena

    2016-01-01

    Small bowel obstructions (SBOs) are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot. We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding. Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. PMID:27554828

  2. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass.

    PubMed

    Green, Jessica; Ikuine, Tomoko; Hacker, Shoshana; Urrego, Hernan; Tuggle, Karleena

    2016-01-01

    Small bowel obstructions (SBOs) are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot. We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding. Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. PMID:27554828

  3. Early Adaptation of Small Intestine After Massive Small Bowel Resection in Rats

    PubMed Central

    Chen, Jie; Qin, Zhen; Shan, Hongmei; Xiao, Yongtao; Cai, Wei

    2015-01-01

    Background: It is important that the residual bowel adapts after massive resection. The necessary intestinal adaptation is a progressive recovery from intestinal failure through increase in absorptive surface area and functional capacity and includes both morphological and functional adaptations. Objectives: The aim of this study was to investigate intestinal morphological and functional adaptations of small bowel syndrome (SBS) model rats (SBS1W) 7 days after bowel resection. Materials and Methods: Male sprague–dawley rats (n = 20/group) underwent either a 75% proximal small bowel resection (SBS1W group) or a control operation (control group). Markers of morphological adaptation were revealed by TEM analysis of H&E-stained tissue samples. The intestinal barrier condition was assessed by BT, and sIgA concentration in intestinal mucus was measured by ELISA. Contractility and the slow wave rhythm of the entire intestinal remnant were measured and recorded. Results: The SBS1W group experienced more weight loss than control group and had a clearly different intestinal morphology as revealed in TEM images. Compared with control rats, the SBS1W group had a lower sIgA concentration in intestinal mucus and higher BT to lymph nodes (70% vs 40%; level I), portal blood (40% vs 10%; level II), and peripheral blood (60% vs 30%; level III). Disorder of spontaneous rhythmic contraction, irregular amplitude, and slow frequency were detected in the SBS1W group by a muscle strips test. Similarly, the slow wave of the entire intestinal remnant in the SBS1W group was irregular and uncoordinated. Conclusions: The finding of intestinal adaptation following massive SBR in SBS1W rats provides more understanding of the mechanisms of progressive recovery from the intestinal failure that underlies SBS. The mechanical, chemical, immunological, and biological barriers were all impaired at 7 days following bowel resection, indicating that the SBS model rats were still in the intestinal

  4. Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.

    PubMed

    Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

    2016-07-01

    In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001).Currently active disease, ileostomy, and remnant small

  5. Reducing false positives of small bowel segmentation on CT scans by localizing colon regions

    NASA Astrophysics Data System (ADS)

    Zhang, Weidong; Liu, Jiamin; Yao, Jianhua; Summers, Ronald M.

    2014-03-01

    Automated small bowel segmentation is essential for computer-aided diagnosis (CAD) of small bowel pathology, such as tumor detection and pre-operative planning. We previously proposed a method to segment the small bowel using the mesenteric vasculature as a roadmap. The method performed well on small bowel segmentation but produced many false positives, most of which were located on the colon. To improve the accuracy of small bowel segmentation, we propose a semi-automated method with minimum interaction to distinguish the colon from the small bowel. The method utilizes anatomic knowledge about the mesenteric vasculature and a statistical method of colon detection. First, anatomic labeling of the mesenteric arteries is used to identify the arteries supplying the colon. Second, a statistical detector is created by combining two colon probability maps. One probability map is of the colon location and is generated from colon centerlines generated from CT colonography (CTC) data. Another probability map is of 3D colon texture using Haralick features and support vector machine (SVM) classifiers. The two probability maps are combined to localize colon regions, i.e., voxels having high probabilities on both maps were labeled as colon. Third, colon regions identified by anatomical labeling and the statistical detector are removed from the original results of small bowel segmentation. The method was evaluated on 11 abdominal CT scans of patients suspected of having carcinoid tumors. The reference standard consisted of manually-labeled small bowel segmentation. The method reduced the voxel-based false positive rate of small bowel segmentation from 19.7%±3.9% to 5.9%±2.3%, with two-tailed P-value < 0.0001.

  6. [Non-small bowel lesions detected with capsule endoscopy in patients with obscure gastrointestinal bleeding].

    PubMed

    Juanmartiñena Fernández, J F; Fernández-Urién, I; Saldaña Dueñas, C; Elosua González, A; Borda Martín, A; Vila Costas, J J

    Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule en-doscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. Howe-ver, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST. PMID:27599960

  7. Fetal primary small bowel volvulus in a child without intestinal malrotation.

    PubMed

    Chung, Jae Hee; Lim, Gye-Yeon; We, Ji Sun

    2013-07-01

    Fetal primary small bowel volvulus without atresia or malrotation is an extremely rare but life-threatening surgical emergency. We report a case of primary small bowel volvulus that presented as sudden fetal distress and was diagnosed on the basis of the 'whirl-pool sign' of fetal sonography. This diagnosis led to emergency operation after birth at the third trimester with a good outcome. Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology. PMID:23895987

  8. Small bowel intussusception with the Meckel's diverticulum after blunt abdominal trauma: a case report

    PubMed Central

    Benjelloun, El Bachir; Ousadden, Abdelmalek; Ibnmajdoub, Karim; Mazaz, Khalid; Taleb, Khalid Ait

    2009-01-01

    Intussusception with the Meckel's diverticulum is a rare but well-known cause of small bowel obstruction in the adult. After blunt abdominal trauma, intussusception is exceedingly rare and has been reported previously only in few cases. We present a case of a previously healthy 28-year-old man developing four days after blunt abdominal trauma signs of small bowel obstruction. Ileo-ileal intussusception was suggested by computed tomography. Exploration revealed ileo-ileal intussusception with Meckel's diverticulum. A diverticulectomy with small bowel resection was performed. PMID:19419572

  9. Thrombocytosis and small bowel perforation: unusual presentation of abdominopelvic actinomycosis.

    PubMed

    Desteli, Güldeniz Aksan; Gürsu, Tvrkan; Bircan, Hüseyin Yüce; Kızılkılıç, Ebru; Demiralay, Ebru; Timurkaynak, Funda

    2013-12-01

    Intrauterine devices (IUD) are frequently used as a family planning procedure in developing countries because they are easy to administer and governmental policies support their use in many countries. It is recommended that IUDs be removed or replaced after 10 years, but longer use is common, especially in developing countries. In some cases, rare infections such as pelvic inflammatory diseases, pelvic tuberculosis, or abdominopelvic actinomycosis related to IUD can develop. Pelvic actinomycosis is a rare disease and is often diagnosed incidentally during surgery. In recent years, there has been an increase in actinomycotic infections mostly due to long-term usage of IUD and forgotten intravaginal pessaries. It usually develops as an ascending infection. It is usually associated with non-specific symptoms such as lower abdominal pain, menstrual disturbances, fever, and vaginal discharge. The disease is sometimes asymptomatic. The rate of accurate preoperative diagnosis for pelvic actinomycosis is less than 10%, and symptoms and imaging studies sometimes mimic pelvic malignancy. This report details a case with abdominopelvic actinomycosis associated with an IUD presenting with highly elevated thromboctye count and small bowel perforation with abscess formation. PMID:24334952

  10. Small bowel carcinoid: Location isn’t everything!

    PubMed Central

    Hari, Danielle M; Goff, Stephanie L; Reich, Heidi J; Leung, Anna M; Sim, Myung-Shin; Lee, Ji Hey; Wolin, Edward; Amersi, Farin

    2013-01-01

    AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid (SBC) using a population-based analysis. METHODS: The Surveillance, Epidemiology and End Results (SEER) database was queried for histologically confirmed SBC between the years 1988 and 2009. Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method and compared using Log rank testing. Log rank and multivariate Cox regression analyses were used to identify predictors of survival using age, year of diagnosis, race, gender, tumor histology/size/location, tumor-node-metastasis stage, number of lymph nodes (LNs) examined and percent of LNs with metastases. RESULTS: Of the 3763 patients, 51.2% were male with a mean age of 62.13 years. Median follow-up was 50 mo. The 10-year OS and DSS for duodenal primaries were significantly better when compared to jejunal and ileal primaries (P = 0.02 and < 0.0001, respectively). On multivariate Cox regression analysis, after adjusting for multiple factors, primary site location was not a significant predictor of survival (P = 0.752 for OS and P = 0.966 DSS) while age, number of primaries, number of LNs examined, T-stage and M-stage were independent predictors of survival. CONCLUSION: This 21-year, population-based study of SBC challenges the concept that location of the primary lesion alone is a significant predictor of survival. PMID:23983905

  11. Increased permeability of macroscopically normal small bowel in Crohn's disease.

    PubMed

    Peeters, M; Ghoos, Y; Maes, B; Hiele, M; Geboes, K; Vantrappen, G; Rutgeerts, P

    1994-10-01

    To investigate permeability alterations of the macroscopically normal jejunum in Crohn's disease, the permeation of two probes was measured during perfusion of an isolated jejunal segment. The data were compared with the results obtained by the standard per oral test in the same patients. Test probes were PEG-400 and [51Cr]EDTA. Ten normal individuals, 12 patients with Crohn's ileitis or ileocolitis, and seven patients with isolated Crohn's colitis all with normal jejunum on x-ray series were studied. Upon perfusion of the proximal small bowel, the 3-hr [51Cr]EDTA excretion was significantly increased in ileitis patients (P = 0.023) as compared to normals. The excretion exceeded the highest value of normals in eight of 12 ileitis patients. The excretion in Crohn's colitis patients was not significantly increased (P = 0.24) and abnormal excretion was found only in one of the Crohn's colitis patients. PEG-400 permeation during perfusion did not differentiate between the groups, but five of the seven patients with isolated Crohn's colitis had PEG-400 excretion exceeding the highest value in normals. Overall, 13 of the 19 patients had increased permeation of one of the two probes through jejunal mucosa during perfusion. These data suggest that the permeability is increased in the majority of patients even in segments that seem normal on x-ray. PMID:7924738

  12. Small bowel imaging-- a rapidly changing field and a challenge to radiology.

    PubMed

    Maglinte, Dean D T

    2006-05-01

    There was a time when the small bowel follow-through (SBFT) was the primary method of diagnosing diseases of the small intestine. Enteroclysis was reinvented in the 70's and with the SBFT remained the dominant methods of investigating the mesenteric small intestine to the late 90's. Since the introduction of the first commercial computed tomography (CT) scanner in 1973, the ability of monoslice CT to diagnose different causes of intestinal obstruction and inflammatory bowel diseases emerged. The introduction of helical CT technology in 1989 and subsequently multichannel CT further changed small bowel imaging. Faster acquisition of a large volume of data with thinner collimation allowed multiplanar reformatting a distinct advantage in evaluating an organ which is longer than wide. The introduction of magnetic resonance (MR) imaging with its increased soft tissue contrast, lack of ionizing radiation, and the ability to acquire ultrafast sequences has made MR imaging an important tool in small bowel imaging (1). PMID:16395533

  13. Two cases of small bowel obstruction secondary to a swallowed potato.

    PubMed

    Castren, E; Hakeem, A; Mahmood, N S; Aryal, K

    2015-01-01

    Bowel obstruction due to bezoars (compaction of ingested material within the gastrointestinal tract) is a rare, but well documented occurrence. In this paper, we present two cases of potato-induced small bowel obstruction. Both patients were approximately 50 years old and had cerebral palsy and learning disabilities, respectively. They presented with abdominal pain and bilious vomiting, with no medical or surgical history. Diagnosis of small bowel obstruction was confirmed by CT prior to taking the patients to the operating theatre, where whole potatoes were found to be obstructing each patient's bowel lumen. Both patients underwent laparotomy with enterotomy and removal of the potato. They both made a good recovery. Through a literature review of bezoar-induced bowel obstruction, these cases highlight important diagnostic and management principles. PMID:26689254

  14. Minimization of small bowel volume within treatment fields utilizing customized belly boards

    SciTech Connect

    Shanahan, T.G.; Mehta, M.P.; Bertelrud, K.L.; Buchler, D.A.; Frank, L.E.; Gehring, M.A.; Kubsad, S.S.; Utrie, P.C.; Kinsella, T.J. )

    1990-08-01

    Thirty consecutive patients with pelvic malignancies were evaluated prospectively for the impact of a novel bowel minimization device (belly board) on the volume of small bowel included within a four field pelvic radiation plan. A customized polyurethane and styrofoam bowel immobilization mold was created for each patient in the prone position. Using contrast enhanced CT scanning on a dedicated radiation treatment planning scanner, we imaged the location of the small intestine in the supine position and the prone position aided by the belly board. Custom in-house interactive image analysis software was developed to allow volumetric determination of small bowel within the treatment portals. The mean small bowel volume was reduced by 66% (299 cm3 to 102 cm3), comparing the standard supine position to the prone position assisted by the belly board. In 13 patients without prior pelvic surgery, the small bowel volume reduction was a more dramatic 74% (334 cm3 to 88 cm3). All patients were found to benefit from this prone belly board setup regardless of body habitus, weight, and age. Compliance with the set-up including use of bladder distension was excellent. All patients completed their pelvic radiotherapy without requiring a treatment break. Weight loss at completion averaged less than 5%. Seventy-six percent of patients experienced little or no diarrhea. This technique is comfortable, inexpensive, highly reproducible, and permits maximal bowel displacement from standard pelvic radiotherapy fields.

  15. Coffee Enema for Preparation for Small Bowel Video Capsule Endoscopy: A Pilot Study

    PubMed Central

    Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck; Ryu, Ho Sang

    2014-01-01

    Coffee enemas are believed to cause dilatation of bile ducts and excretion of bile through the colon wall. Proponents of coffee enemas claim that the cafestol palmitate in coffee enhances the activity of glutathione S-transferase, an enzyme that stimulates bile excretion. During video capsule endoscopy (VCE), excreted bile is one of the causes of poor preparation of the small bowel. This study aimed to evaluate the feasibility and effect of coffee enema for preparation of the small bowel during VCE. In this pilot study, 17 of 34 patients were assigned to the coffee enema plus polyethylene glycol (PEG) 2 L ingestion group, whereas the 17 remaining control patients received 2 L of PEG only. The quality of bowel preparation was evaluated in the two patient groups. Bowel preparations in the proximal segments of small bowel were not differ between two groups. In the mid and distal segments of the small intestine, bowel preparations tend to be better in patients who received coffee enemas plus PEG than in patients who received PEG only. The coffee enema group did not experience any complications or side effects. Coffee enemas may be a feasible option, and there were no clinically significant adverse events related to coffee enemas. More prospective randomized studies are warranted to improve small bowel preparation for VCE. PMID:25136541

  16. Genetic risks and familial associations of small bowel carcinoma

    PubMed Central

    Shenoy, Santosh

    2016-01-01

    Adenocarcinoma of small intestines (SBA) is a relatively rare malignancy with poor outcomes due to delayed diagnosis. Fifty percent of patients have metastases on presentation and therefore early detection and treatment offers the best long term outcomes. Certain genetic polyposis syndromes and familial diseases are associated with increased risks for SBA. These include familial adenomatous polyposis (FAP), Lynch syndromes (LS), Juvenile polyposis syndrome, Peutz-Jeghers syndrome, Crohn’s disease (CD) and celiac disease. Mutations in APC gene, Mismatch repair genes, STK11 gene, and SMAD4 gene have been implicated for the genetic diseases respectively. While there are no specific inherited genetic mutations for CD, genome-wide association studies have established over 140 loci associated with CD. CpG island mutations with defects in mismatch repair genes have been identified in celiac disease. Significant diagnostic advances have occurred in the past decade and intuitively, it would seem beneficial to use these advanced modalities for surveillance of these patients. At present it is debatable and no clear data exists to support this approach except for established guidelines to diagnose duodenal polyps in FAP, and LS. Here we discuss the genetic alterations, cancer risks, signaling mechanisms and briefly touch the surveillance modalities available for these genetic and clinical syndromes. English language articles from PubMed/Medline and Embase was searched were collected using the phrases “small-bowel adenocarcinoma, genetics, surveillance, familial adenomatous polyposis, lynch syndromes, Peutz-Jeghers syndrome, juvenile polyposis syndrome, CD and celiac disease”. Figures, tables and schematic diagram to illustrate pathways are included in the review. PMID:27326320

  17. Genetic risks and familial associations of small bowel carcinoma.

    PubMed

    Shenoy, Santosh

    2016-06-15

    Adenocarcinoma of small intestines (SBA) is a relatively rare malignancy with poor outcomes due to delayed diagnosis. Fifty percent of patients have metastases on presentation and therefore early detection and treatment offers the best long term outcomes. Certain genetic polyposis syndromes and familial diseases are associated with increased risks for SBA. These include familial adenomatous polyposis (FAP), Lynch syndromes (LS), Juvenile polyposis syndrome, Peutz-Jeghers syndrome, Crohn's disease (CD) and celiac disease. Mutations in APC gene, Mismatch repair genes, STK11 gene, and SMAD4 gene have been implicated for the genetic diseases respectively. While there are no specific inherited genetic mutations for CD, genome-wide association studies have established over 140 loci associated with CD. CpG island mutations with defects in mismatch repair genes have been identified in celiac disease. Significant diagnostic advances have occurred in the past decade and intuitively, it would seem beneficial to use these advanced modalities for surveillance of these patients. At present it is debatable and no clear data exists to support this approach except for established guidelines to diagnose duodenal polyps in FAP, and LS. Here we discuss the genetic alterations, cancer risks, signaling mechanisms and briefly touch the surveillance modalities available for these genetic and clinical syndromes. English language articles from PubMed/Medline and Embase was searched were collected using the phrases "small-bowel adenocarcinoma, genetics, surveillance, familial adenomatous polyposis, lynch syndromes, Peutz-Jeghers syndrome, juvenile polyposis syndrome, CD and celiac disease". Figures, tables and schematic diagram to illustrate pathways are included in the review. PMID:27326320

  18. A concealed small bowel perforation in an adult secondary to bicycle handlebar trauma

    PubMed Central

    Nolan, GJ; Simpson, RR

    2013-01-01

    Traumatic abdominal wall hernia (TAWH) secondary to bicycle handlebar is a rare injury. The majority of the literature describes abdominal wall herniation in children. We present a rare case of TAWH in an adult with a concealed small bowel perforation. Although clinical examination in conjunction with computed tomography can exclude the majority of solid organ injuries, small bowel injuries can often be missed. Our case initially revealed a serosal tear in the small bowel but, on close inspection, a separate 3mm perforation was identified, hidden in the small bowel mesentery. We strongly support a low threshold for operative intervention if there is any suspicion. Moreover, we stress the importance of meticulous examination during laparotomy as this injury could have been easily missed, resulting in potential morbidity or mortality in a patient sustaining such an injury. PMID:23676803

  19. Does transperitoneal minimally invasive radical prostatectomy increase the amount of small bowel receiving salvage radiation?

    PubMed Central

    Luz, Murilo A.; Pra, Alan Dal; Tu, Hin-Yu Vincent; Duclos, Marie; Cury, Fabio L.B.; Bachir, Bassel G.; Aprikian, Armen G.; Tanguay, Simon; Kassouf, Wassim

    2013-01-01

    Introduction: Transperitoneal minimally invasive radical prostatectomy (MIRP) has become first choice for several urologists and patients dealing with localized prostate cancer. We evaluate the effect of postoperative radiation on the small bowel in patients who underwent extraperitoneal open versus transperitoneal MIRP. Methods: We reviewed all patients who received postoperative radiation from 2006 to 2010. Planning target volume (PTV) and surrounding organs, including the small bowel, were delineated. The presence of the small bowel in PTV and its volume in receiving each dose level were analyzed. Results: A total of 122 patients were included: 26 underwent MIRP and 96 underwent open prostatectomy. The median age of patients was 66 years, with median body mass index 27 kg/m2. The total PTV dose was 66 Gy, with the minimum and maximum doses received by the small bowel 0.4 and 66.4 Gy, respectively. The maximum volume of small bowel that received the safe limit of 40 Gy was 569 cm3. Of the 26 patients who underwent MIRP, 12 (46%) had small bowel identified inside the PTV compared to 57 (59%) among patients who underwent open prostatectomy (p = 0.228). The mean volume of the small bowel receiving 40 Gy was 26 and 67 cm3 in open and MIRP groups, respectively (p = 0.006); the incidence of acute complications was the same in both groups. Conclusions: Higher volumes of the small bowel are subjected to significant radiation after MIRP procedures compared to open procedures; however, we could not demonstrate any impact on acute complications. Whether there is a difference in late complications remains to be evaluated. PMID:24381666

  20. Risk factors for small bowel angioectasia: The impact of visceral fat accumulation

    PubMed Central

    Yamada, Atsuo; Niikura, Ryota; Kobayashi, Yuka; Suzuki, Hirobumi; Yoshida, Shuntaro; Watabe, Hirotsugu; Yamaji, Yutaka; Hirata, Yoshihiro; Koike, Kazuhiko

    2015-01-01

    AIM: To investigate visceral fat accumulation in association with the risk of small bowel angioectasia. METHODS: We retrospectively investigated 198 consecutive patients who underwent both capsule endoscopy and CT for investigation of obscure gastrointestinal bleeding (OGIB) from January 2009 to September 2013. The visceral fat area (VFA) and subcutaneous fat area were measured by CT, and information on comorbidities, body mass index, and medications was obtained from their medical records. Logistic regression analysis was used to evaluate associations. RESULTS: Capsule endoscopy revealed small bowel angioectasia in 18/198 (9.1%) patients with OGIB. Compared to patients without small bowel angioectasia, those with small bowel angioectasia had a significantly higher VFA (96 ± 76.0 cm2 vs 63.4 ± 51.5 cm2, P = 0.016) and a higher prevalence of liver cirrhosis (61% vs 22%, P < 0.001). The proportion of patients with chronic renal failure was higher in patients with small bowel angioectasia (22% vs 9%, P = 0.11). There were no significant differences in subcutaneous fat area or waist circumference. The prevalence of small bowel angioectasia progressively increased according to the VFA. Multivariate analysis showed that the VFA [odd ratio (OR) for each 10-cm2 increment = 1.1; [95% confidence interval (CI): 1.02-1.19; P = 0.021] and liver cirrhosis (OR = 6.1, 95%CI: 2.2-18.5; P < 0.001) were significant risk factors for small bowel angioectasia. CONCLUSION: VFA is positively associated with the prevalence of small bowel angioectasia, for which VFA and liver cirrhosis are independent risk factors in patients with OGIB. PMID:26109811

  1. Small bowel obstruction due to phytobezoar formation within meckel diverticulum: CT findings

    SciTech Connect

    Frazzini, V.I. Jr.; English, W.J.; Bashist, B.; Moore, E.

    1996-05-01

    Intestinal obstruction due to a phytobezoar within a Meckel diverticulum is exceedingly rare, with only seven reported cases in the surgical literature. The most important precipitating factor is the ingestion of agents high in fiber and cellulose. Small bowel obstruction in all but one case was due to retrograde propagation of the bezoar into the small bowel lumen. We report the clinical and CT findings in such a patient following a vegetarian diet. 14 refs., 2 figs.

  2. Small Bowel Neuroendocrine Tumors with Inguinal Metastases: A Diagnostic and Therapeutic Dilemma

    PubMed Central

    Daly, Kevin P; Askarian, Farhad; Saif, Muhammad W

    2016-01-01

    Small bowel neuroendocrine tumors (NETs) are frequently characterized by a strong propensity to metastasize to the liver, mesentery, and peritoneum. However, only a few extra-abdominal metastatic sites have been reported in the published literature. The present paper implicates that primary small bowel NETs may unusually metastasize to the inguinal lymph nodes. Furthermore, we discuss the formidable diagnostic and therapeutic challenges associated with the metastatic NETs. PMID:27555990

  3. Single-incision laparoscopic resection of small bowel tumours: Making it easier for patient and surgeon

    PubMed Central

    Nickerson, Terry P.; Aho, Johnathon M.; Bingener, Juliane

    2016-01-01

    BACKGROUND: Patients with small bowel tumours frequently require surgical intervention. Minimally invasive techniques require advanced skills and may not be offered to many patients. We present a laparoscopic single-incision technique that is minimally invasive without requiring intracorporeal anastomosis. MATERIALS AND METHODS: The cases of all patients with laparoscopic small bowel resections performed by one surgeon from 2008 to 2012 were reviewed. A single-port technique was introduced after it became available at our institution in 2009. Before that, conventional laparoscopy (LAP) was performed with extension of the periumbilical incision to allow externalisation of the bowel. RESULTS: Totally, 10 patients were identified who underwent laparoscopic resection of small bowel tumours: 9 in the small bowel and 1 in the terminal ileum near the cecum. Three tumours were resected before 2009 using LAP, and 7 were resected using the single-port technique. Median length of stay was 3 days, median follow-up was 16.5 months, and no patients had a recurrence. Operative time, post-operative complications, hospital length of stay, and narcotic utilisation were similar between the single-port and traditional laparoscopic groups. CONCLUSION: Laparoscopic removal of small bowel tumours with a small, periumbilical trocar incision is both effective and feasible without advanced technical skill. PMID:27279394

  4. Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns

    PubMed Central

    Gfroerer, Stefan; Metzger, Roman; Fiegel, Henning; Ramachandran, Priya; Rolle, Udo

    2010-01-01

    AIM: To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel atresia. METHODS: Resected small bowel specimens from affected patients (n = 7) were divided into three parts (proximal, atretic, distal). Standard histology and enzyme immunohistochemistry anti-S100, anti-protein gene product (PGP) 9.5, anti-neurofilament (NF), anti-c-kit-receptor (CD117) was carried out on conventional paraffin sections of the proximal and distal part. RESULTS: The neuronal and glial markers (PGP 9.5, NF, S-100) were expressed in hypertrophied ganglia and nerve fibres within the myenteric and submucosal plexuses. Furthermore, the submucous plexus contained typical giant ganglia. The innervation pattern of the proximal bowel resembled intestinal neuronal dysplasia. The density of myenteric ICCs was clearly reduced in the proximal bowel, whereas a moderate number of muscular ICCs were found. The anti-CD117 immunoreaction revealed additional numerous mast cells. The distal bowel demonstrated normal morphology and density of the ENS, the ICCs and the mast cells. CONCLUSION: The proximal and distal bowel in small bowel atresia revealed clear changes in morphology and density of the ENS and ICCs. PMID:21128321

  5. Role of computed tomography angiography in detection and staging of small bowel carcinoid tumors.

    PubMed

    Bonekamp, David; Raman, Siva P; Horton, Karen M; Fishman, Elliot K

    2015-09-28

    Small-bowel carcinoid tumors are the most common form (42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary small bowel neoplasms are overall rare (3%-6% of all gastrointestinal neoplasms), carcinoids still represent the second most common (20%-30%) primary small-bowel malignancy after small bowel adenocarcinoma. Their imaging evaluation is often challenging. State-of-the-art high-resolution multiphasic computed tomography together with advanced postprocessing methods provides an excellent tool for their depiction. The manifold interactive parameter choices however require knowledge of when to use which technique. Here, we discuss the imaging appearance and evaluation of duodenal, jejunal and ileal carcinoid tumors, including the imaging features of the primary tumor, locoregional mesenteric nodal metastases, and distant metastatic disease. A protocol for optimal lesion detection is presented, including the use of computed tomography enterography, volume acquisition, computed tomography angiography and three-dimensional mapping. Imaging findings are illustrated with a series of challenging cases which illustrate the spectrum of possible disease in the small bowel and mesentery, the range of possible appearances in the bowel itself on multiphase data and extraluminal findings such as the desmoplastic reaction in mesentery and hypervascular liver metastases. Typical imaging pitfalls and pearls are illustrated. PMID:26435774

  6. Role of computed tomography angiography in detection and staging of small bowel carcinoid tumors

    PubMed Central

    Bonekamp, David; Raman, Siva P; Horton, Karen M; Fishman, Elliot K

    2015-01-01

    Small-bowel carcinoid tumors are the most common form (42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary small bowel neoplasms are overall rare (3%-6% of all gastrointestinal neoplasms), carcinoids still represent the second most common (20%-30%) primary small-bowel malignancy after small bowel adenocarcinoma. Their imaging evaluation is often challenging. State-of-the-art high-resolution multiphasic computed tomography together with advanced postprocessing methods provides an excellent tool for their depiction. The manifold interactive parameter choices however require knowledge of when to use which technique. Here, we discuss the imaging appearance and evaluation of duodenal, jejunal and ileal carcinoid tumors, including the imaging features of the primary tumor, locoregional mesenteric nodal metastases, and distant metastatic disease. A protocol for optimal lesion detection is presented, including the use of computed tomography enterography, volume acquisition, computed tomography angiography and three-dimensional mapping. Imaging findings are illustrated with a series of challenging cases which illustrate the spectrum of possible disease in the small bowel and mesentery, the range of possible appearances in the bowel itself on multiphase data and extraluminal findings such as the desmoplastic reaction in mesentery and hypervascular liver metastases. Typical imaging pitfalls and pearls are illustrated. PMID:26435774

  7. A potential association between exposure to hepatitis B virus and small bowel adenocarcinoma.

    PubMed

    DeFilippis, Ersilia M; Mehta, Mamta; Ludwig, Emmy

    2016-06-01

    Chronic infection with hepatitis B virus (HBV) has never been described as a risk factor for small bowel adenocarcinoma, although infection is a known risk factor for hepatocellular carcinoma. From May 2009 to December 2014, we implemented an institution-wide screening program for hepatitis B viral serologies prior to starting chemotherapy. Evidence of exposure [hepatitis B core antibody (anti-HBc) positivity in the absence of hepatitis B surface antigen (HBsAg) positivity] was highest in patients with hepatocellular carcinoma (21.1%), followed by small bowel cancer (12.5%). The small bowel adenocarcinoma cases with anti-HBc positivity were reviewed. Special attention was paid to known risk factors for small bowel cancers. One patient had a diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC). However, the other patients had no genetic syndromes, history of inflammatory bowel disease or other chronic inflammation to explain their risk. We postulate exposure to bile acids, tumorigenesis of hepatocytes and cholangiocytes, and/or damage to the intestinal mucosa secondary to HBV exposure/infection as potential mechanisms for development of small bowel adenocarcinoma. More research is warranted to further elucidate this association. PMID:27284484

  8. A potential association between exposure to hepatitis B virus and small bowel adenocarcinoma

    PubMed Central

    DeFilippis, Ersilia M.; Mehta, Mamta

    2016-01-01

    Chronic infection with hepatitis B virus (HBV) has never been described as a risk factor for small bowel adenocarcinoma, although infection is a known risk factor for hepatocellular carcinoma. From May 2009 to December 2014, we implemented an institution-wide screening program for hepatitis B viral serologies prior to starting chemotherapy. Evidence of exposure [hepatitis B core antibody (anti-HBc) positivity in the absence of hepatitis B surface antigen (HBsAg) positivity] was highest in patients with hepatocellular carcinoma (21.1%), followed by small bowel cancer (12.5%). The small bowel adenocarcinoma cases with anti-HBc positivity were reviewed. Special attention was paid to known risk factors for small bowel cancers. One patient had a diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC). However, the other patients had no genetic syndromes, history of inflammatory bowel disease or other chronic inflammation to explain their risk. We postulate exposure to bile acids, tumorigenesis of hepatocytes and cholangiocytes, and/or damage to the intestinal mucosa secondary to HBV exposure/infection as potential mechanisms for development of small bowel adenocarcinoma. More research is warranted to further elucidate this association. PMID:27284484

  9. Specific acceptance of fetal bowel allograft in mice after combined treatment with anti-intercellular adhesion molecule-1 and leukocyte function-associated antigen-1 antibodies.

    PubMed Central

    Kato, Y; Yamataka, A; Yagita, H; Okumura, K; Fujiwara, T; Miyano, T

    1996-01-01

    OBJECTIVE: The aim of this study was to see whether tolerance could be induced by simultaneous administration of monoclonal antibodies (MoAbs) to intercellular adhesion molecule-1 (ICAM-1) and leukocyte function-associated antigen-1 (LFA-1) after transplantation of fetal small bowel between fully incompatible mice strains. METHODS: Fetal small bowel from either BALB/c (H-2d) or C3H/He (H-2k) mice was transplanted into the space between the peritoneum and rectus abdominis of adult C3H/He recipient mice. Syngeneic (n = 6) and two allogeneic transplant groups were made. In one of the allogeneic groups (n = 8), no immunosuppressant was given. In the other allogeneic group (n = 13), both anti-LFA-1 and anti-ICAM-1 MoAbs (50 micrograms each/mouse/day) were given intraperitoneally after transplantation for the first 4 weeks. In the syngeneic and untreated allogeneic groups, all mice were killed 4 weeks after transplantation. In the treated allogeneic group, eight mice were killed 6 weeks after cessation of the MoAb treatment. At the time the mice were killed, the bowel graft as well as the recipient spleen were taken for histologic analysis and cytotoxic T-lymphocyte (CTL) assay, respectively. Each mouse in the remaining treated five mice was transplanted with BALB/c and C57BL/6 (as third-party) full-thickness skin simultaneously 8 weeks after cessation of the MoAb treatment. RESULTS: All grafts in the syngeneic group survived with normally developing villi, whereas all grafts in the untreated allogeneic group disappeared. In the treated allogeneic group, all allografts developed normal mucosa without any sign of rejection. Splenocytes from the recipient mice in the untreated allogeneic group showed increased CTL induction against donor-type alloantigen (p < 0.005), compared with that in the syngeneic group. Suppressed CTL induction against donor-type alloantigen was observed in the treated allografted recipient (p < 0.001), whereas CTL induction against third

  10. Comparison of Peritoneal Adhesion Formation in Bowel Retraction by Cotton Towels Versus the Silicone Lap Pak Device in a Rabbit Model

    PubMed Central

    Liu, Brian G.; Ruben, Dawn S.; Renz, Wolfgang; Santillan, Antonio; Kubisen, Steven J.; Harmon, John W.

    2011-01-01

    Objective: Manipulation of cotton operating room towels within the abdominal cavity in open abdominal surgery has been associated with the formation of peritoneal adhesions. In a rabbit model, the use of standard cotton operating room towels is compared to the Lap Pak, a silicone bowel-packing device, to determine the potential for reducing the risk of adhesions. Methods: Thirty rabbits were randomly assigned to 3 groups. The rabbits underwent a sham surgery with incision only (n = 10), placement of operating room towels (n = 10), or placement of a Lap Pak (n = 10). After 14 days, the rabbits were sacrificed and the peritoneal cavity explored for adhesions. The number, tenacity, ease of dissection, and density of adhesions were recorded, and the adhesions quantitatively graded using a Modified Hopkins Adhesion scoring system. Results: The operating room towel group had an average adhesion score of 2.5, and 8 (80%) rabbits developed adhesions. The sham group had an average adhesion score of 0.3 and one rabbit (10%) developed adhesions. The Lap Pak group had an average adhesion score of 0.2 and 1 rabbit (10%) developed adhesions. The frequency and severity of adhesions in the operating room towel group were significantly greater from that of the baseline sham group. There was no significant difference between the Lap Pak and sham groups. Conclusions: In this rabbit laparotomy model, the use of the Lap Pak to retract the bowels resulted in significantly fewer adhesions compared to cotton operating room towels. Lap Pak may be beneficial for bowel packing in general abdominal surgeries. PMID:22096614

  11. A rare cause of small bowel obstruction due to bezoar in a virgin abdomen

    PubMed Central

    Nasri, Baongoc; Calin, Marius; Shah, Ajay; Gilchrist, Brian

    2015-01-01

    Introduction Bezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. Case report A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy. Discussion Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected. Conclusions Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis. PMID:26764889

  12. Congenital Internal Hernia Presented with Life Threatening Extensive Small Bowel Strangulation

    PubMed Central

    Lee, Narae; Kim, Su-Gon; Park, Jae-Hong; Son, Seung-Kook; Kim, Soo-Hong; Hwang, Jae-Yeon

    2013-01-01

    Internal hernia (IH) is a rare cause of small bowel obstruction occurs when there is protrusion of an internal organ into a retroperitoneal fossa or a foramen in the abdominal cavity. IH can be presented with acute or chronic abdominal symptom and discovered by accident in operation field. However, various kinds of imaging modalities often do not provide the assistance to diagnose IH preoperatively, but computed tomography (CT) scan has a high diagnostic accuracy. We report a case of congenital IH in a 6-year-old boy who experienced life threatening shock. CT scan showed large amount of ascites, bowel wall thickening with poor or absent enhancement of the strangulated bowel segment. Surgical exploration was performed immediately and had to undergo over two meters excision of strangulated small bowel. To prevent the delay in the diagnosis of IH, we should early use of the CT scan and take urgent operation. PMID:24224153

  13. Radiation Dose-Volume Effects in the Stomach and Small Bowel

    SciTech Connect

    Kavanagh, Brian D.; Pan, Charlie C.; Dawson, Laura A.; Das, Shiva K.; Li, X. Allen; Ten Haken, Randall K.; Miften, Moyed

    2010-03-01

    Published data suggest that the risk of moderately severe (>=Grade 3) radiation-induced acute small-bowel toxicity can be predicted with a threshold model whereby for a given dose level, D, if the volume receiving that dose or greater (VD) exceeds a threshold quantity, the risk of toxicity escalates. Estimates of VD depend on the means of structure segmenting (e.g., V15 = 120 cc if individual bowel loops are outlined or V45 = 195 cc if entire peritoneal potential space of bowel is outlined). A similar predictive model of acute toxicity is not available for stomach. Late small-bowel/stomach toxicity is likely related to maximum dose and/or volume threshold parameters qualitatively similar to those related to acute toxicity risk. Concurrent chemotherapy has been associated with a higher risk of acute toxicity, and a history of abdominal surgery has been associated with a higher risk of late toxicity.

  14. Small bowel obstruction and abdominal pain after robotic versus open radical prostatectomy.

    PubMed

    Lundström, Karl-Johan; Folkvaljon, Yasin; Loeb, Stacy; Axelson, Anna Bill; Stattin, Pär; Nordin, Pär

    2016-06-01

    Objective The aim of this study was to examine whether intraperitoneal robot-assisted surgery leads to small bowel obstruction (SBO), possibly caused by the formation of intra-abdominal adhesions. Materials and methods In total, 7256 men treated by intraperitoneal robot-assisted radical prostatectomy (RARP) and 9787 men treated by retropubic radical prostatectomy (RRP) in 2005-2012 were identified in the Prostate Cancer data Base Sweden (PCBaSe). Multivariable Cox proportional hazards models were used to calculate the risk of readmission for SBO, SBO-related surgery and admissions due to abdominal pain up to 5 years postoperatively. Results During the first postoperative year, the risk of readmission for SBO was higher after RARP than after RRP [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.14-3.25] but after 5 years there was no significant difference (HR 1.28, 95% CI 0.86-1.91), and there was no difference in the risk of SBO surgery during any period. The risk of admission for abdominal pain was significantly increased after RARP during the first year (HR 2.24, 95% CI 1.50-3.33) but not after 5 years (HR 1.23, 95% CI 0.92-1.63). Conclusion Intraperitoneal RARP had an increased risk of SBO and abdominal pain in the short term during the first year, but not in the long term, compared to RRP. PMID:26936203

  15. Online adaptive radiotherapy of the bladder: Small bowel irradiated-volume reduction

    SciTech Connect

    Burridge, Nichola . E-mail: nichola.burridge@physics.cr.man.ac.uk; Amer, Ali; Marchant, Tom; Sykes, Jonathan; Stratford, Julie; Henry, Ann; McBain, Catherine; Price, Pat; Moore, Chris

    2006-11-01

    Purpose: To assess the potential reduction of small bowel volume receiving high-dose radiation by using kilovoltage X-ray cone beam computed tomography (CBCT) and quantized margin selection for adaptive bladder cancer treatment. Methods and Materials: Twenty bladder patients were planned conformally using a four-field, 15-mm uniform margin technique. Two additional planning target volumes (PTVs) were created using margins quantized to 5 and 10 mm in the superior direction only. CBCTs ({approx}8 scans/patient) were acquired during treatment. CBCT volumes were registered with CT planning scans to determine setup errors and to select the appropriate PTV of the day. Margin reduction in other directions was considered. Outlining of small bowel in every fraction is required to properly quantify the volume of small bowel spared from high doses. In the case of CBCT this is not always possible owing to artifacts created by small bowel movement and the presence of gas. A simpler method was adopted by considering the volume difference between PTVs created using uniform and adapted margins, which corresponds to the potential volume of small bowel sparing. Results: The average small bowel volume that can be spared by this form of adaptive radiotherapy is 31 {+-} 23 cm{sup 3} ({+-}1 SD). The bladder for 1 patient was systematically smaller than the planning scan and hence demonstrated the largest average reduction of 76 cm{sup 3}. The clinical target volume to PTV margins in other directions can be safely reduced to 10 mm except in the anterior direction where, like the superior direction, the bladder showed significant variation. Conclusions: Online CBCT-assisted plan selection based on quantized margins can significantly reduce the volume of small bowel receiving high doses for some bladder patients. CBCT allows the 15-mm margins used in some directions to be safely reduced to 10 mm.

  16. Characteristics of the Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Chronic Kidney Disease

    PubMed Central

    Kawamura, Harunobu; Sakai, Eiji; Endo, Hiroki; Taniguchi, Leo; Hata, Yasuo; Ezuka, Akiko; Nagase, Hajime; Kessoku, Takaomi; Yamada, Eiji; Ohkubo, Hidenori; Higrashi, Takuma; Sekino, Yusuke; Koide, Tomoko; Iida, Hiroshi; Nonaka, Takashi; Takahashi, Hirokazu; Inamori, Masahiko; Maeda, Shin; Nakajima, Atsushi

    2013-01-01

    Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small-bowel lesions in these patients, or of the factors that could predict the presence of such lesions. Therefore we enrolled a total of 42 CKD patients (including 19 HD patients and 23 non-HD patients), and compared the incidence of the small-bowel lesions among two groups. Furthermore, to identify predictive factors for the presence of small-bowel lesions, we performed multivariate logistic-regression-analyses. The incidence of small-bowel vascular lesions was significantly higher in CKD patients than in age-and-sex matched non-CKD patients (P < 0.001). On the other hand, there was any significant difference of the incidence of small-bowel lesions between HD and non-HD patients. In CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10–29.1, P = 0.04) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13–31.9, P = 0.04) was identified as that of erosive/ulcerated lesions. This indicated that proactive CE examination would be clinically meaningful for these patients. PMID:24065987

  17. From Capsule Endoscopy to Balloon-Assisted Deep Enteroscopy: Exploring Small-Bowel Endoscopic Imaging

    PubMed Central

    Cooley, D. Matthew; Walker, Andrew J.

    2015-01-01

    In the past 15 years, the use of endoscopic evaluations in patients with obscure gastrointestinal bleeding has become more common. Indications for further endoscopic interventions include iron deficiency anemia, suspicion of Crohn’s disease or small-bowel tumors, assessment of celiac disease or of ulcers induced by nonsteroidal anti-inflammatory drugs, and screening for familial adenomatous polyposis. Often, capsule endoscopy is performed in concert with other endoscopic studies and can guide decisions regarding whether enteroscopy should be carried out in an anterograde or a retrograde approach. Retrograde endoscopy is beneficial in dealing with disease of the more distal small bowel. Multiple studies have examined the diagnostic yield of balloon-assisted deep enteroscopy and have estimated a diagnostic yield of 40% to 80%. Some of the studies have found that diagnostic yields are higher when capsule endoscopy is performed before balloon-assisted deep enteroscopy in a search for small-bowel bleeds. Each of these procedures has a role when performed alone; however, research suggests that they are especially effective as complementary techniques and together can provide better-directed therapy. Both procedures are relatively safe, with high diagnostic and therapeutic yields that allow evaluation of the small bowel. Because both interventions are relatively new to the world of gastroenterology, much research remains to be done regarding their overall efficacy, cost, and safety, as well as further indications for their use in the detection and treatment of diseases of the small bowel. PMID:27099585

  18. From Capsule Endoscopy to Balloon-Assisted Deep Enteroscopy: Exploring Small-Bowel Endoscopic Imaging.

    PubMed

    Cooley, D Matthew; Walker, Andrew J; Gopal, Deepak V

    2015-03-01

    In the past 15 years, the use of endoscopic evaluations in patients with obscure gastrointestinal bleeding has become more common. Indications for further endoscopic interventions include iron deficiency anemia, suspicion of Crohn's disease or small-bowel tumors, assessment of celiac disease or of ulcers induced by nonsteroidal anti-inflammatory drugs, and screening for familial adenomatous polyposis. Often, capsule endoscopy is performed in concert with other endoscopic studies and can guide decisions regarding whether enteroscopy should be carried out in an anterograde or a retrograde approach. Retrograde endoscopy is beneficial in dealing with disease of the more distal small bowel. Multiple studies have examined the diagnostic yield of balloon-assisted deep enteroscopy and have estimated a diagnostic yield of 40% to 80%. Some of the studies have found that diagnostic yields are higher when capsule endoscopy is performed before balloon-assisted deep enteroscopy in a search for small-bowel bleeds. Each of these procedures has a role when performed alone; however, research suggests that they are especially effective as complementary techniques and together can provide better-directed therapy. Both procedures are relatively safe, with high diagnostic and therapeutic yields that allow evaluation of the small bowel. Because both interventions are relatively new to the world of gastroenterology, much research remains to be done regarding their overall efficacy, cost, and safety, as well as further indications for their use in the detection and treatment of diseases of the small bowel. PMID:27099585

  19. Small Bowel Obstruction Secondary to Femoral Hernia; Case Report and Review of the Literature

    PubMed Central

    Akrami, Majid; Karami, MohamamdYasin; Zangouri, Vahid; Deilami, Iman; Maalhagh, Mehrnoush

    2016-01-01

    Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery.This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia.We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament .Laparotomy was performed and patient was treated successfully with surgical therapy.Herniawas repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause. PMID:27162928

  20. Ethanol inhibition of glucose absorption in isolated, perfused small bowel of rats

    SciTech Connect

    Cobb, C.F.; Van Thiel, D.H.; Wargo, J.

    1983-08-01

    There is evidence for both humans and rats that malnutrition frequently occurs when ethanol is chronically ingested. Small bowel /sup 14/C-labelled glucose absorption was measured with an ex vivo system in which the small bowel of the rat was surgically removed and then arterially perfused with an artificial medium. Glucose absorption for a control group of seven rats was 248 +/- 8 microM/min/gm dry weight of small bowel (mean +/- SEM). This was significantly greater than the value 112 +/- 12 microM/min/gm dry weight (P less than 0.005) for a group of five rats in which a competitive inhibitor of glucose absorption, phlorizin (0.2 mM), was added to the bowel lumen. In the presence of 3% ethanol within the gut lumen of five rats, glucose absorption was also reduced (to 131 +/- 12 microM/min/gm dry weight) compared to absorption in the control group (P less than 0.005). The calculated amount of glucose absorbed was corrected for metabolism to lactate and carbon dioxide. We conclude that both phlorizin and ethanol inhibit glucose absorption in the isolated and perfused small bowel of rats and that probably at least part of the malnutrition in ethanol-fed rats is due to glucose malabsorption.

  1. Bedside placement of small-bowel feeding tube in Intensive Care Unit for enteral nutrition

    PubMed Central

    Gokhale, Antara; Kantoor, Sandeep; Prakash, Sadanandan; Manhas, Yogesh; Chandwani, Juhi; Mahmoud, Ashraf Ezzat

    2016-01-01

    Enteral nutrition is the preferred mode of nutrition in critically ill patients whenever feasible as it has a number of advantages over parenteral feeding. Both gastric and small-bowel feeding can effectively deliver calories. In patients with gastroparesis, small-bowel feeding can help avoid parenteral feeding. We carried out a retrospective observational study to assess the ability to insert the Tiger 2 tube into the small bowel at the bedside in 25 patients who failed to tolerate gastric feeds. The time taken, rate of successful insertion, and ability to feed these patients using a standardized feeding protocol were noted. Success rate of insertion was 78% and feeding could be established. This method reduced the delays and risks associated with transportation and dependence on other specialties. PMID:27390461

  2. A case of small bowel ulcer caused by NSAIDs and detected after capsule endoscope retention.

    PubMed

    Sakuma, Toshiyuki; Gocho, Seiho; Ogasawara, Fusao; Tsukune, Yoko; Sawamoto, Kana; Numata, Makoto; Nagata, Naruhiko; Deguchi, Ryuzo; Mine, Tetsuya

    2012-04-01

    We recently detected an annular ulcer thought to have been caused by non-steroidal anti-inflammatory drugs (NSAIDs) when we performed small bowel capsule endoscopy on a patient with suspected small-bowel bleeding and a history of frequent use of oral NSAIDs. The patient was a 64-year-old woman who complained of bloody stools and abdominal pain. The annular ulcer showed concentric stenosis, which caused retention of the capsule endoscope. NSAIDs are some of the most frequently used anti-inflammatory analgesics, and even more frequent use can be expected with the aging of society. No reports to date appear to have described retention of a capsule endoscope due to annular ulceration caused by NSAIDs. We report herein our experience with a patient showing small-bowel ulcer caused by NSAIDs. PMID:22488558

  3. Ume (Japanese apricot)-induced small bowel obstruction with chronic radiation enteritis.

    PubMed

    Hashimoto, Takuya; Kitayama, Joji; Hidemura, Akio; Ishigami, Hironori; Kaizaki, Shoichi; Fukushima, Noriyoshi; Miyata, Tetsuro; Nagawa, Hirokazu

    2007-01-01

    Stricture formation is recognized as one of the complications of chronic radiation enteritis. Here, we present a case of a 73-year-old woman who presented with small bowel obstruction 16 years after pelvic irradiation for uterine cancer. Computed tomographic (CT) scan of the abdomen demonstrated a 1-cm foreign body in the terminal ileum. Laparotomy revealed a stone of ume (Japanese apricot) stuck in an ileal stricture, leading to complete impaction and perforation. She was successfully treated with ileocecal resection and ileocolic anastomosis without any complication. Pathological study revealed that the low compliance caused by fibrosis of the bowel wall prevented the small ume stone from passing through the irradiated ileum. Our case implies the specific risk of food-induced small bowel obstruction in patients with a history of pelvic irradiation. PMID:21487567

  4. Bedside placement of small-bowel feeding tube in Intensive Care Unit for enteral nutrition.

    PubMed

    Gokhale, Antara; Kantoor, Sandeep; Prakash, Sadanandan; Manhas, Yogesh; Chandwani, Juhi; Mahmoud, Ashraf Ezzat

    2016-06-01

    Enteral nutrition is the preferred mode of nutrition in critically ill patients whenever feasible as it has a number of advantages over parenteral feeding. Both gastric and small-bowel feeding can effectively deliver calories. In patients with gastroparesis, small-bowel feeding can help avoid parenteral feeding. We carried out a retrospective observational study to assess the ability to insert the Tiger 2 tube into the small bowel at the bedside in 25 patients who failed to tolerate gastric feeds. The time taken, rate of successful insertion, and ability to feed these patients using a standardized feeding protocol were noted. Success rate of insertion was 78% and feeding could be established. This method reduced the delays and risks associated with transportation and dependence on other specialties. PMID:27390461

  5. Unusually early presentation of small-bowel adenocarcinoma in a patient with Peutz-Jeghers syndrome

    PubMed Central

    Wangler, Michael F.; Chavan, Rishikesh; Hicks, M. John; Nuchtern, Jed.G.; Hegde, Madhuri; Plon, Sharon E.; Thompson, Patrick A.

    2013-01-01

    Peutz-Jeghers (PJS) syndrome is an autosomal dominant cancer predisposition syndrome characterized by melanotic macules, and hamartomatous polyps. Small-bowel surveillance in the pediatric PJS population is not designed to identify small-bowel malignancy which is thought to arise in adulthood. A 13 year old male presented with lead-point intussusception, requiring emergent surgical resection. A mucinous adenocarcinoma was found arising from high-grade dysplasia within a polyp. Based on these findings and mucosal pigmentation he was diagnosed with PJS. DNA sequencing revealed a heterozygous c.921-1G>T STK11 mutation. This case is the earliest onset of small-bowel carcinoma in PJS, an observation relevant to surveillance guidelines. PMID:23426006

  6. Unusually early presentation of small-bowel adenocarcinoma in a patient with Peutz-Jeghers syndrome.

    PubMed

    Wangler, Michael F; Chavan, Rishikesh; Hicks, M John; Nuchtern, Jed G; Hegde, Madhuri; Plon, Sharon E; Thompson, Patrick A

    2013-05-01

    Peutz-Jeghers syndrome (PJS) is an autosomal dominant cancer predisposition syndrome characterized by melanotic macules and hamartomatous polyps. Small-bowel surveillance in the pediatric PJS population is not designed to identify small-bowel malignancy, which is thought to arise in adulthood. A 13-year-old boy presented with lead-point intussusception, requiring emergent surgical resection. A mucinous adenocarcinoma was found arising from high-grade dysplasia within a polyp. On the basis of these findings and mucosal pigmentation, he was diagnosed with PJS. DNA sequencing revealed a heterozygous c.921-1G>T STK11 mutation. This case is the earliest onset of small-bowel carcinoma in PJS, an observation relevant to surveillance guidelines. PMID:23426006

  7. Gastric emptying rate and small bowel transit time in patients with irritable bowel syndrome determined with 99mTc-labeled pellets and scintigraphy

    SciTech Connect

    Nielsen, O.H.; Gjorup, T.; Christensen, F.N.

    1986-12-01

    A new method employing 99mTc-labeled pellets for determination of the gastric emptying rate and small bowel transit time is described. The participants were six normal subjects and 16 patients with irritable bowel syndrome (eight with diarrhea and eight with obstipation as the primary complaint). The gastric emptying rate was the same in the three groups. The patients in the obstipation group had a significantly longer small bowel transit time than the normals (P less than 0.02) and the patients in the diarrhea group (P less than 0.01). There was no demonstrable difference between the small bowel transit time in the normals and in the patients in the diarrhea group.

  8. [Surgical management of small bowel localization of Crohn's disease].

    PubMed

    Pătraşcu, Tr; Catrina, E; Doran, H; Mihalache, O; Bugă, C; Degeratu, D; Predescu, G

    2009-01-01

    Crohn's disease is an inflammatory bowel disease, a chronic condition with recurrent relapses, difficult to diagnose and requiring a complex medical and surgical treatment. Analyzing 11 patients admitted in the surgical Clinique between 2003 and 2008 with Crohn's disease diagnostic, the authors study at the 7 patients operated the reason of the surgical interventions represented by the complications of the inflammatory disease--intestinal obstruction 2 cases, peritonitic syndrome in 3 cases, malignization 1 case, enterovesical fistulae--1 case. Intraoperatory the differential diagnosis between an inflammatory or tumoral etiology of the lesions was very difficult, and the surgical indication was in almost all cases for enteral resection. Postoperative evolution was in most cases with complications (5 cases)--unique anastomotic fistulae 2 cases, or recurrent fistulae in 3 cases, late bowel obstruction--2 cases. Studying the literature, it can be concluded that the surgical treatment is only one stage of the complex treatment that must be individualized for each case and applied only to the complications of the disease. PMID:20187469

  9. Decreasing gastrointestinal morbidity with the use of small bowel contrast during treatment planning for pelvic irradiation

    SciTech Connect

    Herbert, S.H.; Curran, W.J. Jr.; Solin, L.J.; Stafford, P.M.; Lanciano, R.M.; Hanks, G.E. )

    1991-04-01

    Small bowel tolerance is a major dose-limiting factor in treating the pelvis with radiation therapy (RT). The use of small bowel contrast during RT simulation is one technique used to localize the bowel and identify the treatment plan that would exclude the greatest volume. To determine the influence of treatment planning with oral contrast on gastrointestinal injury, acute and chronic small bowel morbidity was analyzed in 115 patients with endometrial and rectal carcinoma who received postoperative radiation therapy at the Fox Chase Cancer Center. Mean and median time of follow-up were 31 and 27 months, respectively. Acute diarrhea was seen in 82% of the patient population. Ten percent of patients experienced major complications requiring hospitalization. Ninety-three percent of patients simulated without contrast experienced side effects compared to 77% of patients simulated with contrast (p = .026). There was an increased incidence of chronic complications in patients who were not simulated with contrast dye (50% vs 23%, p = .014). Median duration of minor side effects was 4 months for patients planned without oral contrast and 1 month for patients who had contrast at the time of simulation (p = .036). The superior aspect of the treatment field was determined to be at a more inferior location in patients simulated with contrast, thereby excluding small bowel from treatment. Seventy-four percent of patients simulated without contrast had the upper border of the field placed at the superior aspect of the sacroiliac joint or above, compared to only 40% of patients planned with oral contrast (p = .002). This study has demonstrated decreased complications (both overall and chronic) as well as a change in the location of the treatment field with the use of small bowel contrast.

  10. Bag and loop small bowel contouring strategies differentially estimate small bowel dose for post-hysterectomy women receiving pencil beam scanning proton therapy.

    PubMed

    Xu, Melody J; Kirk, Maura; Zhai, Huifang; Lin, Lilie L

    2016-07-01

    Background Small bowel (SB) dose-volume relationships established during initial computed tomography (CT) simulations may change throughout therapy due to organ displacement and motion. We investigated the impact of organ motion on SB dose-volume histograms (DVHs) in women with gynecologic malignancies treated with pencil beam scanning (PBS) proton therapy and compared PBS SB DVHs to intensity-modulated radiation therapy (IMRT). Material and methods Post-hysterectomy patients (n = 11) treated for gynecologic cancers were enrolled on an image-guided proton therapy protocol involving CT simulation with full (CTF) and empty (CTE) bladders and weekly/biweekly on-treatment scans. IMRT plans were generated for comparative analysis. SB was contoured as bowel loops or bowel bag. Wilcoxon signed-rank tests were used for matched-pair comparisons of SB, bladder, and rectum dose-volumes between CT scans and between PBS and IMRT plans. Results In PBS loops analysis, on-treatment DVH was significantly higher than CTF for doses <45 Gy (p < 0.05), and not significantly different than CTE. Specifically, V15 for loops was higher on-treatment (median 240 cm(3)) compared to CTF (median 169 cm(3), p = 0.03). In PBS bag analysis, on-treatment DVH was not significantly different from CTF across all dose ranges. Bowel bag V45 was not significantly different between on-treatment (median 540 cm(3)) and CTF (median 499 cm(3), p = 0.53). Decreasing bladder volume was associated with increasing V15 for loops and V45 for bowel bag (p < 0.005, both). Comparing PBS and IMRT, PBS resulted in significantly lower DVHs at low dose regions (<38 Gy) and higher DVHs at high dose regions (42.5-45.5 Gy) in both loops and bag analysis. IMRT plans demonstrated higher on-treatment SB loop DVHs and only minimal differences in bowel bag DVHs compared to CTF. Conclusions SB DVHs were well estimated by CTF bowel bag and underestimated by CTF loops in the setting of inconsistent

  11. Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Association with Colon Motility, Bowel Symptoms, and Psychological Distress

    PubMed Central

    Grover, Madhusudan; Kanazawa, Motoyori; Palsson, Olafur S.; Chitkara, Denesh K.; Gangarosa, Lisa M.; Drossman, Douglas A.; Whitehead, William E.

    2013-01-01

    Background Small intestinal bacterial overgrowth (SIBO) has been implicated in the pathogenesis of irritable bowel syndrome (IBS), although with significant controversy. Aims To determine the prevalence of SIBO in IBS and its association with colonic motility, bowel symptoms and psychological distress. Methods Sucrose hydrogen and methane breath tests were performed in 158 IBS and 34 healthy controls (HC). Thresholds for pain and urgency were tested by barostat in the descending colon. The motility index (MI) was calculated as the average area under the curve for all phasic contractions. Questionnaires assessed psychological distress, IBS symptom severity (IBSSS), IBS Quality of Life (IBS-QOL) and self reported bowel symptoms. Results 52/158 (32.9%) IBS patients had abnormal breath tests compared with 6/34 (17.9%) HC (χ2=0.079). SIBO (SIBO+) and Non-SIBO (SIBO−) did not differ in the prevalence of IBS-subtypes, IBS-SS, IBS-QOL and psychological distress variables. IBS had a greater post-distension increase in MI than HC, but there was no difference between SIBO+ and SIBO−. Predominant methane producers had higher urge thresholds (28.4 vs. 18.3, p<0.05) and higher baseline MI (461 vs. 301.45, p<0.05) than SIBO− IBS, and they reported more “hard or lumpy stools” when compared to predominant hydrogen producers (p<0.05) and SIBO− IBS (p< 0.05). Conclusions SIBO is unlikely to contribute significantly in the pathogenesis of IBS. Methane production is associated with constipation. PMID:18482250

  12. Peritonitis with small bowel perforation caused by a fish bone in a healthy patient.

    PubMed

    Choi, Yonghoon; Kim, Gyuwon; Shim, Chansup; Kim, Dongkeun; Kim, Dongju

    2014-02-14

    Perforation of the gastrointestinal tract by ingested foreign bodies is extremely rare in otherwise healthy patients, accounting for < 1% of cases. Accidentally ingested foreign bodies could cause small bowel perforation through a hernia sac, Meckel's diverticulum, or the appendix, all of which are uncommon. Despite their sharp ends and elongated shape, bowel perforation caused by ingested fish bones is rarely reported, particularly in patients without intestinal disease. We report a case of 57-year-old female who visited the emergency room with periumbilical pain and no history of underlying intestinal disease or intra-abdominal surgery. Abdominal computed tomography and exploratory laparotomy revealed a small bowel micro-perforation with a 2.7-cm fish bone penetrating the jejunal wall. PMID:24587641

  13. [A case of small bowel cancer with positive peritoneal cytology and five-year recurrence-free survival].

    PubMed

    Matsumura, Atsushi; Shimizu, Keiji; Nishibeppu, Keiji; Matsuyama, Takehisa; Ogino, Shiro; Takemura, Manabu; Mugitani, Tatsuro; Ishida, Hidekazu; Akami, Toshikazu; Okano, Shinji

    2014-11-01

    Small bowel cancer is frequently detected at an advanced stage and its prognosis is poor. We report on a patient with small bowel cancer with positive peritoneal cytology who survived for 5 years without recurrence after surgery.The case involved a 73-year-old woman who had undergone partial resection of the small intestine and lymphadenectomy for a small bowel tumor with obstruction. Pathological examination confirmed papillary adenocarcinoma with partial serosal invasion. Ascites cytology indicated a class V tumor. Adjuvant chemotherapy with TS-1 was administered for 20 months, and the patient has survived without evidence of disease for over 5 years.In this case, it is possible that TS-1 chemotherapy was effective for prevention against small bowel cancer recurrence.Furthermore , peritoneal cytology in patients with small bowel cancer should be evaluated as a predictor of prognosis. PMID:25731552

  14. Quantification, validation, and follow-up of small bowel motility in Crohn's disease

    NASA Astrophysics Data System (ADS)

    Cerrolaza, Juan J.; Peng, Jennifer Q.; Safdar, Nabile M.; Conklin, Laurie; Sze, Raymond; Linguraru, Marius George

    2015-03-01

    The use of magnetic resonance enterography (MRE) has become a mainstay in the evaluation, assessment and follow up of inflammatory bowel diseases, such as Crohn's disease (CD), thanks to its high image quality and its non-ionizing nature. In particular, the advent of faster MRE sequences less sensitive to image-motion artifacts offers the possibility to obtain visual, structural and functional information of the patient's small bowel. However, the inherent subjectivity of the mere visual inspection of these images often hinders the accurate identification and monitoring of the pathological areas. In this paper, we present a framework that provides quantitative and objective motility information of the small bowel from free-breathing MRE dynamic sequences. After compensating for the breathing motion of the patient, we create personalized peristaltic activity maps via optical flow analysis. The result is the creation of a new set of images providing objective and precise functional information of the small bowel. The accuracy of the new method was also evaluated from two different perspectives: objective accuracy (1.1 ± 0.6 mm/s of error), i.e., the ability of the system to provide quantitative and accurate information about the motility of moving bowel landmarks, and subjective accuracy (avg. difference of 0.7 ± 0.7 in a range of 1 to 5), i.e., the degree of agreement with the subjective evaluation of an expert. Finally, the practical utility of the new method was successfully evaluated in a preliminary study with 32 studies of healthy and CD cases, showing its potential for the fast and accurate assessment and follow up of CD in the small bowel.

  15. A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy tube due to mesenteric penetration.

    PubMed

    Roos, J

    2015-07-01

    A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy (PEG) tube is described. At laparotomy, the PEG tube was found to have penetrated the jejunal mesentery at two points, thereby acting as a focus for a volvulus. Direct injury and obstruction to the small bowel have been described but volvulus due to mesenteric penetration has not. PMID:26264109

  16. Milk is a useful test meal for measurement of small bowel transit time.

    PubMed

    Kondo, T; Liu, F; Toda, Y

    1994-12-01

    To improve and standardize the measurement of small bowel transit time, milk was employed for the test meal instead of the conventional lactulose meal. Although 92% of the subjects were lactase deficient, only 2% were milk intolerant and 13% were lactose intolerant. Small bowel transit time with milk (milk breath hydrogen test) was 113 +/- 9 min (mean +/- SE, n = 20); the normal range calculated from the mean +/- 2 SD was 31-195 min. The coefficient of variation in the milk hydrogen breath test was 13 +/- 4% (n = 6), whereas in the lactulose hydrogen breath test, it was 39 +/- 16% (n = 10). The frequency of non-hydrogen producers, the occurrence of discomfort, and the reproducibility were better, though not significantly so, in the milk hydrogen breath test than in the lactulose. Since lactase activity in the intestine is variable in lactase-deficient subjects, small bowel transit times for milk may change from subject to subject. However, individual reproducibility of the milk hydrogen breath test is good. It could be useful for pharmacological experiments using paired comparison, for screening tests, or for the follow up of diseases in which small bowel transit time is affected. PMID:7874265

  17. Acute appendicitis with intestinal non-rotation presenting with partial small bowel obstruction diagnosed on CT.

    PubMed

    Zissin, R; Kots, E; Shpindel, T; Shapiro-Feinberg, M

    2000-05-01

    The findings of acute appendicitis on CT have been extensively described in the literature. This is a report of a case of acute appendicitis in a patient with intestinal non-rotation presenting with partial small bowel obstruction. Analysis of the CT findings allowed a correct diagnosis. PMID:10884757

  18. Herpes simplex colitis in a child with combined liver and small bowel transplant.

    PubMed

    Delis, S; Kato, T; Ruiz, P; Mittal, N; Babinski, L; Tzakis, A

    2001-10-01

    Herpes simplex virus (HSV) has been a rare cause of gastrointestinal (GI) infection, especially in immunocompromised patients. A variety of GI sites may be involved; however, only three reported cases of HSV colitis have been documented in the literature. To our knowledge, this is the first report of HSV colitis in a small bowel transplant recipient. PMID:11560759

  19. NSAID-induced deleterious effects on the proximal and mid small bowel in seronegative spondyloarthropathy patients

    PubMed Central

    Rimbaş, Mihai; Marinescu, Mădălina; Voiosu, Mihail Radu; Băicuş, Cristian Răsvan; Caraiola, Simona; Nicolau, Adriana; Niţescu, Doina; Badea, Georgeta Camelia; Pârvu, Magda Ileana

    2011-01-01

    AIM: To investigate the small bowel of seronegative spondyloarthropathy (SpA) patients in order to ascertain the presence of mucosal lesions. METHODS: Between January 2008 and June 2010, 54 consecutive patients were enrolled and submitted to avideo capsule endoscopy (VCE) examination. History and demographic data were taken, as well as the history of non-steroidal anti-inflammatory drug (NSAID) consumption. After reading each VCE recording, a capsule endoscopy scoring index for small bowel mucosal inflammatory change (Lewis score) was calculated. Statistical analysis of the data was performed. RESULTS: The Lewis score for the whole cohort was 397.73. It was higher in the NSAID consumption subgroup (P = 0.036). The difference in Lewis score between NSAID users and non-users was reproduced for the first and second proximal tertiles of the small bowel, but not for its distal third (P values of 0.036, 0.001 and 0.18, respectively). There was no statistical significant difference between the groups with regard to age or sex of the patients. CONCLUSION: The intestinal inflammatory involvement of SpA patients is more prominent in NSAID users for the proximal/mid small bowel, but not for its distal part. PMID:21448355

  20. Endoscopic Findings of Small-Bowel Lesions in Familial Amyloid Polyneuropathy

    PubMed Central

    Asakura, Kensuke; Yanai, Shunichi; Nakamura, Shotaro; Kawaski1, Keisuke; Eizuka, Makoto; Ishida, Kazuyuki; Sugai, Tamotsu; Ueda, Mitsuharu; Yamashita, Taro; Ando, Yukio; Matsumoto, Takayuki

    2016-01-01

    Abstract Familial amyloid polyneuropathy (FAP) is an autosomal dominant disease associated with the mutations in the transthyretin gene. To date, the endoscopic findings of the small-bowel lesions of FAP have never been described. We report a rare case of FAP with gastrointestinal involvement. A 71-year-old woman complaining of refractory diarrhea for 1 year was referred to our institution. She had sensory disturbance, movement disorder due to muscle weakness, and autonomic nervous system disorders including orthostatic hypotension and dysuria. Her eldest sister had cardiac amyloidosis. Small-bowel radiography and retrograde double-balloon endoscopy (DBE) revealed that fine granular protrusions were diffusely observed both in the jejunum and ileum. Histologic examination of the biopsy specimens obtained from the small bowel revealed perivascular amyloid deposits mainly in the muscularis mucosae and submucosa, which were immunoreactive with transthyretin antibodies. Analysis of the genomic DNA showed a heterozygous Gly47Val mutation in the transthyretin gene. Thus a diagnosis of FAP was established. Diffuse fine granular protrusions in the jejunum and the ileum visualized by small-bowel radiography and DBE may be characteristic of FAP. Multiple biopsies from the gastrointestinal mucosa are recommended for the definitive histologic diagnosis of FAP. PMID:26986100

  1. Prospective evaluation of small bowel preparation with bisacodyl and sodium phosphate for capsule endoscopy

    PubMed Central

    Franke, Andreas; Hummel, Frank; Knebel, Phillip; Antoni, Christoph; Böcker, Ulrich; Singer, Manfred V; Löhr, Matthias

    2008-01-01

    AIM: To determine the effect of Prepacol®, a combination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy (CE). METHODS: Fivety two consecutive patients were included in this prospective study. CE was performed following a 12 h fasting period. Twenty six patients were randomized for additional preparation with Prepacol®. The quality of CE was assessed separately for the proximal and the distal small bowel by 3 experienced endoscopists on the basis of a graduation which was initially developed with 20 previous CE. RESULTS: Preparation with Prepacol® accelerated small bowel transit time (262 ± 55 min vs 287 ± 97 min), but had no effect on the quality of CE. Visibility was significantly reduced in the distal compared to the proximal small bowel. CONCLUSION: The significantly reduced visibility of CE in the distal small bowel allocates the need for a good preparation. Since Prepacol® has no beneficial effect on CE the modality of preparation and the ideal time of application remains unclear. Further standardized examinations are necessary to identify sufficient preparation procedures and to determine the impact of the volume of the preparation solution. PMID:18395907

  2. Irritable Bowel Syndrome and the Small Intestinal Microflora. What Do We Know?

    PubMed

    Moraru, Ioana G; Moraru, A G; Dumitraşcu, D L

    2015-01-01

    Irritable bowel syndrome, one of the most common functional gastro intestinal disorders all over the world is considered to have a multi factorial pathogenesis. Recently more and more studies are focusing on the changes that take place in the microbiota of patients with irritable bowel syndrome, underlining the bacterial role in this pathogenesis. As a consequence, bacterial overgrowth, along with intestinal dysmotility, altered brain-gut axis and genetic factors are considered part of this pathophysiology. This report intends to summarize the actual knowledge on irritable bowel syndrome and small intestinal bacterial overgrowth syndrome, from details on the epidemiology, clinical manifestation, pathophysiology, diagnosis, treatment to details on the relationship between these two syndromes. PMID:26076568

  3. Host-microbe interactions in the small bowel

    PubMed Central

    Davies, Julie M.; Abreu, Maria T.

    2015-01-01

    Purpose of Review The intestine, home to a vast microbiome, balances its immune reactivity on a knife’s edge. This review will summarize recent studies examining innate immune signals that shape the microbiota, and how pathogens can usurp protective responses to their advantage. Recent findings Innate signaling uses several pathways to maintain epithelial defense. Toll-like receptor signaling through myeloid differentiation factor 88 maintains segregation between bacteria and the epithelium through production of anti-microbial proteins and inflammasome signaling mediates efficient goblet cell release of mucus containing granules. Conversely, negative regulators of TLR signaling help maintain a healthy microbiota resistant to pathogen infection. Methods to evade immune elimination by pathogens associated with human infections and inflammatory bowel disease are described. Emerging evidence that pattern recognition receptors can differentiate between commensals and pathogens will be examined. Summary The balance of innate signaling in the intestine is crucial to homeostasis: too little and bacteria can directly contact the epithelium, too much depletes the protective microbiota creating a niche for pathogens. Understanding the dynamic interaction between the immune system and the microbiota in a variety of infection and inflammation models will hopefully translate to new therapies. PMID:25426971

  4. Toxic epidermal necrolysis complicated by small bowel intussusception: a case report.

    PubMed

    Bouziri, Asma; Khaldi, Ammar; Hamdi, Asma; Borgi, Aida; Ghorbel, Sofiene; Kharfi, Monia; Hadj, Sarra Bel; Menif, Khaled; Ben Jaballah, Nejla

    2011-02-01

    Intestinal involvement in toxic epidermal necrolysis (TEN) has been identified only rarely. We report a case of TEN complicated by small bowel intussusception. The patient was a previously healthy 8-year-old boy who presented with TEN and extensive lesions, including up to 40% of the body surface area as well as conjunctival, oropharyngeal, respiratory, and genital mucosa. Rapidly after the onset of a constant rate of enteral feeding, he developed bilious vomiting, diarrhea, and significant abdominal distension. Abdominal sonography showed a small bowel intussusception. At abdominal exploration, an ileoileal intussusception was observed with a viable but inflamed bowel wall. Manual reduction was performed. During the postoperative clinical course, the patient was managed with total parenteral nutrition and local care of the skin and mucous membranes. Enteral feeding was introduced on the sixth postoperative day, and the child left the hospital 15 days after his admission. The association of TEN and small bowel intussusception has not been previously reported in the literature. PMID:21292071

  5. Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature

    PubMed Central

    Frontario, S. Christopher N.; Loveitt, Andrew; Goldenberg-Sandau, Anna; Liu, Jun; Roy, Darshan; Cohen, Larry W.

    2015-01-01

    Patient: Female, 76 Final Diagnosis: Peritoneal mesothelioma epithelioid type Symptoms: Alternating bowel habits • ascites • small bowel obstruction • weight loss Medication: — Clinical Procedure: Exploratory laparotomy • excisional biopsy Specialty: Surgery Objective: Rare disease Background: Peritoneal mesothelioma is a rare malignancy that affects the serosal surfaces of the peritoneum. The peritoneum is the second most common site of mesothelium affected following the pleura. The aggressive nature and vague presentation pose many obstacles in not only diagnosis but also the treatment of patients with this disease. Case Report: We present a case of a 76-year-old woman who presented with small bowel obstruction secondary to carcinomatosis secondary to primary peritoneal mesothelioma. The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation. Conclusions: We discuss the highly varied and elusive presentation of peritoneal mesothelioma. Cumulative asbestos exposure, either directly or indirectly, remains the leading cause of mesothelioma. However, there are other non-asbestos etiologies. Small bowel obstruction often is a late-presenting symptom of widespread tumor burden. A concise review of the current diagnostic and surgical treatment of primary peritoneal mesothelioma demonstrates that early diagnosis and implementation remains vital. PMID:26222965

  6. New targeted therapies such as anti-adhesion molecules, anti-IL-12/23 and anti-Janus kinases are looking toward a more effective treatment of inflammatory bowel disease.

    PubMed

    Bravatà, Ivana; Fiorino, Gionata; Allocca, Mariangela; Repici, Alessandro; Danese, Silvio

    2015-01-01

    Antitumor necrosis factor α agents have dramatically changed the management of inflammatory bowel disease (IBD). However, a significant proportion of patients does not respond or lose response over time. Hence, there is an urgent need for new molecules, with different mechanisms of action, and with a targeted and more effective approach. These new drugs include either small molecules or biological agents. We describe the three most promising classes of molecules in the field of IBD: anti-adhesion, anti-interleukin 12/23 and anti-Janus Kinases therapies. PMID:25523561

  7. Small Bowel Dose Parameters Predicting Grade ≥3 Acute Toxicity in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation: An Independent Validation Study Comparing Peritoneal Space Versus Small Bowel Loop Contouring Techniques

    SciTech Connect

    Banerjee, Robyn; Chakraborty, Santam; Nygren, Ian; Sinha, Richie

    2013-04-01

    Purpose: To determine whether volumes based on contours of the peritoneal space can be used instead of individual small bowel loops to predict for grade ≥3 acute small bowel toxicity in patients with rectal cancer treated with neoadjuvant chemoradiation therapy. Methods and Materials: A standardized contouring method was developed for the peritoneal space and retrospectively applied to the radiation treatment plans of 67 patients treated with neoadjuvant chemoradiation therapy for rectal cancer. Dose-volume histogram (DVH) data were extracted and analyzed against patient toxicity. Receiver operating characteristic analysis and logistic regression were carried out for both contouring methods. Results: Grade ≥3 small bowel toxicity occurred in 16% (11/67) of patients in the study. A highly significant dose-volume relationship between small bowel irradiation and acute small bowel toxicity was supported by the use of both small bowel loop and peritoneal space contouring techniques. Receiver operating characteristic analysis demonstrated that, for both contouring methods, the greatest sensitivity for predicting toxicity was associated with the volume receiving between 15 and 25 Gy. Conclusion: DVH analysis of peritoneal space volumes accurately predicts grade ≥3 small bowel toxicity in patients with rectal cancer receiving neoadjuvant chemoradiation therapy, suggesting that the contours of the peritoneal space provide a reasonable surrogate for the contours of individual small bowel loops. The study finds that a small bowel V15 less than 275 cc and a peritoneal space V15 less than 830 cc are associated with a less than 10% risk of grade ≥3 acute toxicity.

  8. [Comorbid Meckel's diverticulum and omphalomesenteric cyst evaluated by small bowel series under double-balloon enteroscopy: a case report].

    PubMed

    Tsuruta, Shinichi; Sumida, Yorinobu; Harada, Naohiko; Hata, Yoshitaka; Nakamuta, Makoto; Ikejiri, Koji; Momosaki, Masaya; Takahashi, Shunsuke; Hirahashi, Minako

    2016-04-01

    A 59-year-old man was referred to our hospital for examination of intermittent abdominal pain. Computed tomography scan showed a cystic lesion adjoining the ileum, and small bowel series demonstrated a small bowel diverticulum. Double-balloon enteroscopy (DBE) revealed a diverticulum in the ileum and a soft and smooth elevated lesion with a small hole at the base of the diverticulum. Small bowel series under DBE demonstrated that the cystic lesion communicated with the diverticulum through the small hole. The diagnosis was Meckel's diverticulum and an omphalomesenteric cyst. This is the first reported case of a Meckel's diverticulum and omphalomesenteric cyst communicating through a small hole without a fibrous ligament. In addition, precise evaluation was possible by small bowel series and DBE. PMID:27052394

  9. Repeated small bowel resection in a patient with Buerger's disease and intestinal involvement.

    PubMed

    Enshaei, Ali; Hajipour, Babak; Masoudi, Naser

    2016-04-01

    Buerger's disease, also called thromboangiitis obliterans, is a recurrent and an uncommon vaso-occlusive inflammatory disease, which typically affects small and medium-sized arteries, veins and nerves of the upper and lower extremities. Mesenteric and multisystem involvement of two or more organs is extremely rare. Here we report the case of a 39-year-old male heavy smoker who had undergone four repetitive laparotomies and multiple small bowel resections for ischaemic involvement of Buerger's disease. He had below-the-knee amputation of the right leg and finger of the left hand because of that disease before bowel involvement. Histopathological findings revealed that the arteries and veins of the resected small intestine were occluded with organised thrombi. Inflammatory cell infiltration was recognised mainly in the intima of distal branches of mesenteric artery. These findings were compatible with previous findings in histopathological examinations of amputated extremities. PMID:27122278

  10. Interventional digital subtraction angiography for small bowel gastrointestinal stromal tumors with bleeding

    PubMed Central

    Chen, Yao-Ting; Sun, Hong-Liang; Luo, Jiang-Hong; Ni, Jia-Yan; Chen, Dong; Jiang, Xiong-Ying; Zhou, Jing-Xing; Xu, Lin-Feng

    2014-01-01

    AIM: To retrospectively evaluate the diagnostic efficacy of interventional digital subtraction angiography (DSA) for bleeding small bowel gastrointestinal stromal tumors (GISTs). METHODS: Between January 2006 and December 2013, small bowel tumors in 25 consecutive patients undergoing emergency interventional DSA were histopathologically confirmed as GIST after surgical resection. The medical records of these patients and the effects of interventional DSA and the presentation and management of the condition were retrospectively reviewed. RESULTS: Of the 25 patients with an age range from 34- to 70-year-old (mean: 54 ± 12 years), 8 were male and 17 were female. Obscure gastrointestinal bleeding, including tarry or bloody stool and intermittent melena, was observed in all cases, and one case also involved hematemesis. Nineteen patients required acute blood transfusion. There were a total of 28 small bowel tumors detected by DSA. Among these, 20 were located in the jejunum and 8 were located in the ileum. The DSA characteristics of the GISTs included a hypervascular mass of well-defined, homogeneous enhancement and early developed draining veins. One case involved a complication of intussusception of the small intestine that was discovered during surgery. No pseudoaneurysms, arteriovenous malformations or fistulae, or arterial rupture were observed. The completely excised size was approximately 1.20 to 5.50 cm (mean: 3.05 ± 1.25 cm) in maximum diameter based on measurements after the resection. There were ulcerations (n = 8), erosions (n = 10), hyperemia and edema (n = 10) on the intra-luminal side of the tumors. Eight tumors in patients with a large amount of blood loss were treated with transcatheter arterial embolization with gelfoam particles during interventional DSA. CONCLUSION: Emergency interventional DSA is a useful imaging option for locating and diagnosing small bowel GISTs in patients with bleeding, and is an effective treatment modality. PMID:25548494

  11. CT enteroclysis/enterography findings in drug-induced small-bowel damage

    PubMed Central

    Shimizu, K; Hashimoto, S; Onoda, H; Washida, Y; Sakaida, I; Matsunaga, N

    2014-01-01

    Objective: To evaluate the CT enteroclysis (CTE)/enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. Methods: CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). Results: Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. Conclusion: On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. Advances in knowledge: Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE. PMID:25348282

  12. A jejunal GIST presenting with obscure gastrointestinal bleeding and small bowel obstruction secondary to intussusception.

    PubMed

    Sadeghi, Peter; Lanzon-Miller, Sandro

    2015-01-01

    A 68-year-old man with episodes of overt obscure gastrointestinal (GI) bleeding was investigated with multiple upper and lower GI endoscopies, CT enterography and capsule endoscopy, but no cause was found. He then presented acutely with small bowel obstruction. A laparotomy revealed complete small bowel obstruction secondary to jejunal intussusception over a 4 cm intraluminal polyp. Following resection and primary anastomosis, histology revealed that the polyp was a GI stromal tumour (GIST). This is an exceptionally uncommon presentation of a rare tumour. It is surprising that this tumour was not detected by CT enterography and not seen on capsule endoscopy. Immunohistochemistry and mutation analysis of the GIST suggested that it had a low risk of metastatic disease, but a high risk of recurrence. Staging CT scans did not reveal evidence of distal spread. The patient is currently receiving 3 years of chemotherapy with imatinib. PMID:26527610

  13. Radiation-induced small bowel disease: latest developments and clinical guidance

    PubMed Central

    Stacey, Rhodri

    2014-01-01

    Ionizing radiation is commonly used to treat a number of malignancies. Although highly effective and now more targeted, many patients suffer side effects. The number of cancer survivors has increased and so there are more patients presenting with symptoms that have arisen as a result of radiotherapy. Radiation damage to small bowel tissue can cause acute or chronic radiation enteritis producing symptoms such as pain, bloating, nausea, faecal urgency, diarrhoea and rectal bleeding which can have a significant impact on patient’s quality of life. This review outlines the pathogenesis of radiation injury to the small bowel along with the prevention of radiation damage via radiotherapy techniques plus medications such as angiotensin-converting enzyme inhibitors, statins and probiotics. It also covers the treatment of both acute and chronic radiation enteritis via a variety of medical (including hyperbaric oxygen), dietetic, endoscopic and surgical therapies. PMID:24381725

  14. Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use

    PubMed Central

    Pamukçu Günaydın, Gül; Çiftçi Sivri, Hatice Duygu; Sivri, Serkan; Otal, Yavuz; Özhasenekler, Ayhan; Kurtoğlu Çelik, Gülhan

    2015-01-01

    Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma. PMID:26649210

  15. Multiple carcinomas of the large and small bowel in childhood

    PubMed Central

    Harvey, David R.; Paradinas, Fernando J.

    1975-01-01

    A case is reported of multiple metachronous carcinomas of the small and large intestine in a child. The latter were associated with multiple adenomatous polyps in the colon. A desmoid tumour and multiple keloids developed in the laparotomy scars. The relationship of this case to Gardner's syndrome and polyposis coli is discussed and the literature on intestinal carcinoma in childhood is briefly reviewed. ImagesFig. 1Fig. 2Fig. 3Figs. 4 and 5 PMID:172879

  16. In vitro allograft irradiation prevents graft-versus-host disease in small-bowel transplantation

    SciTech Connect

    Lee, K.K.; Schraut, W.H.

    1985-04-01

    In small-bowel transplantation, the transfer of large numbers of donor lymphocytes with the intestinal allograft may provoke a lethal graft-versus-host reaction. The effectiveness of allograft irradiation in vitro as a method of preventing graft-versus-host disease (GVHD) was studied in a rat model of small-bowel transplantation, with the Lewis----Lewis X Brown Norway F1 hybrid strain combination. Cold harvested small-bowel allografts were irradiated immediately prior to heterotopic or orthotopic transplantation. Animals that had received heterotopic allografts irradiated with 0, 250, or 500 rad all died of GVHD after 14.4 +/- 3.0, 15.0 +/- 1.3, and 14.2 +/- 1.9 days, respectively. None of the animals that had received allografts treated with 1000 rad developed clinical or pathologic evidence of GVHD, however, and all survived for more than 6 months (P less than 0.001). Allograft function was studied in animals that underwent orthotopic transplantation. Recipients of nonirradiated orthotopic allografts all died of GVHD after 14.0 +/- 0.7 days, whereas recipients of allografts irradiated with 1000 rad all survived for more than 5 months (P less than 0.001). After 120 days, weight gain (51.8 +/- 11.7%), serum albumin (3.9 +/- 0.7 g/dl), serum triglycerides (67.0 +/- 24.3 mg/dl), CBC, and differential in these animals were not statistically different from those in either age-matched isograft recipients or normal animals, and when the rats were sacrificed, irradiated allografts showed no changes suggestive of radiation injury. These results indicate that irradiation of small-bowel allografts in vitro prevents development of GVHD, and that this can be achieved at a dose which does not cause injury to or malfunction of the allograft.

  17. Calcium absorption following small bowel resection in man. Evidence for an adaptive response.

    PubMed

    Colette, C; Gouttebel, M C; Monnier, L H; Saint-Aubert, B; Joyeux, H

    1986-08-01

    Seventeen patients who had undergone extensive small bowel resection were studied for calcium absorption (FACa) and plasma vitamin D metabolites. FACa was measured by a double radio-tracer technique and expressed as percentage of total oral dose. FACa was decreased compared with controls (34%, range: 3-46 v 65%, range: 57-73, P less than 0.01). A positive correlation (r = 0.49, P = 0.05) was found between FACa and the remaining length of small bowel (SBL). As wide variations in both SBL and duration after surgery were observed among the seventeen investigated patients, we were led to individualize less heterogeneous subgroups of patients. Better correlations were found when the patients were divided into two subgroups according to whether the time interval between the resection and the investigation was shorter (r = 0.75, n = 11, P less than 0.02) or longer (r = 0.89, n = 6, P = 0.05) than 2 years. In thirteen patients who had a SBL shorter than 100 cm, a positive correlation was observed between FACa and the time interval after surgery (months): r = 0.65, P less than 0.05. Plasma 1,25 (OH)2D was markedly reduced in the whole group (31 pmol l-1, range: 8-108) compared with controls (103 pmol-1, range: 59-134, P less than 0.01). The present study shows that in extensively small bowel resected patients, calcium absorption is reduced, the alteration being dependent both on the length of the remnant small bowel and on the time after surgery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3093239

  18. Does magnetically assisted capsule endoscopy improve small bowel capsule endoscopy completion rate? A randomised controlled trial

    PubMed Central

    Hale, Melissa F.; Drew, Kaye; Sidhu, Reena; McAlindon, Mark E.

    2016-01-01

    Background and study aims: Delayed gastric emptying is a significant factor in incomplete small bowel capsule examinations. Gastric transit could be hastened by external magnetic control of the capsule. We studied the feasibility of this approach to improve capsule endoscopy completion rates. Patients and methods: Prospective, single-center, randomized controlled trial involving 122 patients attending for small bowel capsule endoscopy using MiroCam Navi. Patients were randomized to either the control group (mobilisation for 30 minutes after capsule ingestion, followed by intramuscular metoclopramide 10 mg if the capsule failed to enter the small bowel) or the intervention group (1000 mL of water prior to capsule ingestion, followed by positional change and magnetic steering). Outcome measures were capsule endoscopy completion rate, gastric clarity and distention, relationship of body habitus to capsule endoscopy completion rate (CECR), and patient comfort scores. Results: 122 patients were recruited (61 each to the control and intervention groups: mean age 49 years [range 21 – 85], 61 females). There was no significant difference in CECR between the two groups (P = 0.39). Time to first pyloric image was significantly shorter in the intervention group (P = 0.03) but there was no difference in gastric transit times (P = 0.12), suggesting that magnetic control hastens capsular transit to the gastric antrum but does not influence duodenal passage. Gastric clarity and distention were significantly better in the intervention group (P < 0.0001 and P < 0.0001 respectively). Conclusions: Magnetic steering of a small bowel capsule is unable to overcome pyloric contractions to enhance gastric emptying and improve capsule endoscope completion rate. Excellent mucosal visualisation within the gastric cavity suggests this technique could be harnessed for capsule examination of the stomach. PMID:26878053

  19. Ethanol Ablation of a Peripheral Nerve Sheath Tumor Presenting as a Small Bowel Obstruction.

    PubMed

    Chin, Matthew; Chen, Chien-Lin; Chang, Kenneth; Lee, John; Samarasena, Jason

    2015-10-01

    Ethanol has historically been used as an ablative agent for a variety of lesions. One of the more common applications of this technique is celiac plexus neurolysis; however, recent reports have suggested a role for the endoscopic alcohol ablation of a variety of solid and cystic lesions. We report a novel case of endoscopic ethanol ablation of a peripheral nerve sheath tumor presenting as a small bowel obstruction. PMID:26504873

  20. Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

    PubMed Central

    Torroni, Filippo; Romeo, Erminia; Rea, Francesca; Angelis, Paola De; Foschia, Francesca; Faraci, Simona; Abriola, Giovanni Federici di; Contini, Anna Chiara; Caldaro, Tamara; Dall’Oglio, Luigi

    2014-01-01

    AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure. RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm). CONCLUSION: The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of

  1. Passage of intestinal (small bowel) cast – an unusual complication of neutropenic sepsis

    PubMed Central

    Samee, A; Kirby, R M; Brunt, A M

    2010-01-01

    A 52-year-old woman was admitted with neutropenic sepsis, 3 days following the final cycle of adjuvant chemotherapy for breast cancer. Her condition deteriorated with progressive abdominal distension, bilious vomiting and diarrhoea. Abdominal examination revealed a mild degree of peritonism. Five days later she passed a small bowel cast per rectum, showing gross fungal contamination on histology. She was managed conservatively with antibiotics and antifungal medications and nutritional support. PMID:22767625

  2. Recent advances in small bowel diseases: Part I

    PubMed Central

    Thomson, Alan BR; Chopra, Angeli; Clandinin, Michael Tom; Freeman, Hugh

    2012-01-01

    As is the case in all parts of gastroenterology and hepatology, there have been many advances in our knowledge and understanding of small intestinal diseases. Over 1000 publications were reviewed for 2008 and 2009, and the important advances in basic science as well as clinical applications were considered. In Part I of this Editorial Review, seven topics are considered: intestinal development; proliferation and repair; intestinal permeability; microbiotica, infectious diarrhea and probiotics; diarrhea; salt and water absorption; necrotizing enterocolitis; and immunology/allergy. These topics were chosen because of their importance to the practicing physician. PMID:22807604

  3. Evaluation of different small bowel contrast agents by multi - detector row CT

    PubMed Central

    Wang, Yong-Ren; Yu, Xiao-Li; Peng, Zhi-Yi

    2015-01-01

    Objective: This study aims to evaluate the effects of different oral small bowel contrast agents towards the intestinal dilatation and intestinal wall structure exhibition by the abdominal multi - detector row CT (MDCT) examination. Methods: 80 patients were performed the whole abdominal CT examination, then randomly divided into four groups, with 20 patients in each group. 45 minutes before the CT examination, the patients were served with a total of 1800 ml pure water, pure milk, dilute lactulose solution and isotonic mannitol solution, respectively. Results: The images were blinded read by two experienced abdominal radiologists in the workstation, the cross-sectional diameters of duodenum, jejunum, proximal and terminal ends of ileum of each patient were measured, then the analysis of variance was performed to analyze the differences in the intestinal dilatation among the experimental groups. The scoring method was used to score the intestinal dilatation and intestinal structure exhibition. The diluted lactulose solution and 2.5% mannitol exhibited the best intestinal dilation degrees. Similarly, the diluted lactulose solution and 2.5% mannitol exhibited the highest scores in the entire small bowel dilatation degree and intestinal structure exhibition. Conclusions: 2.5% osmotic mannitol and the diluted lactulose solution enabled the full dilatation of small bowel, and could clearly exhibit the wall structure. PMID:26629131

  4. Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

    PubMed Central

    Smith, Ethan A.; Sanchez, Ramon J.; DiPietro, Michael A.; DeMatos-Maillard, Vera; Strouse, Peter J.; Darge, Kassa

    2015-01-01

    Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population. ©RSNA, 2015 PMID:25839736

  5. Laparoscopic management of mesh erosion into small bowel and urinary bladder following total extra-peritoneal repair of inguinal hernia

    PubMed Central

    Aggarwal, Sandeep; Praneeth, Kokkula; Rathore, Yashwant; Waran, Vignesh; Singh, Prabhjot

    2016-01-01

    Mesh erosion into visceral organs is a rare complication following laparoscopic mesh repair for inguinal hernia with only 15 cases reported in English literature. We report the first case of complete laparoscopic management of mesh erosion into small bowel and urinary bladder. A 62-year-male underwent laparoscopic total extra-peritoneal repair of left inguinal hernia at another centre in April 2012. He presented to our centre 21 months later with persistent lower urinary tract infection (UTI). On evaluation mesh erosion into bowel and urinary bladder was suspected. At laparoscopy, a small bowel loop was adhered to the area of inflammation in the left lower abdomen. After adhesiolysis, mesh was seen to be eroding into small bowel. The entire infected mesh was pulled out from the pre-peritoneal space and urinary bladder wall using gentle traction. The involved small bowel segment was resected, and bowel continuity restored using endoscopic linear cutter. The resected bowel along with the mesh was extracted in a plastic bag. Intra-operative test for leak from urinary bladder was found to be negative. The patient recovered uneventfully and is doing well at 12 months follow-up with resolution of UTI. Laparoscopic approach to mesh erosion is feasible as the plane of mesh placement during laparoscopic hernia repair is closer to peritoneum than during open hernia repair. PMID:26917927

  6. Small Bowel Adenocarcinoma as the Cause of Gastrointestinal Bleeding in Celiac Disease: A Rare Malignancy in a Common Disease

    PubMed Central

    Fallah, Jaleh; Afari, Maxwell Eyram; Cordova, Alfredo C.; Olszewski, Adam J.; Minami, Taro

    2015-01-01

    Introduction. Celiac disease is associated with an increased risk of small bowel malignancies, particularly lymphoma. Its association with small bowel carcinoma is less known. Case Description. We report a case of an 89-year-old woman with celiac disease who experienced recurrent episodes of gastrointestinal bleeding and was ultimately found to have adenocarcinoma of the small intestine. Discussion and Evaluation. Diagnosis of small bowel adenocarcinoma is often delayed because of the need for specialized modalities, which are often deferred in the inpatient setting. Although resection is the modality of choice for small bowel tumors, a majority is either locally advanced or metastatic at diagnosis, and even localized cancers have worse prognosis than stage-matched colorectal tumors. The role of adjuvant chemotherapy is uncertain, but it is often offered extrapolating data from other gastrointestinal cancers. Small bowel carcinomas occurring in the context of celiac disease appear to be associated with higher rates of microsatellite instability than sporadic tumors, although other specific genomic abnormalities and mechanisms of carcinogenesis in celiac disease remain unknown. Conclusion. Recurrent episodes of gastrointestinal bleeding in a patient with celiac disease should prompt an early evaluation of the small bowel to assure timely diagnosis of carcinoma at an early curable stage. PMID:26290763

  7. Small bowel obstruction following computed tomography and magnetic resonance enterography using psyllium seed husk as an oral contrast agent.

    PubMed

    Chen, Yingming Amy; Cervini, Patrick; Kirpalani, Anish; Vlachou, Paraskevi A; Grover, Samir C; Colak, Errol

    2014-01-01

    The authors report a case series describing four patients who developed small bowel obstruction following the use of psyllium seed husk as an oral contrast agent for computed tomography or magnetic resonance enterography. Radiologists who oversee computed tomography and magnetic resonance enterography should be aware of this potential complication when using psyllium seed husk and other bulking agents, particularly when imaging patients with known or suspected small bowel strictures or active inflammation. PMID:25157531

  8. Small bowel obstruction following computed tomography and magnetic resonance enterography using psyllium seed husk as an oral contrast agent

    PubMed Central

    Chen, Yingming Amy; Cervini, Patrick; Kirpalani, Anish; Vlachou, Paraskevi A; Grover, Samir C; Colak, Errol

    2014-01-01

    The authors report a case series describing four patients who developed small bowel obstruction following the use of psyllium seed husk as an oral contrast agent for computed tomography or magnetic resonance enterography. Radiologists who oversee computed tomography and magnetic resonance enterography should be aware of this potential complication when using psyllium seed husk and other bulking agents, particularly when imaging patients with known or suspected small bowel strictures or active inflammation. PMID:25157531

  9. Actively bleeding Dieulafoy’s lesion of the small bowel identified by capsule endoscopy and treated by push enteroscopy

    PubMed Central

    Palma, Giovanni D De; Patrone, Francesco; Rega, Maria; Simeoli, Immacolata; Masone, Stefania; Persico, Giovanni

    2006-01-01

    Dieulafoy’s lesion is an unusual cause of recurrent GI bleeding. This report describes a case of actively bleeding Dieulafoy’s lesion of the small bowel in which the diagnosis was made by capsule endoscopy, followed by treatment with the use of push enteroscopy. The case illustrates that capsule endoscopy and enteroscopy are highly complementary in patients with small bowel diseases. PMID:16804987

  10. Reversible small bowel obstruction in the chicken foetus

    PubMed Central

    von Sochaczewski, Christina Oetzmann; Wenke, Katharina; Metzger, Roman Patrick; Loveland, Jerome Alexander; Westgarth-Taylor, Chris; Kluth, Dietrich

    2015-01-01

    Background: Ligation of the embryonic gut is an established technique to induce intestinal obstruction and subsequently intestinal atresia in chicken embryos. In this study, we modified this established chicken model of prenatal intestinal obstruction to describe (1) the kinetics of morphological changes, (2) to test if removal of the ligature in ovo is possible in later embryonic development and (3) to describe morphological adaptations following removal of the ligature. Materials and Methods: On embryonic day (ED) 11, small intestines of chick embryos were ligated micro surgically in ovo. In Group 1 (n = 80) gut was harvested proximal and distal to the ligation on ED 12-19. In Group 2 (n = 20) the induced obstruction was released on day 15 and gut was harvested on ED 16-19. Acetyl choline esterase staining was used as to assess resulting morphological changes. Results: A marked intestinal dilatation of the proximal segment can be seen 4 days after the operation (ED 15). The dilatation increased in severity until ED 19 and intestinal atresia could be observed after ED 16. In the dilated proximal segments, signs of disturbed enteric nervous system morphology were obvious. In contrast to this, release of the obstruction on ED 15 in Group 2 resulted in almost normal gut morphology at ED 19. Conclusion: Our model not only allows the description of morphological changes caused by an induced obstruction on ED 11 but also-more important - of morphological signs of adaptation following the release of the obstruction on ED 15. PMID:25659543

  11. Small-bowel capsule endoscopy: A ten-point contemporary review

    PubMed Central

    Koulaouzidis, Anastasios; Rondonotti, Emanuele; Karargyris, Alexandros

    2013-01-01

    The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn’s disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn’s disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is

  12. Plasma citrulline level as a biomarker for cancer therapy-induced small bowel mucosal damage.

    PubMed

    Barzał, Justyna A; Szczylik, Cezary; Rzepecki, Piotr; Jaworska, Małgorzata; Anuszewska, Elżbieta

    2014-01-01

    Regimen-related mucosal toxicity is extremely common following cytotoxic chemotherapy and radiotherapy. Mucositis is as an important determinant of the inflammatory response and infectious complications in cancer treated patients. Most assessment scales for mucosal damage are focussed on oral mucositis, since it is easy to evaluate. Measuring gastrointestinal musocal damage objectively remains difficult because it cannot be seen directly or readily detected. One of potential non-invasive biomarkers of gastrointestinal mucosal damage is plasma citrulline level. Citrulline is an amino acid produced by small bowel enterocytes. Low concentration of free circulating citrulline signifies severe intestinal mucosal damage in humans with nonmalignant disorders, such as villous atrophy-associated diseases, short bowel syndrome, Crohn's disease, and is used in follow-up after small bowel transplantation. The plasma citrulline level is a reliable and objective biochemical marker of enterocyte mass and function in humans, and therefore can be used to monitor enterocyte toxicity resulting from chemotherapy and radiotherapy during anticancer therapy in patients with severely disturbed gut integrity. PMID:25473654

  13. Primary Malignancies of the Small Bowel: A Report of 96 Cases and Review of the Literature

    PubMed Central

    Wilson, James M.; Melvin, David B.; Gray, George F.; Thorbjarnarson, Bjorn

    1974-01-01

    The clinical records and histologic sections of 96 cases of primary small bowel malignancies (excluding lymphomas and periamullary lesions) were reviewed. The location, clinical presentation, pathologic findings, treatment and outcome are compared to the collected published experience, approximately 2400 cases. There were 48 adenocarcinomas, 37 carcinoids, and 11 leiomyosarcomas. Fifty-one men and 45 women ranged from 31 to 83 years old. Eighty-four caused symptoms leading to operative diagnosis; 12 carcinoids were incidental autopsy findings. The most common presentation was pain (33%) followed by weight loss (23%) obstruction (16%), hemorrhage (15%), jaundice (5%), intussusception (3%) and perforation (3%). Masses were felt in 30% of the cases, but were usually dilated bowel or intussusception rather than the tumor per se. Curative resection was attempted in 80 of 84 operatively diagnosed tumors. The 80% mortality among patients followed 5 years is attributed to the late appearance of symptoms and anatomic obstacles to a truly radical operation. PMID:4843046

  14. Small bowel injury after suprapubic catheter insertion presenting 3 years after initial insertion

    PubMed Central

    Gallagher, Kevin M; Good, Daniel W; Brush, John P; Al-hasso, Ammar; Stewart, Grant D

    2013-01-01

    A 77-year-old woman was referred to urology with blockages of her suprapubic catheter (SPC). The catheter was replaced easily in the emergency department, however, no urine was draining, only a cloudy green fluid was visible. On cystoscopy bilious material was identified in the bladder. There was no catheter visible. There seemed to be a fistulous tract entering the bladder at the left dome. The urethra was dilated, a urethral catheter was placed and the SPC was removed. A CT demonstrated that the SPC tract transfixed a loop of pelvic small bowel and entered the bladder with no intraperitoneal contrast leak. The patient recovered well and did not require laparotomy. This case emphasises that bowel perforation, although rare, must be considered as a complication of SPC placement even years after initial insertion when catheter problems arise. Unusually, we learn that this complication may not present with abdominal pain or peritonism. PMID:24326435

  15. Small Bowel Obstruction—Who Needs an Operation? A Multivariate Prediction Model

    PubMed Central

    Eiken, Patrick W.; Bannon, Michael P.; Heller, Stephanie F.; Lohse, Christine M.; Huebner, Marianne; Sarr, Michael G.

    2016-01-01

    Background Proper management of small bowel obstruction (SBO) requires a methodology to prevent nontherapeutic laparotomy while minimizing the chance of overlooking strangulation obstruction causing intestinal ischemia. Our aim was to identify preoperative risk factors associated with strangulating SBO and to develop a model to predict the need for operative intervention in the presence of an SBO. Our hypothesis was that free intraperitoneal fluid on computed tomography (CT) is associated with the presence of bowel ischemia and need for exploration. Methods We reviewed 100 consecutive patients with SBO, all of whom had undergone CT that was reviewed by a radiologist blinded to outcome. The need for operative management was confirmed retrospectively by four surgeons based on operative findings and the patient’s clinical course. Results Patients were divided into two groups: group 1, who required operative management on retrospective review, and group 2 who did not. Four patients who were treated nonoperatively had ischemia or died of malignant SBO and were then included in group 1; two patients who had a nontherapeutic exploration were included in group 2. On univariate analysis, the need for exploration (n = 48) was associated (p < 0.05) with a history of malignancy (29% vs. 12%), vomiting (85% vs. 63%), and CT findings of either free intraperitoneal fluid (67% vs. 31%), mesenteric edema (67% vs. 37%), mesenteric vascular engorgement (85% vs. 67%), small bowel wall thickening (44% vs. 25%) or absence of the “small bowel feces sign” (so-called fecalization) (10% vs. 29%). Ischemia (n = 11) was associated (p < 0.05 each) with peritonitis (36% vs. 1%), free intraperitoneal fluid (82% vs. 44%), serum lactate concentration (2.7 ± 1.6 vs. 1.3 ± 0.6 mmol/l), mesenteric edema (91% vs. 46%), closed loop obstruction (27% vs. 2%), pneumatosis intestinalis (18% vs. 0%), and portal venous gas (18% vs. 0%). On multivariate analysis, free intraperitoneal fluid [odds ratio

  16. Magnetic attraction leading to a small bowel obstruction in a child.

    PubMed

    Fenton, Stephen J; Torgenson, Marcus; Holsti, Maija; Black, Richard E

    2007-12-01

    Foreign body ingestion in small children is common yet only 1% of cases require operative management of associated complications (Arana et al. in Eur J Pediatr 160:468-472, 2001). A 6-year-old boy was referred to our institution with a 12 h history of abdominal pain. This pain was diffuse and crampy in nature and associated with multiple episodes of non-bilious, non-bloody emesis. On evaluation he was stable and his abdomen demonstrated slight distention and tenderness without peritoneal signs. Plain abdominal radiographs demonstrated some distended loops of small bowel and a radio-opaque foreign object within the mid-abdomen. A small bowel obstruction secondary to foreign body ingestion was diagnosed and an emergent laparotomy performed. Upon exploration, a transition zone was noted near the ileocecal valve. Further exploration revealed the obstruction to be caused secondary to the apposition of two small (8 mm) magnets, one in the proximal ileum and the other near the ileocecal valve, resulting in an internal hernia. The magnets were easily separated relieving the obstruction and both were removed via two small bowel enterotomies. After being presented with the magnets, his parents suspected that they came from the clothes of a Polly Pocket (Mattel, Inc., El Segundo, CA) doll. The patient had an uneventful post-operative course and was discharged to home on the second post-operative day. This case demonstrates the complications that may occur with multiple magnet ingestion. It highlights the need for close observation and early surgical intervention in children with a suspected history of foreign body ingestion, a clinical picture of gastrointestinal distress, and radiographic evidence of a radio-opaque foreign object. PMID:17694401

  17. Computer-aided detection of small bowel strictures in CT enterography

    NASA Astrophysics Data System (ADS)

    Sainani, Nisha I.; Näppi, Janne J.; Sahani, Dushyant V.; Yoshida, Hiroyuki

    2011-03-01

    The workflow of CT enterography in an emergency setting could be improved significantly by computer-aided detection (CAD) of small bowel strictures to enable even non-expert radiologists to detect sites of obstruction rapidly. We developed a CAD scheme to detect strictures automatically from abdominal multi-detector CT enterography image data by use of multi-scale template matching and a blob detector method. A pilot study was performed on 15 patients with 22 surgically confirmed strictures to study the effect of the CAD scheme on observer performance. The 77% sensitivity of an inexperienced radiologist assisted by CAD was comparable with the 81% sensitivity of an unaided expert radiologist (p=0.07). The use of CAD reduced the reading time to identify strictures significantly (p<0.0001). Most of the false-positive CAD detections were caused by collapsed bowel loops, approximated bowel wall, muscles, or vessels, and they were easy to dismiss. The results indicate that CAD could provide radiologists with a rapid and accurate interpretation of strictures to improve workflow in an emergency setting.

  18. Effects of trimebutine on intestinal motility after massive small bowel resection.

    PubMed

    Uchiyama, M; Iwafuchi, M; Yagi, M; Iinuma, Y; Kanada, S; Ohtaki, M; Homma, S

    2000-08-01

    Effects of trimebutine maleate (TM) on intestinal motility in short bowel syndrome (SBS) were studied in conscious canines in both acute and chronic phases following 80% massive distal small bowel resection (MSBR). TM was administered orally to beagles with MSBR or as controls in the postprandial and fasting states, and given simultaneously with meals. Intestinal motility was measured using bipolar electrodes for approximately 1 month after the electrodes were implanted in each beagle and the data compared between treatment groups. When TM was given with meals, the postprandial period without duodenal migrating myoelectric (or motor) complexes (MMCs) was shorter than in those given meals only. When TM was given in the postprandial state in short bowel beagles, the initial duodenal MMCs occurred earlier, i.e. the postprandial period was shorter. Diarrhea did not occur in these beagles. When TM was given in the fasting state, duodenal MMCs occurred and propagated to the distal intestine. In conclusion, oral TM administration can produce a more appropriate intestinal condition for the next food intake and make enteral nutrition possible even in the acute phase after MSBR. Such feeding can be carried out without overloading gut function as a result of the modulation of gastrointestinal motility by TM. PMID:11286295

  19. Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

    PubMed Central

    Springer, Jeremy E.; Bailey, Jonathan G.; Davis, Philip J.B.; Johnson, Paul M.

    2014-01-01

    Background The purpose of this research was to examine the morbidity, mortality and rate of recurrent bowel obstruction associated with the treatment of small bowel obstruction (SBO) in older adults. Methods We prospectively enrolled all patients 70 years or older with an SBO who were admitted to a tertiary care teaching centre between Jul. 1, 2011, and Sept. 30, 2012. Data regarding presentation, investigations, treatment and outcomes were collected. Results Of the 104 patients admitted with an SBO, 49% were managed nonoperatively and 51% underwent surgery. Patients who underwent surgery experienced more complications (64% v. 27%, p = 0.002) and stayed in hospital longer (10 v. 3 d, p < 0.001) than patients managed nonoperatively. Nonoperative management was associated with a high rate of recurrent SBO: 31% after a median follow-up of 17 months. Of the patients managed operatively, 60% underwent immediate surgery and 40% underwent surgery after attempted nonoperative management. Patients in whom nonoperative management failed underwent surgery after a median of 2 days, and 89% underwent surgery within 5 days. The rate of bowel resection was high (29%) among those who underwent delayed surgery. Surgery after failed nonoperative management was associated with a mortality of 14% versus 3% for those who underwent immediate surgery; however, this difference was not significant. Conclusion These data suggest that some elderly patients with SBO may be waiting too long for surgery. PMID:25421079

  20. Aminoguanidine Alleviates Radiation-Induced Small-Bowel Damage Through Its Antioxidant Effect

    SciTech Connect

    Huang, E.-Y.; Wang, F.-S.; Lin, I-H.; Yang, Kuender D.

    2009-05-01

    Purpose: To evaluate the effect and its mechanism of aminoguanidine (AG) on small-bowel protection after whole-abdominal irradiation (WAI) in rats. Methods and Materials: Male Sprague-Dawley rats (300-400 g) subjected to 12 Gy WAI were used for the study. Aminoguanidine at a dose of 50-800 mg/kg was administered by the gavage route 2 h before WAI. Mucosal damage of small bowel was evaluated by the grade of diarrhea and crypt survival; oxidative stress was determined by the level of 8-hydroxy 2'-deoxyguanosine (8-OHdG) with immunohistochemistry (IHC). Nitrosative stress was evaluated by the expression of inducible nitric oxide synthase (iNOS) and 3-nitrotyrosine (3-NT) with IHC, and systemic and portal vein NOx (nitrite + nitrate) levels were measured and compared with and without AG treatment after WAI. Results: Aminoguanidine showed a dose-dependent effect against WAI-induced diarrhea. Aminoguanidine at a dose of 400 mg/kg had the best protective effect, from 92% to 17% (p = 0.002). Aminoguanidine increased crypt survival from 23% to 46% (p = 0.003). It also significantly attenuated 8-OHdG expression but not 3-NT and iNOS expression at both 4 and 8 h after 12-Gy WAI. Aminoguanidine did not alter the portal vein NOx levels 4 and 8 h after 12-Gy WAI. Conclusion: Aminoguanidine has a radioprotective effect against radiation-induced small-bowel damage due to its antioxidant effect but not inhibition of nitric oxide production. Dietary AG may have a potentially protective effect on the small intestine of patients subjected to pelvic and abdominal radiotherapies.

  1. Adhesion

    MedlinePlus

    ... adhesions Ovarian cyst References Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin N Am Kulaylat MN, Dayton, MT. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ...

  2. Small Bowel Carcinoids: A Single Surgeon’s Experience in Southern India

    PubMed Central

    Hegde, Nishchit

    2015-01-01

    Introduction Small bowel carcinoid tumours are indolent neuroendocrine tumours usually seen in the 6th and 7th decades. Most often, they are silent with non-specific symptoms. They generate serotonin, provoking a desmoplastic reaction in the mesentery leading to bowel ischemia and obstruction. While CECT abdomen can help raise suspicion and show regional spread, elevated 24-hour urinary 5-HIAA levels, histopathology and immunohistochemistry for Chromogranin A are confirmatory. Aim To analyse a single surgeon’s experience of clinical features and diagnosis of carcinoid tumours of the small intestine. Setting and Design Retrospective study conducted at MS Ramaiah Medical College and Hospital, Bangalore, India. Materials and Methods Fourteen cases of carcinoid of the small bowel presenting to our institution over a 9-year period between December 2005 and November 2014 comprised the study. This included 10 males to 4 females aged 43 to 67 years (Mean: 54.4 years). The patients were investigated using x-ray abdomen, barium study, CECT abdomen, colonoscopy and 24-hour urinary 5- HIAA levels. All patients were surgically treated and histological examination of the resected tumours and immunohistochemistry for Chromogranin A was performed. Results Twelve patients with ileal carcinoids presented with long standing intestinal colic and sub-acute obstruction. Two patients with jejunal carcinoids had epigastric pain. X-ray abdomen was suggestive of small bowel obstruction in 12 patients. CECT abdomen done in 6 patients, showed ileal narrowing causing proximal dilatation; and cocooining of ileal loops at ileo-caecal junction in 2 cases. Ten patients underwent segmental resection-anastomosis of the tumour-bearing intestine while 4 patients underwent a right hemicolectomy. Lymph node spread was seen in 8 patients of whom 4 had liver metastases. Histopathology and Chromogranin A positivity confirmed the diagnoses. Postoperatively, 24-hour urinary 5-HIAA was mildly elevated in 2

  3. Increased density of tolerogenic dendritic cells in the small bowel mucosa of celiac patients

    PubMed Central

    Vorobjova, Tamara; Uibo, Oivi; Heilman, Kaire; Uibo, Raivo

    2015-01-01

    AIM: To investigate the densities of dendritic cells (DCs) and FOXP3+ regulatory T cells (Tregs) and their interrelations in the small bowel mucosa in untreated celiac disease (CD) patients with and without type 1 diabetes (T1D). METHODS: Seventy-four patients (45 female, 29 male, mean age 11.1 ± 6.8 years) who underwent small bowel biopsy were studied. CD without T1D was diagnosed in 18 patients, and CD with T1D was diagnosed in 15 patients. Normal small bowel mucosa was found in two T1D patients. Thirty-nine patients (mean age 12.8 ± 4.9 years) with other diagnoses (functional dyspepsia, duodenal ulcer, erosive gastritis, etc.) formed the control group. All CD patients had partial or subtotal villous atrophy according to the Marsh classification: Marsh grade IIIa in 9, grade IIIb in 21 and grade IIIc in 3 cases. Thirty-nine patients without CD and 2 with T1D had normal small bowel mucosa (Marsh grade 0). The densities of CD11c+, IDO+, CD103+, Langerin (CD207+) DCs and FOXP3+ Tregs were investigated by immunohistochemistry (on paraffin-embedded specimens) and immunofluorescence (on cryostat sections) methods using a combination of mono- and double-staining. Sixty-six serum samples were tested for IgA-tissue transglutaminase (tTG) using a fully automated EliA™ Celikey® IgA assay (Pharmacia Diagnostics, Freiburg, Germany). RESULTS: The density of CD11c+ DCs was significantly increased in CD patients compared with patients with normal mucosa (21.67 ± 2.49 vs 13.58 ± 1.51, P = 0.007). The numbers of FOXP3+ cells were significantly higher in CD patients (10.66 ± 1.50 vs 1.92 ± 0.37, P = 0.0002) and in patients with CD and coexisting T1D (8.11 ± 1.64 vs 1.92 ± 0.37, P = 0.002) compared with patients with normal mucosa. The density of FOXP3+ cells significantly correlated with the histological grade of atrophic changes in the small bowel mucosa according to the March classification (r = 0.62; P < 0.0001) and with levels of IgA antibody (r = 0.55; P < 0

  4. Disruption of the Murine Glp2r Impairs Paneth Cell Function and Increases Susceptibility to Small Bowel Enteritis

    PubMed Central

    Lee, Seung-Jun; Lee, Jennifer; Li, Karen K.; Holland, Dianne; Maughan, Heather; Guttman, David S.; Yusta, Bernardo; Drucker, Daniel J.

    2013-01-01

    Exogenous glucagon-like peptide-2 receptor (GLP-2R) activation elicits proliferative and cytoprotective responses in the gastrointestinal mucosa and ameliorates experimental small and large bowel gut injury. Nevertheless, the essential physiological role(s) of the endogenous GLP-2R remain poorly understood. We studied the importance of the GLP-2R for gut growth, epithelial cell lineage allocation, the response to mucosal injury, and host-bacterial interactions in Glp2r−/− and littermate control Glp2r+/+ mice. Glp2r−/− mice exhibit normal somatic growth and preserved small and large bowel responses to IGF-I and keratinocyte growth factor. However, Glp2r−/− mice failed to up-regulate intestinal epithelial c-fos expression in response to acute GLP-2 administration and do not exhibit changes in small bowel conductance or small or large bowel growth after administration of GLP-2R agonists. The crypt and villus compartment and the numbers and localization of Paneth, enteroendocrine, and goblet cells were comparable in Glp2r+/+ vs. Glp2r−/− mice. Although the severity and extent of colonic mucosal injury in response to 3% oral dextran sulfate was similar across Glp2r genotypes, Glp2r−/− mice exhibited significantly increased morbidity and mortality and increased bacterial translocation after induction of enteritis with indomethacin and enhanced mucosal injury in response to irinotecan. Moreover, bacterial colonization of the small bowel was significantly increased, expression of Paneth cell antimicrobial gene products was reduced, and mucosal bactericidal activity was impaired in Glp2r−/− mice. Although the Glp2r is dispensable for gut development and the response to colonic injury, Glp2r−/− mice exhibit enhanced sensitivity to small bowel injury, and abnormal host-bacterial interactions in the small bowel. PMID:22253424

  5. Simethicone adjunct to polyethylene glycol improves small bowel capsule endoscopy imaging in non-Crohn’s disease patients

    PubMed Central

    Papamichael, Konstantinos; Karatzas, Pantelis; Theodoropoulos, Ioannis; Kyriakos, Nikos; Archavlis, Emmanuel; Mantzaris, Gerasimos J.

    2015-01-01

    Background Currently, there is no standardized protocol for bowel preparation before small bowel capsule endoscopy (SBCE). This study aimed to investigate the effect of simethicone combined with polyethylene glycol (PEG) on the visualization quality (VQ) of the SBCE in patients with or without known or suspected Crohn’s disease (CD). Methods This observational, prospective, single-center study included consecutive patients undergoing a SBCE between 2007 and 2008. Patients received either a standard bowel cleansing preparation of 2 L PEG and 80 mg simethicone orally 12 and 1 h before SBCE respectively (Group A) or only PEG (Group B). VQ, based on scores for luminal bubbles in frames taken from the small intestine, examination completeness, SBCE diagnostic yield, gastric and small bowel transit times were recorded. Results Of the 115 patients finally included (Group A, n=56 and Group B, n=59) the cecum was visualized in 103 (89.6%). Simethicone overall improved the VQ in the proximal [OR: 2.43 (95%CI: 1.08-5.45), P=0.032] but not in the distal bowel segment (P=0.064). Nevertheless, this effect was not observed in patients undergoing SBCE for either known or suspected CD. Conclusion Simethicone as an adjunct to PEG for bowel preparation in patients undergoing SBCE significantly improved the VQ in non-CD patients. PMID:26423317

  6. Small Bowel Ischemia due to Jejunum Volvulus in Pregnancy: A Case Report

    PubMed Central

    Vassiliou, Ioannis; Tympa, Aliki; Derpapas, Michalis; Kottis, Georgios; Vlahos, Nikolaos

    2012-01-01

    The diagnosis of intestinal obstruction in pregnancy is difficult, as the symptoms may mimic pregnancy-associated complaints. The surgical management is challenging, as the mortality rate of midgut volvulus in pregnancy is high. We report the case of a 35-year-old woman at 21 weeks and 5 days of gestation with small bowel obstruction who presented to our institution with a 24 h history of colicky abdominal pain and nausea and who finally had a successful open repair. PMID:23304583

  7. A comparison of metoclopramide and trimebutine on small bowel motility in humans.

    PubMed

    Grandjouan, S; Chaussade, S; Couturier, D; Thierman-Duffaud, D; Henry, J F

    1989-08-01

    Trimebutine meleate and metoclopramide increase small bowel motility. The present manometric study of the human normal interdigestive duodeno-jejunal motility demonstrated two different pharmacological effects in 15 healthy volunteers. Trimebutine constantly induced a premature phase 3 activity (0.81 +/- 0.4 min after a 100-mg intravenous injection) with patterns similar to spontaneous phase 3. Metoclopramide increased the motility index (contractile activity) during phase 2 without inducing a premature phase 3. No significant variations in plasma motilin concentration were noticed after either trimebutine or metoclopramide. The pancreatic polypeptide concentration rose significantly after metoclopramide injection. PMID:2518853

  8. Small bowel Dieulafoy lesions: An uncommon cause of obscure bleeding in cirrhosis

    PubMed Central

    Holleran, Grainne; Hussey, Mary; McNamara, Deirdre

    2016-01-01

    Dieulafoy lesions (DLs) are an uncommon cause of gastrointestinal bleeding, accounting for up to 2% of cases overall. They are largely under recognised and difficult to treat. Up to 95% occur in the stomach, and only case reports document their occurrence in the small bowel (SB). Little is known about their pathophysiology, although there have been associations made previously with chronic liver disease, thought to be due to the erosive effects of alcohol on the mucosa overlying the abnormally dilated vessels. We present a case series of 4 patients with a long duration of obscure gastrointestinal bleeding, who were diagnosed with small intestinal DLs and incidentally diagnosed with chronic liver disease. The histories describe the challenges in both diagnosis and treatment of small intestinal DLs. Our case series suggest a previously unreported link between chronic liver disease and SB DLs which may be due to anatomical vasculature changes or a shift in angiogenic factors as a consequence of portal hypertension or liver cirrhosis.

  9. Relationship of Bowel MR Imaging to Health-related Quality of Life Measures in Newly Diagnosed Pediatric Small Bowel Crohn Disease.

    PubMed

    Dillman, Jonathan R; Carlos, Ruth C; Smith, Ethan A; Davenport, Matthew S; De Matos Maillard, Vera; Adler, Jeremy

    2016-08-01

    Purpose To determine if utility measures of health-related quality of life (HRQOL) in pediatric small bowel Crohn disease (a) change in response to infliximab therapy, (b) correlate with proxy parent or guardian assessments, and (c) correlate with magnetic resonance (MR) imaging and laboratory markers of intestinal active inflammation. Materials and Methods This prospective single-center cohort study was approved by the institutional review board and was compliant with HIPAA. Parental informed consent and subject assent were obtained from all study participants. Twenty-six children with newly diagnosed small bowel Crohn disease receiving infliximab therapy were prospectively enrolled. All subjects underwent measurement of HRQOL utilities (visual analog scale [VAS], time trade-off [TTO], and standard gamble [SG]), MR enterography, and laboratory assessment at baseline and 6 months later. The Wilcoxon signed-rank test was used to compare paired nonparametric data; Spearman correlation (ρ) was used to assess bivariate relationships. Results The median VAS score was 47.5 (interquartile range [IQR]: 20.0-52.2) before infliximab therapy and 83.0 (IQR: 62.0-92.0) at follow-up (P = .0003). There was positive correlation between subject and parent or guardian change in VAS score between baseline and follow-up (ρ = 0.71; P = .0006). The authors identified significant negative correlations between VAS score and MR imaging bowel wall arterial phase enhancement after contrast material administration at baseline (ρ = -0.57, P = .0032) as well as between change in VAS score and change in bowel wall enhancement in the arterial phase at contrast-enhanced MR imaging over time (ρ = -0.51, P = .02). No correlations between VAS score and laboratory inflammatory markers were identified. Conclusion VAS assessment of HRQOL changes over time in response to infliximab therapy in children with small bowel Crohn disease. There are statistically significant correlations between child

  10. Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype.

    PubMed

    Ghoshal, Uday C; Srivastava, Deepakshi

    2014-03-14

    Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain or discomfort, bloating, and altered stool form and passage. Small intestinal bacterial overgrowth (SIBO) is a condition in which there is overgrowth of bacteria in small bowel in excess of 10⁵ colony forming units per milliliter on culture of the upper gut aspirate. Frequency of SIBO varied from 4%-78% among patients with IBS and from 1%-40% among controls. Higher frequency in some studies might be due to fallacious criteria [post-lactulose breath-hydrogen rise 20 PPM above basal within 90 min (early-peak)]. Glucose hydrogen breath test (GHBT) has a low sensitivity to diagnose SIBO. Hence, studies based on GHBT might have under-estimated frequency of SIBO. Therefore, it is important to analyze these studies carefully to evaluate whether the reported association between IBS and SIBO is over or under-projected. This review evaluates studies on association between SIBO and IBS, discordance between different studies, their strength and weakness including methodological issues and evidence on therapeutic manipulation of gut flora on symptoms of IBS. PMID:24627585

  11. Geriatric Small Bowel Obstruction: An Analysis of Treatment and Outcomes Compared to a Younger Cohort

    PubMed Central

    Krause, William R.; Webb, Travis P.

    2016-01-01

    Background Small bowel obstruction (SBO) is a common condition, but little is known about its presentation, management, and outcomes in geriatric patients. Methods A retrospective review was performed comparing geriatric (≥65 years of age) and non-geriatric patients admitted with SBO. Admission characteristics, treatment, and outcomes were compared. Data analysis included Student’s t test and chi-square test or Fisher exact test. Results Among 80 geriatric and 136 non-geriatric patients no difference was observed between admission characteristics, treatment, time to or type of surgery, length of post-op stay, or overall complications. Cardiac complications (15% vs 0%, p=0.0082) and sub-acute care facility discharge (29% vs 5%, p<0.001) were more common for geriatric patients. Conclusions Compared to younger adults, elderly patients with SBO have similar presentations and overall outcomes with the exception of cardiac morbidity and discharge disposition. Pre-operative attention to cardiac risk profile and discharge disposition discussion should be encouraged. Summary This study analyzes geriatric patients presenting with small bowel obstruction when cared for by an Acute Care Surgery service. Compared to younger adults, the presentation, treatment response, and outcomes are similar with the exception of cardiac complications and discharge destination. PMID:25048569

  12. Neuromesenchymal hamartoma of small bowel - an extremely rare entity: a case report

    PubMed Central

    2009-01-01

    Neuromuscular and vascular hamartoma (NMVH) is a very rare stricturing condition of the small intestine, occurring focally and causing recurrent obstructive symptoms or occult chronic gastrointestinal bleeding. Salas et al. (Neuromesenchymal hamartoma of the small bowel. J Clin Gastroenterol. 1990, 12 (6): 705-9) proposed the term of "Neuromesenchymal hamartoma" for the cases of NMVH with participation of mesenchymal tissues. We present the case of a 60-year-old male patient admitted twice in a month with abdominal pain. On the third admission with clinical signs of acute abdomen, an exploratory laparotomy was performed. The clinical and laboratory findings that occurred after the patient's evaluation, the intraoperative findings and the pathological features of this lesion are reported. PMID:19943922

  13. The Dose-Volume Relationship of Small Bowel Irradiation and Acute Grade 3 Diarrhea During Chemoradiotherapy for Rectal Cancer

    SciTech Connect

    Robertson, John M. Lockman, David; Yan Di; Wallace, Michelle

    2008-02-01

    Purpose: Previous work has found a highly significant relationship between the irradiated small-bowel volume and development of Grade 3 small-bowel toxicity in patients with rectal cancer. This study tested the previously defined parameters in a much larger group of patients. Methods and Materials: A total of 96 consecutive patients receiving pelvic radiation therapy for rectal cancer had treatment planning computed tomographic scans with small-bowel contrast that allowed the small bowel to be outlined with calculation of a small-bowel dose-volume histogram for the initial intended pelvic treatment to 45 Gy. Patients with at least one parameter above the previously determined dose-volume parameters were considered high risk, whereas those with all parameters below these levels were low risk. The grade of diarrhea and presence of liquid stool was determined prospectively. Results: There was a highly significant association with small-bowel dose-volume and Grade 3 diarrhea (p {<=} 0.008). The high-risk and low-risk parameters were predictive with Grade 3 diarrhea in 16 of 51 high-risk patients and in 4 of 45 low-risk patients (p = 0.01). Patients who had undergone irradiation preoperatively had a lower incidence of Grade 3 diarrhea than those treated postoperatively (18% vs. 28%; p = 0.31); however, the predictive ability of the high-risk/low-risk parameters was better for preoperatively (p = 0.03) than for postoperatively treated patients (p = 0.15). Revised risk parameters were derived that improved the overall predictive ability (p = 0.004). Conclusions: The highly significant dose-volume relationship and validity of the high-risk and low-risk parameters were confirmed in a large group of patients. The risk parameters provided better modeling for the preoperative patients than for the postoperative patients.

  14. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child

    PubMed Central

    Lee, Yeoun Joo; Hwang, Jae-Yeon; Cho, Yong Hoon; Kim, Yong-Woo; Kim, Tae Un; Shin, Dong Hoon

    2016-01-01

    Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients. PMID:27110342

  15. Mechanical small bowel obstruction following a blunt abdominal trauma: A case report

    PubMed Central

    Zirak-Schmidt, Samira; El-Hussuna, Alaa

    2015-01-01

    Introduction Intestinal obstruction following abdominal trauma has previously been described. However, in most reported cases pathological finding was intestinal stenosis. Presentation of the case A 51-year-old male was admitted after a motor vehicle accident. Initial focused abdominal sonogram for trauma and enhanced computerized tomography were normal, however there was a fracture of the tibia. Three days later, he complained of abdominal pain, constipation, and vomiting. An exploratory laparotomy showed bleeding from the omentum and mechanical small bowel obstruction due to a fibrous band. Discussion The patient had prior abdominal surgery, but clinical and radiological findings indicate that the impact of the motor vehicle accident initiated his condition either by causing rotation of a bowel segment around the fibrous band, or by formation of a fibrous band secondary to minimal bleeding from the omentum. Conclusion High index of suspicion of intestinal obstruction is mandatory in trauma patients presenting with complaints of abdominal pain, vomiting, and constipation despite uneventful CT scan. PMID:26566436

  16. High-Protein Diet Improves Postoperative Weight Gain After Massive Small-Bowel Resection

    PubMed Central

    Sun, Raphael C.; Choi, Pamela M.; Diaz-Miron, Jose; Sommovilla, Joshua; Guo, Jun; Erwin, Christopher R.

    2016-01-01

    Introduction Short bowel syndrome (SBS) is a morbid clinical condition that results from massive small-bowel resection (SBR). After SBR, there is a dramatic weight loss in the acute postoperative period. Our aim was to determine the impact of a high-protein diet (HPD) on weight gain and body composition in mice after SBR. Methods C57BL/6 mice underwent 50 % proximal SBR. Postoperatively, mice were randomly selected to receive standard rodent liquid diet (LD) (n=6) or an isocaloric HPD (n=9) for 28 days. Mice weights were recorded daily. Body composition analyses were obtained weekly. Student's t test was used for statistical comparisons with p<0.05 considered significant. Results Mice that were fed HPD after SBR returned to baseline weight on average at postoperative day (POD) 8 versus mice that were fed LD that returned to baseline weight on average at POD 22. Total fat mass and lean mass were significantly greater by POD 14 within the HPD group. Both groups of mice demonstrated normal structural adaptation. Conclusion HPD results in greater weight gain and improved body composition in mice after SBR. This finding may be clinically important for patients with SBS since improved weight gain may reduce the time needed for parenteral nutrition. PMID:25519080

  17. Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction: Value of Adding Unenhanced CT to Contrast-enhanced CT.

    PubMed

    Chuong, Anh Minh; Corno, Lucie; Beaussier, Hélène; Boulay-Coletta, Isabelle; Millet, Ingrid; Hodel, Jérôme; Taourel, Patrice; Chatellier, Gilles; Zins, Marc

    2016-07-01

    Purpose To determine whether adding unenhanced computed tomography (CT) to contrast material-enhanced CT improves the diagnostic performance of decreased bowel wall enhancement as a sign of ischemia complicating mechanical small bowel obstruction (SBO). Materials and Methods This retrospective study was approved by the institutional review board, which waived the requirement for informed consent. Two gastrointestinal radiologists independently performed retrospective assessments of 164 unenhanced and contrast-enhanced CT studies from 158 consecutive patients (mean age, 71.2 years) with mechanical SBO. The reference standard was the intraoperative and/or histologic diagnosis (in 80 cases) or results from clinical follow-up in patients who did not undergo surgery (84 cases). Decreased bowel wall enhancement was evaluated with contrast-enhanced images then and both unenhanced and contrast-enhanced images 1 month later. Diagnostic performance of decreased bowel wall enhancement and confidence in the diagnosis were compared between the two readings by using McNemar and Wilcoxon signed rank tests. Interobserver agreement was assessed by using κ statistics and compared with bootstrapping. Results Ischemia was diagnosed in 41 of 164 (25%) episodes of SBO. For both observers, adding unenhanced images improved decreased bowel wall enhancement sensitivity (observer 1: 46.3% [19 of 41] vs 65.8% [27 of 41], P = .02; observer 2: 56.1% [23 of 41] vs 63.4% [26 of 41], P = .45), Youden index (from 0.41 to 0.58 for observer 1 and from 0.42 to 0.61 for observer 2), and confidence score (P < .001 for both). Specificity significantly increased for observer 2 (84.5% [104 of 123] vs 94.3% [116 of 123], P = .002), and interobserver agreement significantly increased, from moderate (κ = 0.48) to excellent (κ = 0.89; P < .0001). Conclusion Adding unenhanced CT to contrast-enhanced CT improved the sensitivity, diagnostic confidence, and interobserver agreement of the diagnosis of ischemia

  18. Mesenchymal stem cell therapy in patients with small bowel transplantation: Single center experience

    PubMed Central

    Doğan, Sait Murat; Kılınç, Selçuk; Kebapçı, Eyüp; Tuğmen, Cem; Gürkan, Alp; Baran, Maşallah; Kurtulmuş, Yusuf; Ölmez, Mustafa; Karaca, Cezmi

    2014-01-01

    AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation. METHODS: In our transplantation center, 6 isolated intestinal transplants have been performed with MSC therapy since 2009. The primary reasons for transplants were short gut syndrome caused by surgical intestine resection for superior mesenteric artery thrombosis (n = 4), Crohn’s disease (n = 1) and intestinal aganglionosis (n = 1). Two of the patients were children. At the time of reperfusion, the first dose of MSCs cultured from the patient’s bone marrow was passed into the transplanted intestinal artery at a dose of 1000000 cells/kg. The second and third doses of MSCs were given directly into the mesenteric artery through the arterial anastomosis using an angiography catheter on day 15 and 30 post-transplant. RESULTS: The median follow-up for these patients was 10.6 mo (min: 2 mo-max: 30 mo). Three of the patients developed severe acute rejection. One of these patients did not respond to bolus steroid therapy. Although the other two patients did respond to anti-rejection treatment, they developed severe fungal and bacterial infections. All of these patients died in the 2nd and 3rd months post-transplant due to sepsis. The remaining patients who did not have acute rejection had good quality of life with no complications observed during the follow-up period. In addition, their intestinal grafts were functioning properly in the 13th, 25th and 30th month post-transplant. The patients who survived did not encounter any problems related to MSC transplantation. CONCLUSION: Although this is a small case series and not a randomized study, it is our opinion that small bowel transplantation is an effective treatment for intestinal failure, and MSC therapy may help to prevent acute rejection and graft vs host disease following intestinal transplantation. PMID:25009395

  19. Concurrent Occurrence of Tumor in Colon and Small Bowel following Intestinal Obstruction: A Case Report and Review of the Literature

    PubMed Central

    Nejatollahi, Seyed Mohammad Reza; Etemad, Omid

    2016-01-01

    An intestinal obstruction occurs when either the small or large intestine is partly or completely blocked so it prevents passing the food or fluid through the small/large bowel. This blockage is due to the existence of a mechanical obstruction such as foreign material, mass, hernia, or volvulus. Common symptoms include cramping pain, nausea and vomiting, changes in bowel habits, inability to pass stool, and lack of gas. We present a case of an 83-year-old man who had been referred to Taleghani Hospital with symptoms of bowel obstruction. He underwent the surgery. The findings of exploration of the entire abdomen showed two types of mass separately in two different organs. In postoperative workup, pathology reported two types of tumors (adenocarcinoma and neuroendocrine tumors). PMID:27200205

  20. Prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation

    SciTech Connect

    Gallagher, M.J.; Brereton, H.D.; Rostock, R.A.; Zero, J.M.; Zekoski, D.A.; Poyss, L.F.; Richter, M.P.; Kligerman, M.M.

    1986-09-01

    The volume, distribution, and mobility of opacified pelvic small bowel (PSB) were determined by fluoroscopy and orthogonal radiographs in 150 consecutive patients undergoing pelvic irradiation. Various techniques including uteropexy, omental transposition, bladder distention, inclining the patient, and anterior abdominal wall compression in the supine and prone treatment position were studied for their effect on the volume and location of small bowel within the pelvis. Abdominal wall compression in the prone position combined with bladder distention was selected for further investigation because of its simplicity, reproducibility, patient comfort, and ability to displace the small bowel. Factors correlating with the volume of pelvic small bowel (PSB) included prior pelvic surgery, pelvic irradiation (XRT), and body mass index. After pelvic surgery, especially following abdominoperineal resection (APR), there was a greater volume of PSB which was also less mobile. The severity of acute gastrointestinal effects positively correlated with the volume of irradiated small bowel. Overall, 67% of patients experienced little or no diarrhea, 30% developed mild diarrhea, and no patient required treatment interruption. Late gastrointestinal effects correlated with the prior pelvic surgery and with the volume of small bowel receiving greater than 45 Gy. Small bowel obstruction was not observed in 75 patients who had no previous pelvic surgery. However, following pelvic surgery excluding APR, 2/50 patients and following APR, 3/25 patients developed small bowel obstruction.

  1. Capsule Endoscopy for Ileitis with Potential Involvement of Other Sections of the Small Bowel

    PubMed Central

    2016-01-01

    Ileitis is defined as inflammation of the ileum. This condition includes ulcers, aphthous ulcers, erosions, and nodular or erythematous mucosa. Various etiologies are associated with ileitis. Crohn's disease, ulcerative colitis, medications such as nonsteroidal anti-inflammatory drugs, infectious conditions, neoplasms, infiltrative disorders, vasculitides, spondyloarthritis, endometriosis, and radiation therapy-related conditions involve the ileum. However, the differential diagnosis of terminal ileitis can be difficult in many cases. Video capsule endoscopy (VCE) has become a useful tool for the diagnosis of a variety of small bowel lesions. This review describes each of the various conditions associated with ileitis and the diagnostic value of VCE for ileitis, which may help identify and evaluate these conditions in clinical practice. Based on the information provided by VCE, a definitive diagnosis could be made using the patients' medical history, clinical course, laboratory and ileocolonoscopic findings, radiologic imaging findings, and histologic findings. PMID:26880904

  2. Small bowel disaccharidase activity in the rat as affected by intestinal resection and pectin feeding.

    PubMed

    Koruda, M J; Rolandelli, R H; Settle, R G; Rombeau, J L

    1988-03-01

    This study investigated the effects of small bowel resection (SBR) and a pectin-supplemented elemental diet (ED) on intestinal disaccharidase activity. Rats underwent placement of feeding gastrostomy and swivel apparatus. Control animals were returned to their cages while resected animals underwent an 80% SBR. Postoperatively, animals received either a pectin-free ED or the ED supplemented with 2% pectin. After 2 wk jejunal and ileal mucosal sucrase, maltase, and lactase activities and protein content were determined. Feeding the ED after SBR resulted in significant increases in all three ileal segmental disaccharidase activities but only maltase activity was significantly increased in the jejunum. The pectin-supplemented ED, however, significantly enhanced the adaptation of jejunal and ileal segmental sucrase, maltase, and lactase activity to SBR with the increase in all three jejunal disaccharidase activities being significantly greater than that of the resected animals fed the ED alone. PMID:3126640

  3. Small bowel adenocarcinoma arising in a patient with hereditary hemorrhagic telangiectasia: A case report

    PubMed Central

    YOSHIOKA, YUICHIRO; NOZAWA, HIROAKI; TANAKA, JUNICHIRO; NISHIKAWA, TAKESHI; TANAKA, TOSHIAKI; KIYOMATSU, TOMOMICHI; KAWAI, KAZUSHIGE; HATA, KEISUKE; KAZAMA, SHINSUKE; YAMAGUCHI, HIRONORI; ISHIHARA, SOICHIRO; SUNAMI, EIJI; KITAYAMA, JOJI; WATANABE, TOSHIAKI

    2016-01-01

    Patients with hereditary hemorrhagic telangiectasia (HHT) are reportedly at a lower overall risk of malignancies, and small bowel adenocarcinoma (SBA) arising in a HHT patient is extremely rare. In this study, the case of a 37-year-old female with HHT who developed a poorly differentiated jejunal adenocarcinoma five years after ileocecal resection for multiple colonic adenomas is presented. The patient underwent curative resection of the cancer invading the ileum and the mesentery of the transverse colon, but had to overcome critical complications perioperatively, stemming from HHT-associated peripheral capillary dilatation and arteriovenous malformation, including nosebleeds and possible infusion-induced air embolism through pulmonary shunts. The patient subsequently received adjuvant chemotherapy including capecitabine and oxaliplatin for 6 months, and currently remains alive without any evidence of recurrence 12 months after the second surgery. This patient with SBA was an instructive case demonstrating the necessity of careful attention during major surgery in HHT. PMID:26998137

  4. Small bowel perforation due to indistinguishable metastasis of angiosarcoma: case report and brief literature review.

    PubMed

    Uchihara, Tomoyuki; Imamura, Yu; Iwagami, Shiro; Kajihara, Ikko; Kanemaru, Hisashi; Karashima, Ryuichi; Ida, Satoshi; Ishimoto, Takatsugu; Baba, Yoshifumi; Sakamoto, Yasuo; Miyamoto, Yuji; Yoshida, Naoya; Watanabe, Masayuki; Iyama, Ken-Ichi; Ihn, Hironobu; Baba, Hideo

    2016-12-01

    Intestinal metastasis of angiosarcoma is extremely rare. We herein report a case of intestinal perforation due to intestinal metastasis of angiosarcoma. The patient was a 72-year-old Japanese man with multiple recurrent angiosarcomas of the scalp. He developed acute abdominal pain with guarding, and we performed an emergency exploratory laparotomy. An intestinal perforation was found 80 cm from the ligament of Treitz, and partial jejunectomy was successfully performed. Macroscopic inspection revealed no obvious injury, ulcer, or tumor at or around the perforation site. Pathological examination revealed angiosarcoma cells penetrating through all layers of the jejunum at the site of intestinal perforation. This is the first reported case of intestinal perforation caused by indistinguishable intestinal metastasis of angiosarcoma. This case emphasizes intestinal metastasis of angiosarcoma as a possible cause of small bowel perforation in patients with advanced angiosarcoma, even when no visible tumor is present during surgery. PMID:27156097

  5. Small bowel diverticulosis as a cause of ileus: a case report.

    PubMed

    Janevska, D; Trajkovska, M; Janevski, V; Serafimoski, V

    2013-01-01

    Small bowel diverticulosis (SBD) is a rare condition. In most cases it is asymptomatic, but sometimes it can be manifested with chronic non-specific or acute symptoms. Because of the absence of pathognomonic signs and symptoms and truly reliable diagnostic tests, SBD is hard to diagnose and this is usually done incidentally by radiographic examination or during laparatomy. For uncomplicated patients, those with chronic abdominal pain, syndromes of malabsorption related to jejunoileal diverticulosis, bacterial overgrowth or an episode of intestinal obstruction, as in our case, conservative management is the initial option for treatment. A case of a patient with obstructive symptoms of the gastrointestinal tract due to SBD that was conservatively treated and had a positive outcome is presented. PMID:23917752

  6. Jejunal intussusception and small bowel transmural infarction in a baboon (Papio hamadryas anubis).

    PubMed

    Cary, Max E; Suarez-Chavez, Maria; Wolf, Roman F; Kosanke, Stanley D; White, Gary L

    2006-03-01

    A 4.3-y-old, colony-bred female baboon (Papio hamadryas anubis) of low social rank and exhibiting no clinically significant signs of illness or distress was found dead at the Oklahoma University Health Sciences Center baboon breeding facility at El Reno, OK. Prior to death she exhibited excessive grooming behavior both toward herself and other baboons. In addition, she was consistently shy, timid, reclusive, and prone to minimal sustained movement (that is, generally lethargic behavior). Animals of low social rank typically exhibit some degree of these behaviors in order to avoid surplus interactions with other animals within their groups, which can lead to conflict and injury. Accordingly, her death was surprising in view of the apparent lack of clinical signs. Necropsy established the cause for death as systemic shock with resultant cardiovascular collapse resulting from a massive jejunal intussusception. This intussusception and resulting entrapment of the jejunal mesenteric vasculature caused total occlusion of the small bowel blood supply, with resulting hemorrhage and ischemic necrosis (small bowel infarction). Jejunal intussusceptions generally are considered to be uncommon and therefore are rarely reported in either the veterinary or human literature. Of special interest was the cause for this intussusception, determined to have been a large hairball located at the most proximal portion of the jejunum. Extending from this hairball and traversing essentially the entire length of the jejunum was a braided strand of hair acting as a string foreign body about which the intussusception formed. In light of our findings we suggest that animals of low social rank exhibiting excessive grooming behavior and lethargy might merit clinical evaluation to rule out possible abdominal disorders. PMID:16542042

  7. MicroRNAs associated with small bowel neuroendocrine tumours and their metastases.

    PubMed

    Miller, Helen C; Frampton, Adam E; Malczewska, Anna; Ottaviani, Silvia; Stronach, Euan A; Flora, Rashpal; Kaemmerer, Daniel; Schwach, Gert; Pfragner, Roswitha; Faiz, Omar; Kos-Kudła, Beata; Hanna, George B; Stebbing, Justin; Castellano, Leandro; Frilling, Andrea

    2016-09-01

    Novel molecular analytes are needed in small bowel neuroendocrine tumours (SBNETs) to better determine disease aggressiveness and predict treatment response. In this study, we aimed to profile the global miRNome of SBNETs, and identify microRNAs (miRNAs) involved in tumour progression for use as potential biomarkers. Two independent miRNA profiling experiments were performed (n=90), including primary SBNETs (n=28), adjacent normal small bowel (NSB; n=14), matched lymph node (LN) metastases (n=24), normal LNs (n=7), normal liver (n=2) and liver metastases (n=15). We then evaluated potentially targeted genes by performing integrated computational analyses. We discovered 39 miRNAs significantly deregulated in SBNETs compared with adjacent NSB. The most upregulated (miR-204-5p, miR-7-5p and miR-375) were confirmed by qRT-PCR. Two miRNAs (miR-1 and miR-143-3p) were significantly downregulated in LN and liver metastases compared with primary tumours. Furthermore, we identified upregulated gene targets for miR-1 and miR-143-3p in an existing SBNET dataset, which could contribute to disease progression, and show that these miRNAs directly regulate FOSB and NUAK2 oncogenes. Our study represents the largest global miRNA profiling of SBNETs using matched primary tumour and metastatic samples. We revealed novel miRNAs deregulated during SBNET disease progression, and important miRNA-mRNA interactions. These miRNAs have the potential to act as biomarkers for patient stratification and may also be able to guide treatment decisions. Further experiments to define molecular mechanisms and validate these miRNAs in larger tissue cohorts and in biofluids are now warranted. PMID:27353039

  8. Small duct primary sclerosing cholangitis without inflammatory bowel disease is genetically different from large duct disease

    PubMed Central

    Næss, Sigrid; Björnsson, Einar; Anmarkrud, Jarl A.; Al Mamari, Said; Juran, Brian D.; Lazaridis, Konstantinos N.; Chapman, Roger; Bergquist, Annika; Melum, Espen; Marsh, Steven G. E.; Schrumpf, Erik; Lie, Benedicte A.; Boberg, Kirsten Muri; Karlsen, Tom H.; Hov, Johannes R.

    2014-01-01

    Background & aims Small duct primary sclerosing cholangitis (PSC) is phenotypically a mild version of large duct PSC, but it is unknown whether these phenotypes share aetiology. We aimed to characterize their relationship by investigating genetic associations in the HLA complex, which represent the strongest genetic risk factors in large duct PSC. Methods Four classical HLA loci (HLA-A, HLA-B, HLA-C, HLA-DRB1) were genotyped in 87 small duct PSC patients, 485 large duct PSC patients and 1117 controls across three geographical regions. Results HLA-DRB1*13:01 (OR=2.0, 95% CI 1.2–3.4, P=0.01) and HLA-B*08 (OR=1.6, 95% CI 1.1–2.4, P=0.02) were significantly associated with small duct PSC compared with healthy controls. Based on the observed frequency of HLA-B*08 in small duct PSC, the strongest risk factor in large duct PSC, an estimated 32% (95% CI 4%–65%) of this population can be hypothesized to represent early stages or mild variants of large duct PSC. This subgroup may be constituted by small duct PSC patients with inflammatory bowel disease (IBD), which greatly resembled large duct PSC in its HLA association. In contrast, small duct PSC without IBD was only associated with HLA-DRB1*13:01(P=0.03) and was otherwise distinctly dissimilar from large duct PSC. Conclusions Small duct PSC with IBD resembles large duct PSC in its HLA association and may represent early stages or mild variants of large duct disease. Different HLA associations in small duct PSC without IBD could indicate that this subgroup is a different entity. HLA-DRB1*13:01 may represent a specific risk factor for inflammatory bile duct disease. PMID:24517468

  9. Laparoscopic treatment of acute small bowel obstruction due to left paraduodenal hernia: A case report and literature review

    PubMed Central

    Zizzo, Maurizio; Smerieri, Nazareno; Barbieri, Italo; Lanaia, Andrea; Bonilauri, Stefano

    2016-01-01

    Introduction Internal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera through an opening in the intraperitoneal recesses of the abdominal cavity. Small bowel obstruction due to internal hernia is not common (0.25–0.9% of cases). The most common group is that of paraduodenal hernias (53%), of which the left-sided one is the most common type (75%). Presentation of case We report a case of a 43 year-old man with a history of recurrent abdominal pain, who was hospitalized because of an episode of acute small bowel obstruction. He had no previous surgery. Computed tomography revealed an encapsulated circumscribed cluster of jejunal loops in the left upper quadrant, near the ligament of Treitz, and the hernia orifice was adjacent to the left side of the inferior mesenteric vessels. Emergency laparoscopic surgery was performed: the small bowel was found completely herniated under the inferior mesenteric vessels. It was gradually reduced and the hernia space was closed with a running suture. The patient was discharged on the fourth day without complications. Conclusion Left paraduodenal hernia is a rare cause of small bowel obstruction that should be taken into account in a patient with a history of recurrent abdominal pain or intestinal obstruction, and no previous surgery. Computed tomography is the standard for a correct diagnosis. Surgery is treatment of choice, because it reduces the risk of emergency and complications associated to hernia. Laparoscopic approach is feasible and effective, also in emergency situation. PMID:26826933

  10. Bowel Obstruction.

    PubMed

    Gore, Richard M; Silvers, Robert I; Thakrar, Kiran H; Wenzke, Daniel R; Mehta, Uday K; Newmark, Geraldine M; Berlin, Jonathan W

    2015-11-01

    Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented. PMID:26526435