WorldWideScience
1

Diverticular Disease of the Small Bowel  

OpenAIRE

A diverticulum is a bulging sack in any portion of the gastrointestinal tract. The most common site for the formation of diverticula is the large intestine. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptom is non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, pancreatic or biliary (in the case of duodenal diverticula) disease, intesti...

Ferreira-aparicio, Francisco Emilio; Gutie?rrez-vega, Rafael; Ga?lvez-molina, Yolanda; Ontiveros-nevares, Patricia; Athie-gu?tierrez, Ce?sar; Montalvo-jave?, Eduardo E.

2012-01-01

2

Diverticular disease of the small bowel.  

Science.gov (United States)

A diverticulum is a bulging sack in any portion of the gastrointestinal tract. The most common site for the formation of diverticula is the large intestine. Small intestine diverticular disease is much less common than colonic diverticular disease. The most common symptom is non-specific epigastric pain and a bloating sensation. Major complications include diverticulitis, gastrointestinal bleeding, acute perforation, pancreatic or biliary (in the case of duodenal diverticula) disease, intestinal obstruction, intestinal perforation, localized abscess, malabsorption, anemia, volvulus and bacterial overgrowth. We describe the clinical case of a 65-year-old female patient with a diagnosis on hospital admittance of acute appendicitis and a intraoperative finding of diverticular disease of the small intestine, accompanied by complications such as intestinal perforation, bleeding and abdominal sepsis. This was surgically treated with intestinal resection and ileostomy and a subsequent re-intervention comprising perforation of the ileostomy and stomal remodeling. The patient remained hospitalized for approximately 1 month with antibiotics and local surgical wound healing, as well as changes in her diet with food supplements and metabolic control. She showed a favorable clinical evolution and was dismissed from the hospital to her home. We include here a discussion on trends in medical and surgical aspects as well as early handling or appropriate management to reduce the risk of fatal complications. PMID:23185148

Ferreira-Aparicio, Francisco Emilio; Gutiérrez-Vega, Rafael; Gálvez-Molina, Yolanda; Ontiveros-Nevares, Patricia; Athie-Gútierrez, César; Montalvo-Javé, Eduardo E

2012-09-01

3

Surgical management of complicated small bowel diverticular disease. About 4 clinical reports.  

Science.gov (United States)

Diverticula of the small intestine are relatively rare. A retrospective analysis of 4 cases of the practice of Department of General and Hepatopancreatic surgery, University Hospital "Alexandrovska"--Sofia was performed. Two patients are with Meckel diverticulum--the first one with diverticulitis, and the second with perforation and formed abscess cavity. The third case presents a patient with an intestinal loop with diverticula accreted in hernial sack and forth one is with diverticular perforation of the small intestine. All of them underwent surgery. This is accomplished with a literature review presenting the possible diagnostic and treatment modalities applied to this disease. Complications of intestinal diverticulosis often require surgical management in urgent conditions. PMID:23847804

Arabadzhieva, E; Boney, S; Dimitrova, V

2013-01-01

4

Bleeding small bowel diverticulosis  

OpenAIRE

Diverticular disease affecting the small bowel, specifically the jejunum, is rare with an incidence of 1–2% in the general population. We report a case of a 67-year-old man who presented with clinical signs and symptoms suggesting peptic ulcer disease, but complications resulting from small bowel diverticular disease should be borne in mind as they may mimic the above pathology. The diagnosis of small bowel diverticulosis can often be challenging in someone who presents or develops massive ...

Hamid, Umar Imran; Khattak, Shahid

2009-01-01

5

Coexistent widespread small intestinal and colonic diverticular disease.  

Science.gov (United States)

A 73-year-old woman with a history of multiple abdominal surgery and sigmoid diverticulosis presented with severe constipation refractory to conservative management. As a result, she had developed food aversion and cachexia. Patient opted for laparotomy and defunctioning ileostomy to improve quality of life. At laparotomy, extensive diverticulae involving the small and large bowels were identified. Defunctioning ileostomy was performed. The patient regained her quality of life and reinstituted normal diet. Histology revealed marked serosal fibrosis and pulsion diverticulae. PMID:23470669

Duff, Gerald P; Chang, Kah Hoong; Peirce, Colin; Coffey, J Calvin

2013-01-01

6

Volvulus: Small Bowel and Colon  

OpenAIRE

Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in children and is most often secondary to malrotation. Small bowel volvulus is an uncommon cause for small bowel obstruction in adults, and is more likely to be secondary to postoperative adhesive bands. Colonic volvulus is a rare cause of large bowel obstruction, but more common than small bowel volvulus. The sigmoid is most frequently involved, with redundant colon as the primary cause. Cecal volv...

Valsdottir, Elsa; Marks, John H.

2008-01-01

7

Small Bowel Lymphangioma  

Directory of Open Access Journals (Sweden)

Conclusions: Small bowel lymphangiomas can cause gross or occult GI bleeding, anemia, abdominal pain, and/or obstruction. Endoscopists should be aware of this rare tumor and its unique endoscopic features. The optimal treatment is radical excision, since incomplete resection may lead to recurrence. Argon plasma coagulation or polypectomy have been used to achieve endoscopic ablation and palliation of GI bleeding.

Shou-jiang Tang

2014-01-01

8

Small Bowel Obstruction- A Surprise  

Science.gov (United States)

Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction. PMID:25738033

CP, Ganesh Babu; M, Balachandar; M, Ramanathan

2015-01-01

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Small bowel mesentery fibroma  

Directory of Open Access Journals (Sweden)

Full Text Available Fibromas are rarely localized in the abdomen, but almost always in the mesentery or omentum. We present a 63-year old woman in whom the examination of the upper abdominal pain showed a well distinct abdominal mass at the level of the lower edge of the pancreas. During the operation a tumor 100 ? 87 x 70 mm in size, from the radix of small bowel mesentery, was excised, Seven months later the patient is symptom-free with normal ultrasonographic and CT findings.

?olovi? Radoje B.

2002-01-01

10

Jejunal Diverticular Perforation due to Enterolith  

OpenAIRE

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life-threatening and require early surgical treatment. Small bowel perforation secondary to jejunal diverticulitis by enteroliths is rare. The aim of this study was to report a case of small intestinal perforation caused by a large jejunal enterolith. An 86-year-old woman w...

Nonose, Ronaldo; Valenciano, Juliana Santos; Souza Lima, Jacintho Soares; Nascimento, Enzo Fabri?cio; Silva, Camila Morais Gonc?alves; Martinez, Carlos Augusto Real

2011-01-01

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Small bowel faeces sign in patients without small bowel obstruction  

International Nuclear Information System (INIS)

Aim: To evaluate frequency and clinical relevance of the 'small bowel faeces' sign (SBFS) on computed tomography (CT) in patients with and without small bowel obstruction (SBO) presenting with acute abdominal or acute abdominal and flank pain. Methods: Abdominal CTs of consecutive patients presenting to the emergency department with abdominal or flank pain over a 6 month period were retrospectively reviewed by six radiologists, independently, for the presence of the SBFS. Examinations with positive SBFS were further evaluated in consensus by three radiologists, blinded to the final diagnosis. The small bowel was graded as non-dilated (4 cm) dilated. The location of SBFS and presence of distal small bowel collapse indicative of SBO was recorded. Imaging findings were subsequently correlated with the final diagnosis via chart review and compared between patients with and without SBO. Results: Of 1642 CT examinations, a positive SBFS was found in 100 (6%) studies. Of 100 patients with a positive SBFS, 32 (32%) had documented SBO. The remaining 68 patients had other non-obstructive diagnoses. SBFS was located in proximal, central, distal and multisegmental bowel loops in one (3.1%), eight (25.0%), 21 (65.6%) and two (6.3%) patients with SBO, and in zero (0%), 10 (14.7%), 53 (77.9%) and five (7.4%) of patients without SBO (p < 0.273). The small bowel was non-dilated and mildly, moderately or severely dilatd and mildly, moderately or severely dilated in one (3%), five (16%), 20 (62%) and six (19%) patients with SBO, and in 61(90%), seven (10%), zero (0%) and zero (0%) patients without SBO. Normal or mildly dilated small bowel was seen in all (100%) patients without SBO, but only in six (19%) of 32 patients with SBO (p < 0.0001). Moderate or severe small bowel dilatation was seen in 26 (81%) patients with SBO (p < 0.0001), but it was absent in patients without SBO. Distal small bowel collapse was found in 27 (84.4%) of 32 patients with SBO, but not in patients without SBO (p < 0.0001). A combination of SBFS, moderate or severe small bowel distension and distal collapse was found in 23 (71.9%) patients with SBO (p < 0.0001), but was not found in patients without SBO. Conclusion: A SBFS is more frequent in patients presenting with acute abdominal/flank pain without bowel obstruction. When seen in association with moderate or severe small bowel dilatation, a SBFS is significantly more common in patients with SBO. When a SBFS is associated with normal or mildly dilated small bowel, the majority of patients have no bowel obstruction

12

Primary malignant small bowel tumor  

Energy Technology Data Exchange (ETDEWEB)

Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings.

Oh, Kyung Seung; Suh, Ho Jong; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk [Kosin College, Pusan (Korea, Republic of)

1990-07-15

13

Primary malignant small bowel tumor  

International Nuclear Information System (INIS)

Small bowel tumors are rarely detected unless there is intestinal obstruction or bleeding. In the seven years 1982-1988, at Kosin Medical Center, 25 primary malignant small bowel tumors were studied radiographically with barium and / or computed tomography (CT). CT revealed gastrointestinal abnormalities in 20 patients. In ten, lesion were identified by upper G-I series, in 15 by small bowel series, and in addition, in 3 by colon enema. The most common malignant small bowel tumor was adenocarcinoma (N=15) and was next common lymphoma (N=7). On barium study, primary adenocarcinoma appeared as an irregular stricture (66.7%) and polypoid mass with intussusception was most prominent finding in lymphoma. Leiomyosarcoma appeared as an exophytic mass with excavation or ulceration. CT was found to be accurate in detecting wall thickening, complications and other associated findings. In conclusion, barium study was useful in the diagnosis of primary malignant small bowel tumor and CT was more accurate in detecting secondary findings

14

Adenocarcinoma of the small bowel  

International Nuclear Information System (INIS)

Adenocarcinoma of small bowel is generally a rather rare primary tumour of small bowel with a prevalence rate of 0.5 - 3.0 / 100.000 population, but the most frequent tumour of small intestine. It more often involves the duodenum and jejunum than the ileum. The aim of this paper is also to point out the value of small bowel follow through (SBFT) in the diagnosis of stenosing lesions. An 83 - year old male patient suffered from abdominal pain, malaise, vomiting, cachexia and diarrhoea for 3 months. The result of occult blood testing was negative. Haemoglobin level was normal. Proctoscopy, colonoscopy, upper gastrointestinal (GI) endoscopy, and ultrasonography (US) did not explain the patient's problems. Ileus of the small bowel was established with abdominal plain film. Small bowel follow through (SBFT) and computer tomography (CT) showed a stenosing tumour in the jejunum. Adenocarcinoma of the small bowel was established with histological examination after resection of the tumor. SBFT, with manual compression of all segments of the small bowel, can be a very accurate diagnostic investigation for evaluation of stenosing lesions in this part of the intestine. (author)

15

Severe adhesive small bowel obstruction.  

Science.gov (United States)

Adhesive small bowel obstruction is a frequent cause of hospital admission. Water soluble contrast studies may have diagnostic and therapeutic value and avoid challenging demanding surgical operations, but if bowel ischemia is suspected, prompt surgical intervention is mandatory. A 58-year-old patient was operated for extensive adhesive small bowel obstruction after having had two previous laparotomies for colorectal surgery, and had a complex clinical course with multiple operations and several complications. Different strategies of management have been adopted, including non-operative management with the use of hyperosmolar water soluble contrast medium, multiple surgical procedures, total parenteral nutrition (TPN) support, and finally use of antiadherences icodextrin solution. After 2 years follow-up the patient was doing well without presenting recurrent episodes of adhesive small bowel obstruction. For patients admitted several times for adhesive small bowel obstruction, the relative risk of recurring obstruction increases in relation to the number of prior episodes. Several strategies for non-operative conservative management of adhesive small bowel obstruction have already addressed diagnostic and therapeutic value of hyperosmolar water soluble contrast. According to the most recent evidence-based guidelines, open surgery is the preferred method for surgical treatment of strangulating adhesive small bowel obstruction as well as after failed conservative management. Research interest and clinical evidence are increasing in adhesions prevention. Hyaluronic acid-carboxycellulose membrane and icodextrin may reduce incidence of adhesions. PMID:23054502

Di Saverio, Salomone; Catena, Fausto; Kelly, Michael D; Tugnoli, Gregorio; Ansaloni, Luca

2012-12-01

16

Small bowel volvulus in children  

International Nuclear Information System (INIS)

Two children with small bowel volvulus diagnosed on barium enema examination are reported. In one patient the volvulus was associated with malrotation and in the other patient there was a post-operative peritoneal adhesion. In both cases the diagnosis was based on beaking of the head of the barium column at the site of volvulus. Radiographic demonstration of a beak sign in the small bowel on barium enema examination should suggest a diagnosis of small bowel volvulus, and indicates the need for immediate surgery. (orig.)

17

Scintigraphic pattern of small bowel bleeding  

International Nuclear Information System (INIS)

Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 menlesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma camera fitted with LEAP collimator. Delayed imaging up to 6 hours was optional and was undertaken only when first 90 minutes images did not reveal any site of bleeding. Two nuclear physicians reviewed the sequential static images for 1) First appearance of focus of activity in a particular quadrant/region of abdomen and 2) looking for its migration pattern. Scintigraphic results were prospectively compared with surgical outcome in 10 patients. Results: Tc-99m RBC Scan localized site of bleeding in 10 of 13 patient evaluated (77%). Ten scan positive patients underwent exploratory laprotomy. On surgical exploration, five culprit lesions were identified in jejunum and as many number of lesions were detected in ileum. Etiological lesions were mainly inflammatory or ulcerative (n=5) followed by neoplastic and vascular ectasias in 2 patients each. One patient showed diverticular disease of jejunum as the source of haemorrhage.Tc-99m RBC Scan was able to distinguish between proximal (jejunal) and distal (ileal) small bowel bleeding in 8 of 10 scan positive cases (80%). Scintigraphy correctly localized bleeding in jejunum and ileum in 3 and 5 patients respectively. In majority of patients (7/10, 70%), scan became positive within 3 hours. Six types of scan patterns were noticed in thirteen patients evaluated with Tc-99m RBCs scan. Five scintigraphic patterns were representative of small bowel bleeding. A serpentine appearance of bowel loops in mid abdomen, focal tracer appearance in right iliac region with subsequent outlining of ascending colon on delayed images, and a focus of activity showing distal extension in circular fashion on sequential static images were characteristic of ileal bleeding. Visualization of fixed loop in left flank region corroborated with jejunal lesion (Leiomyoma) in our series. An abnormal blush and early localization of diffuse activity in left upper quadrant followed by its centripetal extension/movement, was seen in patient with jejunitis. Scintigraphy was false negative in cases of systemic diseases

18

Small bowel obstruction and perforation secondary to primary enterolithiasis in a patient with jejunal diverticulosis.  

Science.gov (United States)

We describe a rare case of small bowel obstruction and perforation secondary to a primary enterolith in an 84-year-old female patient with jejunal diverticulosis. She underwent an emergency laparotomy, small bowel resection and primary anastomosis. Multiple jejunal diverticula and a large stone were identified at the time of operation. Analysis of the stone demonstrated mainly faecal material consistent with a true primary enterolith. A literature search of Medline and PubMed revealed three cases similar to the one described. The pathogenesis and management of enterolithiasis in jejunal diverticular disease is considered. PMID:24626387

Chaudhery, Baber; Newman, Peter Alexander; Kelly, Michael Denis

2014-01-01

19

Tumours in the Small Bowel  

Directory of Open Access Journals (Sweden)

Full Text Available Small bowel tumours are rare and originate from a wide variety of benign and malignant entities. Adenocarcinomas are the most frequent primary malignant small bowel tumours. Submucosal tumours like gastrointestinal stromal tumours (GIST or neuroendocrine tumours (NET may show a central umbilication, pathologic vessels, bridging folds or an ulceration of the overlying mucosa. These signs help to differentiate them from harmless bulges caused by impression from outside, e.g. from other intestinal loops. Sarcomas of the small bowel are rare neoplasias with mesenchymal origin, sometimes presenting as protruding masses. Benign tumours like lipoma, fibrolipoma, fibroma, myoma, and heterotopias typically present as submucosal masses. They cannot be differentiated endoscopically from those with malignant potential as GIST or NET. Neuroendocrine carcinomas may present with diffuse infiltration, which may resemble other malignant tumours. The endoscopic appearance of small bowel lymphomas has a great variation from mass lesions to diffuse infiltrative changes. Melanoma metastases are the most frequent metastases to the small bowel. They may be hard to distinguish from other tumours when originating from an amelanotic melanoma.

N. Kurniawan

2014-01-01

20

Nonoperative Management of Complicated Diverticular Disease  

OpenAIRE

The complications of diverticular disease of the colon can be divided into those related to inflammatory conditions (diverticular abscess, fistula, and perforation) and those related to noninflammatory conditions (lower gastrointestinal hemorrhage and noninflammatory stricture or obstruction). Nonoperative management of uncomplicated diverticulitis includes bowel rest and antibiotics. For abscesses, percutaneous drainage by radiologic guidance often turns complicated diverticulitis to an unco...

Schaffzin, David M.; Wong, W. Douglas

2004-01-01

21

Small bowel tumors  

OpenAIRE

SUMMARY Small intestinal neoplasms are uncommonly encountered in clinical practice. Small intestinal neoplasms may occur sporadically, or in association with genetic diseases such as familial adenomatous polyposis coli or Peutz-Jeghers syndrome, or in association with chronic intestinal inflammatory disorders such as Crohn?s disease or celiac sprue. Benign small intestinal tumors such as leiomyoma, lipoma, hamartoma or desmoid tumor, are usually asymptomatic but may present with intu...

Xynopoulos D.; Paraskevas E.; Dimitroulopoulos D.; Heuman D.M.; Mihas A.A.

2007-01-01

22

Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation.  

Science.gov (United States)

Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Further CT analysis pinpointed fine tracts of air leading from a jejunal diverticulum up toward the pancreas, suggesting causation by a sealed jejunal diverticular perforation. He responded well to intravenous antibiotics and conservative management. Although small bowel diverticular disease is linked to chronic pancreatitis, evidence for association with acute pancreatitis is scarce. The authors believe this is the first reported case of jejunal diverticular disease causing acute pancreatitis, and it highlights micro-perforation as a potential disease mechanism. PMID:22665561

King, Angela; Peters, Christopher John; Shorvon, Philip

2012-01-01

23

CT enteroclysis in small bowel Crohn's disease  

International Nuclear Information System (INIS)

The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

24

Small bowel gas in severe ulcerative colitis.  

OpenAIRE

The prognostic significance of excess small bowel gas on a plain abdominal radiograph has been assessed in 75 patients with severe attacks of ulcerative colitis requiring intravenous hydrocortisone. The radiographs were reviewed without knowledge of the subsequent outcome. Small bowel distension was defined as the presence of three or more loops of gas filled small bowel. Forty two patients responded to medical treatment and 33 underwent colectomy. The two groups were comparable for age, sex,...

Chew, Cn; Nolan, Dj; Jewell, Dp

1991-01-01

25

Small bowel stricture following abdominal trauma.  

OpenAIRE

A case of small bowel stricture developing 2 months after blunt abdominal trauma from a lap seat belt is presented. The cause of the stricture was probably a small perforation sustained at the time of the injury but overlooked clinically. At operation an abscess around the terminal ileum was found. The patient made an uneventful recovery following resection of the strictured small bowel.

Welch, G. H.; Anderson, J. R.

1985-01-01

26

Perforated small bowel diverticulitis after gastric bypass.  

Science.gov (United States)

We report a rare case of complicated jejunal diverticulitis in a patient with previous bariatric surgery. Small bowel diverticulosis is generally considered an inoffensive disease. In this report we describe a case of small bowel perforation in an obese subject who had undergone laparoscopic Roux-en-Y gastric bypass. PMID:24680159

Corcelles, Ricard; Pavel, Mihai; Lacy, Antonio

2014-01-01

27

Radiopathological review of small bowel carcinoid tumours  

International Nuclear Information System (INIS)

Full text: Small bowel carcinoid tumours are endocrine tumours of the gastrointestinal tract. This pictorial essay will review the pathology, clinical features, treatment and prognosis and illustrate the radiographic, computed tomographic, sonographic, magnetic resonance and nuclear medicine appearances of small bowel carcinoid tumours.

28

Disturbances in small bowel motility.  

LENUS (Irish Health Repository)

Recently, the small intestine has become the focus of investigation as a potential site of dysmotility in the irritable bowel syndrome (IBS). A number of motor abnormalities have been defined in some studies, and include \\'clustered\\' contractions, exaggerated post-prandial motor response and disturbances in intestinal transit. The significance of these findings remains unclear. The interpretation of available studies is complicated by differences in subject selection, the direct influence of certain symptoms, such as diarrhoea and constipation, and the interference of compounding factors, such as stress and psychopathology. Dysmotility could also reflect autonomic dysfunction, disturbed CNS control and the response to heightened visceral sensation or central perception. While motor abnormalities may not explain all symptoms in IBS, sensorimotor interactions may be important in symptom pathogenesis and deserve further study.

Quigley, E M

2012-02-03

29

Diverticular Disease  

Science.gov (United States)

... PDF Version (397 KB) Spanish Version Additional Links ? Irritable Bowel Syndrome Contact Us Digestive Disease Information Phone: 1-800- ... in the colon wall. Other conditions, such as irritable bowel syndrome and stomach ulcers, cause similar problems, so these ...

30

Tuberculous perforation of the small bowel.  

OpenAIRE

Small bowel perforation occurs in up to 2 percent of patients with abdominal tuberculous. Patients present with an acute abdomen. Resection of the diseased segment and 18 months treatment with anti-tuberculosis drugs is recommended.

Aston, N. O.; Costa, A. M.

1985-01-01

31

Diverticulosis of the small bowel with Diverticulitis  

International Nuclear Information System (INIS)

Case report of diverticulosis of the small bowel complicated by diverticulitis. Radiography is the method of choice to demonstrate this finding preoperatively. This entity should be included in the differential diagnosis of right lower quadrant abdominal pecin. (orig.)

32

Diverticulosis of the small bowel with Diverticulitis  

Energy Technology Data Exchange (ETDEWEB)

Case report of diverticulosis of the small bowel complicated by diverticulitis. Radiography is the method of choice to demonstrate this finding preoperatively. This entity should be included in the differential diagnosis of right lower quadrant abdominal pecin.

Barner, L.; Doldt, H.; Strecker, E.P.

1980-11-01

33

Small bowel barium examination in childrem  

International Nuclear Information System (INIS)

The indications for small bowel barium examination, the radiologic findings, and the clinical outcome were compared retrospectively in 331 children, aged 0 to 15 years. Sixty examinations (18%) were pathologic, which is in accordance with adult materials. The most common indications for referral were inflammatory bowel disease (48%) and small bowel obstruction (25%). The examinations were positive in 19% and 17%, respectively. Indications for referring patients with non-specific symptoms led to a low frequency of pathologic findings. A therapeutic or diagnostic procedure was performed in 38 of the 60 pathologic radiologic examinations (63%). In 18 patients (30%) a pathologic finding caused no change in therapy. No consistent difference in sensitivity, specificity or predictive values of a positive or negative result was found concerning enteroclysis or elective follow-through examination. For screening purposes of the small bowel in children follow-through examinations give adequate radiologic information and should be used instead of enteroclysis. (orig.)

34

Primary Small Bowel Liposarcoma (Atypical Lipomatous Tumour) with Myogenic Differentiation  

OpenAIRE

Primary small intestinal liposarcomas originating in the small bowel are uncommon with a generally poor prognosis due to the advanced stage at the time of diagnosis. We describe a case of primary small bowel dedifferentiated liposarcoma presenting as a solid mass in the right iliac fossa. The current case is unusual as the tumour seemingly originated from the bowel and the well-differentiated component was seen extensively infiltrating the bowel wall including the small bowel submucosa.

Speake, W.; Macculloch, T. A.; Deb, R.; Patel, J.

2010-01-01

35

Computed tomography features of small bowel volvulus  

International Nuclear Information System (INIS)

Small bowel volvulus is a cause of acute abdomen and commonly occurs in neonates and young infants. Although it is rare in adults in the Western world,' it is a relatively common surgical emergency in the Middle East, India and Central Africa. It is associated with a mortality rate of 10-67% and, hence, it is important to make an early diagnosis to expedite surgical intervention. Computed tomography has become an important imaging modality in diagnosis and a number of signs have been recognized in a handful of documented case reports. We describe a case of small bowel volvulus that illustrates these important CT signs. Copyright (1999) Blackwell Science Pty Ltd

36

Small bowel endometriosis masquerading as regional enteritis.  

Science.gov (United States)

A 35-year-old female presented with recurrent right lower quadrant pain, nausea, and vomiting. She was afebrile with diffuse abdominal tenderness. Plain x-ray of abdomen revealed small bowel obstruction. A barium x-ray of the small bowel showed stricture of the terminal ileum. A CT scan of the abdomen showed a 6-cm mass in right lower quadrant. She was empirically managed as having Crohn's disease. She underwent laparotomy after failure of medical management with high-dose steroids. There was ulceration and narrowing of terminal ileum. Frozen sections revealed endometriosis. Ileocecectomy was performed. Histopathology of resected specimen confirmed the diagnosis of endometriosis, and there was no evidence of chronic inflammatory bowel disease or neoplasia. Ileal endometriosis should be considered in the differential diagnosis of Crohn's disease in menstruating females presenting with perimenstrual symptoms. PMID:8174427

Minocha, A; Davis, M S; Wright, R A

1994-05-01

37

Challenges in diagnosing adhesive small bowel obstruction  

OpenAIRE

Adhesive small bowel obstruction (ASBO) is the most frequently encountered surgical disorder of the small intestine. Up to 80% of ASBO cases resolve spontaneously and do not require invasive treatment. It is important to identify such patients that will benefit from conservative treatment in order to prevent unnecessarily exposing them to the risks associated with surgical intervention, such as morbidity and further adhesion formation. For the remaining ASBO patients, timely surgical interven...

Dp, Misha Luyer; Hjt, Ignace Hingh; Ac, Bart Aerts; Oudheusden, Thijs R.

2013-01-01

38

CT enteroclysis in small bowel Crohn's disease  

Energy Technology Data Exchange (ETDEWEB)

The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

Kohli, Marc D. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Maglinte, Dean D.T. [Department of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)], E-mail: dmaglint@iupui.edu

2009-03-15

39

Imaging in pediatric small bowel transplantation.  

Science.gov (United States)

Small bowel transplantation, alone or with other organs as multivisceral transplantation, is performed for patients with chronic intestinal failure. With advancing surgical techniques and improved post-surgical management, survival of these patients has increased tremendously in the last two decades. The radiologist has an important role in the preoperative and postoperative management of these patients. Knowledge of surgical techniques and post-surgical complications seen in the transplant recipient is necessary for adequate management of these patients. PMID:25489131

Khan, Nadir; Phillips, Grace S; Heller, Matthew T; Linam, Leann E; Parnell, Shawn E; Moshiri, Mariam; Bhargava, Puneet

2014-10-01

40

Transplante de intestino delgado / Small bowel transplantation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Languages: English, Portuguese Abstract in portuguese INTRODUÇÃO: O transplante de intestino delgado, em razão de sua complexidade, apresentou evolução mais lenta que os demais órgãos sólidos. Diversos avanços permitiram sua aplicação clínica. OBJETIVO: Revisão da evolução do transplante de intestino delgado e seu estado atual. MÉTODO: levantamento bib [...] liográfico nas bases de dados MEDLINE e ScIELO. Os termos usados como descritores foram: intestinal failure, intestinal transplant, small bowel transplant, multivisceral transplant. Foram analisados dados sobre evolução histórica, centros, indicações, tipos de enxertos, seleção e captação de órgãos, manejo pós-operatório, complicações e resultados. CONCLUSÃO: Apesar de desenvolvimento mais lento, o transplante intestinal é hoje a terapia para pacientes portadores de falência intestinal irreversível que apresentam complicações da nutrição parenteral. Envolve algumas modalidades: intestino delgado isolado, fígado-intestino, multivisceral e multivisceral modificado. Atualmente a sobrevida é semelhante aos demais órgãos sólidos. A maioria dos pacientes fica livre da nutrição parenteral. Abstract in english BACKGROUND: Small bowel transplantation evolution, because of its complexity, was slower than other solid organs. Several advances have enabled its clinical application. AIM: To review intestinal transplantation evolution and its current status. METHOD: Search in MEDLINE and ScIELO literature. The t [...] erms used as descriptors were: intestinal failure, intestinal transplantation, small bowel transplantation, multivisceral transplantation. Were analyzed data on historical evolution, centers experience, indications, types of grafts, selection and organ procurement, postoperative management, complications and results. CONCLUSION: Despite a slower evolution, intestinal transplantation is currently the standard therapy for patients with intestinal failure and life-threatening parenteral nutrition complications. It involves some modalities: small bowel transplantation, liver-intestinal transplantation, multivisceral transplantation and modified multivisceral transplantation. Currently, survival rate is similar to other solid organs. Most of the patients become free of parenteral nutrition.

Rafael Antonio Arruda, Pécora; André Ibrahim, David; André Dong, Lee; Flávio Henrique, Galvão; Ruy Jorge, Cruz-Junior; Luiz Augusto Carneiro, D' Albuquerque.

2013-09-01

41

Transient small bowel angioedema due to intravenous iodinated contrast media  

OpenAIRE

Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented. Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum. The bowel wall was normal in non-enhanced images, and normal or inconspicuous in arterial phase enhanced images. In one of the three cases, the bowel wall...

Xiu-Hua Hu; Xiang-Yang Gong; Peng Hu

2012-01-01

42

Intramucosal ganglion cells are common in diverticular disease.  

OpenAIRE

AIMS: Ganglion cells were thought not to occur within the mucosa of the normal colon and found only in the setting of inflammatory bowel disease and neuronal intestinal dysplasia. The aim of this study was to firmly establish the incidence of intramucosal ganglion cells in diverticular disease, normal mucosa and in a spectrum of gastrointestinal diseases. METHODS: We retrospectively reviewed 50 resection specimens from cases of symptomatic diverticular disease and biopsies and/or resection sp...

Oh, He; Chetty, R.

2008-01-01

43

Challenges in diagnosing adhesive small bowel obstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Adhesive small bowel obstruction (ASBO is the most frequently encountered surgical disorder of the small intestine. Up to 80% of ASBO cases resolve spontaneously and do not require invasive treatment. It is important to identify such patients that will benefit from conservative treatment in order to prevent unnecessarily exposing them to the risks associated with surgical intervention, such as morbidity and further adhesion formation. For the remaining ASBO patients, timely surgical intervention is necessary to prevent small bowel strangulation, which may cause intestinal ischemia and bowel necrosis. While early identification of these patients is key to decreasing ASBO-related morbidity and mortality, the non-specific signs and laboratory findings upon clinic presentation limit timely diagnosis and implementation of appropriate clinical management. Combining the clinical presentation findings with those from other diagnostic imaging modalities, such as abdominal X-ray, computed tomography-scan and water-soluble contrast studies, will improve diagnosis of ASBO and help clinicians to better evaluate the potential of conservative management as a safe strategy for a particular patient. Nonetheless, patients who present with moderate findings by all these approaches continue to represent a challenge. A new diagnostic strategy is urgently needed to further improve our ability to identify early signs of strangulated bowel, and this diagnostic modality should be able to indicate when surgical management is required. A number of potential serum markers have been proposed for this purpose, including intestinal fatty acid binding protein and ?-glutathione S transferase. On-going research is attempting to clearly define their diagnostic utility and to optimize their potential role in determining which patients should be managed surgically.

Misha DP Luyer

2013-01-01

44

The radiolesions of the small bowel  

International Nuclear Information System (INIS)

The irradiation of the pelvic abdominal cancers extends beyond the centre of the tumour and may induce actinic digestive lesions. The bowel and more rarely the small bowel -which is the subject-matter of our study- are concerned by those radiolesions that are favoured by therapeutic overdose, post-operative adhesions fastening the bows, radio-surgical or chemicostatic associations, and lastly by vascular or nutritive deficiencies. One may distinguish between two kinds of lesions, depending on the lapse of time before their coming out and on the symptoms. The early or acute types are characterized by a radio-mucitis and give an exsudative enteropathy with anorexia, vomiting, diarrhoea and loss of weight, of which the diagnosis is easy because it occurs during the irradiation and lessens at the end of the treatment. The late radiolesions of the small bowel are characterized by sclerosis and chronic endarteritis and, after a longlasting period of latency, give varied symptoms: disordered intestinal transit which sometimes is irreversible, perforation, fistula, syndrome of malabsorption, giving often rise to be mistaken for a recurrence of the cancer. The treatment varies whether the lesion is segmental or diffuse. In the first case, the failure of the medical means accounts for the surgical cutting away or the internal derivation; in the second case, the digestive mutilation which would result from an enlargement of the lesion commands to be more cautious and to call formmands to be more cautious and to call for the methods of parenteral feeding and digestive setting to rest

45

Pathophysiology of the nodular and micronodular small bowel fold  

International Nuclear Information System (INIS)

The normal small bowel fold is easily seen on conventional studies of the small intestine, but visualization of the small bowel villus is just at the resolution of current roentgenographic technique. When the villi are enlarged, they can be seen radiographically as an irregularity or micronodularity of the small bowel fold. The anatomy of the fold and the pathophysiology of diseases producing fold nodularity (tumor, inflammatory disease, NLH, mastocytosis) and micronodularity (lymphangiectasia, Waldenstrom macroglobulinemia, Whipple disease) are presented, with an emphasis on radiologic-pathologic correlation. The radiologist should suggest certain diseases or conditions based on the roentgenographic characteristics of the closely analyzed small bowel fold

46

The pathophysiology of the nodular and micronodular small bowel fold  

International Nuclear Information System (INIS)

The normal small bowel fold is easily seen on conventional studies of the small intestine, but visualization of the small bowel villus is at the limit of resolution of current roentgenographic technique. When the villi are enlarged, they appear radiographically as an irregularity or micronodularity of the small bowel fold. The anatomy of the fold and the pathophysiology of diseases producing fold nodularity (tumor,inflammatory disease, NLH, mastocytosis) and micronodularity (lymphangiectasia, Waldenstrom macroglobulinemia, Whipple disease) are presented, with an emphasis on radiologic-pathologic correlation. The radiologist should suggest certain diseases or conditions based on the roentgenographic characteristics of the closely analyzed small bowel fold

47

Clinical and immunohistochemical studies of small bowel carcinoid tumours  

OpenAIRE

Small bowel carcinoid tumours arising from enterochromaffin cells in the jejunum and ileum are neuroendocrine tumours (NETs) characterized by secretion of serotonin, tachykinins and other bioactive substances. These substances may lead to the typical carcinoid syndrome as well as pronounced fibrosis locally and in the heart. Although the most frequent histological subtype of malignancy in the small bowel, small bowel carcinoids are rare and therefore difficult to study. We found that previous...

Landerholm, Kalle

2011-01-01

48

Pathophysiology of acute small bowel disease with CT correlation  

International Nuclear Information System (INIS)

The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

49

Pathophysiology of acute small bowel disease with CT correlation  

Energy Technology Data Exchange (ETDEWEB)

The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

Sarwani, N., E-mail: nsarwani@hmc.psu.ed [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States); Tappouni, R.; Tice, J. [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States)

2011-01-15

50

Two way push videoenteroscopy in investigation of small bowel disease  

OpenAIRE

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 foll...

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

1998-01-01

51

Surgical management of tuberculous small bowel obstruction  

International Nuclear Information System (INIS)

Background: Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored. Methods: Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months. Results: Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%. Conclusion: Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming leste. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery. (author)

52

Cellobiose: mannitol differential permeability in small bowel disease.  

OpenAIRE

Cellobiose and mannitol absorption were studied in patients with suspected abnormal function of the small bowel mucosa. The urinary cellobiose:mannitol ratio was increased in subtotal villous atrophy, iron deficiency anaemia, and small intestinal Crohn's disease. The test seems a sensitive indicator of the integrity of small bowel mucosa.

Hodges, S.; Ashmore, S. P.; Patel, H. R.; Tanner, M. S.

1989-01-01

53

An immunoglobulin G-4 related sclerosing disease of the small bowel: CT and small bowel series findings  

Energy Technology Data Exchange (ETDEWEB)

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

Ko, Young Hwan; Hwang, Dae Hyun; Min, Seon Jeong [Dept. of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong (Korea, Republic of); Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul [Hallym University Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of)

2013-10-15

54

An immunoglobulin G-4 related sclerosing disease of the small bowel: CT and small bowel series findings  

International Nuclear Information System (INIS)

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

55

An Immunoglobulin G4-Related Sclerosing Disease of the Small Bowel: CT and Small Bowel Series Findings  

OpenAIRE

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

Ko, Younghwan; Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul; Hwang, Daehyun; Min, Seon Jeong

2013-01-01

56

An immunoglobulin G4-related sclerosing disease of the small bowel: CT and small bowel series findings.  

Science.gov (United States)

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation. PMID:24043971

Ko, Younghwan; Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul; Hwang, Daehyun; Min, Seon Jeong

2013-01-01

57

CT findings of small bowel rupture after abdominal trauma  

International Nuclear Information System (INIS)

The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel rupture after abdominal trauma is controversal. This study was conducted to ascertain CT finding of small bowel rupture result from abdominal trauma. A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel rupture was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. Diagnostic findings of small bowel rupture including pneumoperitoneum or retroperitoneal air, discontinuity of the bowel wall and extravasation of oral contrast materials were observed in 33 cases(83%). Intraperitoneal or retroperitoneal free air was seen in 31 cases(78%) and intraperitoneal or retroperitoneal free fluid collection was seen in 38 patients(95%). Small bowel wall was thickened in 31 cases(78%), bowel wall was enhanced in 12 cases(30%) and bowel wall discontinuity and extravasation of oral contrast material was seen in 5 cases, respectively. The CT scan is sensitive and effective modality for evaluation of small bowel rupture after abdominal trauma, because of high detectability of diagnostic and suggestive CT findings

58

Diarrhoea due to small bowel diseases.  

Science.gov (United States)

Small intestinal diseases are a common, though often overlooked cause of diarrhoeal illness. Fully 1% of the Caucasian population are affected by coeliac disease and a substantial portion of children living in poverty in the developing world are affected by environmental enteropathy. These are but two examples of the many diseases that cause mucosal injury to the primary digestive and absorptive organ in our body. While diarrhoea may be a common, though not universally seen symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhoea. Immunodeficiency states, including HIV enteropathy, adult autoimmune enteropathy, drug-associated enteropathy, and tropical sprue continue to occur and require specific therapy. All patients with severe diarrhoea or diarrhoea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management. PMID:23384804

Murray, Joseph A; Rubio-Tapia, Alberto

2012-10-01

59

Incarcerated small bowel in a spigelian hernia.  

Science.gov (United States)

We report on a case of a 68-year-old man who was transferred to our department to undergo surgical treatment of intestinal obstruction and a palpable right sided abdominal mass. The abdominal computed tomography scan revealed a small bowel obstruction with an incarcerated spigelian hernia. A mesh repair was performed by suturing the mesh to the internal oblique muscle and to the rectus sheath. The postoperative course was uneventful, and no recurrence has occurred during the 2-year follow-up. An urgent operation should be performed as soon as an accurate diagnosis of incarcerated spigelian hernia has been made. Computed tomography should be helpful in order to establish an accurate diagnosis of the incarcerated hernia. PMID:15045648

Tsalis, K; Zacharakis, E; Lambrou, I; Betsis, D

2004-12-01

60

Use of CT Enterography for Small Bowel Pathology:Experience and Findings in 90 Patients  

International Nuclear Information System (INIS)

Proper evaluation of the small intestine is achieved with the combination of intravenous contrast medium and large volume of neutral contrast medium administered orally to stretch the intestinal lumen and produce images for the assessment of the lumen, thickness and pattern of enhancement of the small intestine walls. Materials and methods: Between May 2007 and February 2009 we retrospectively collected 90 cases of mainly outpatients who consulted our clinic. They were prepared taking a liquid diet for 24 hours that had no residue and complete fasting 4 hours prior to the examination. A total of 2000 cc of water was administrated orally (divided in 500 cc, 75, 65, 25 and 15 minutes prior to the examination). Then 100 cc of contrast medium (OptirayTM ) were administered intravenously, at a rate of 4 cc/sec. An early arterial phase was performed 20 seconds after injection, and a portal phase 60 seconds after IV contrast administration. The studies were performed in a 16 channels, General Electric multidetector scanner, with 3.0 mm slices, with multiplanar reconstructions and MIP. Results: The studies were interpreted by a group body imaging radiologists. The most frequent findings were: diverticular disease, cystic lesions, neoplasia, Crohn's disease,ileitis, mechanical obstruction, hiatal hernia, cholelithiasis, hepatic hemangiomas, duodenal diverticulum, polyposis, intestinal mal rotation, and active bleeding. Conclusions: CT enterography is a useful and noninvasive tenterography is a useful and noninvasive technique for diagnosing small bowel disorders, allowing, in most cases, a satisfactory distension of the small bowel without the use of an enteral tube.

61

Multiphasic MDCT in small bowel volvulus  

International Nuclear Information System (INIS)

Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusid in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

62

Multiphasic MDCT in small bowel volvulus  

Energy Technology Data Exchange (ETDEWEB)

Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.

Feng Shiting, E-mail: fst1977@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Chan Tao, E-mail: taochan@hku.hk [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Sun Canhui, E-mail: canhuisun@sina.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Li Ziping, E-mail: liziping163@tom.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Guo Huanyi, E-mail: guohuanyi@163.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Yang Guangqi, E-mail: shwy03@126.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Peng Zhenpeng, E-mail: ppzhen@21cn.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Meng Quanfei, E-mail: mzycoco@gmail.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China)

2010-11-15

63

CT imaging features of phytobezoar associated with small bowel obstruction  

International Nuclear Information System (INIS)

The purpose of this study was to evaluate the CT findings of phytobezoar associated with small bowel obstruction. In 19 patients with phytobezoar associated with small bowel obstruction, two of whom had underlying small bowel disease, we analyzed the morphological characteristics of phytobezoars and changes in the bowel and perienteric regions, as revealed by abdominal CT imaging. On CT, phytobezoars appeared as single or multiple, gas-containing masses in 17 patients (89%) and as a solid mass without gas in the remaining two (11%). An encapsulating wall was noted in six patients (32%). Among the 17 without underlying small bowel disease, the bowel wall was thickened in 13 (76%) at the obstructed site and/or the bowel proximal to the obstruction. Mesenteric vascular engorgement and haziness were seen in 18 patients (95%) and a small amount of ascites in six (32%). MR images of one patient showed the phytobezoar as a hypointense mass on all sequences. CT imaging is useful for the diagnosis of phytobezoar associated with small bowel obstruction

64

MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?  

International Nuclear Information System (INIS)

Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders. (orig.)

65

MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?  

Energy Technology Data Exchange (ETDEWEB)

Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 = very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders. (orig.)

Kinner, Sonja; Kuehle, Christiane A.; Ladd, Susanne C.; Barkhausen, Joerg [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Herbig, Sebastian [University Hospital Essen, Institute of Pharmacy and Pharmaceutical Services, Essen (Germany); Haag, Sebastian [University Hospital Essen, Department of Hepatology and Gastroenterology, Essen (Germany); Lauenstein, Thomas C. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Emory University Hospital, Department of Radiology, Atlanta, GA (United States)

2008-11-15

66

Intestinal small bowel lymphomas - diagnosis and treatment  

International Nuclear Information System (INIS)

Primary intestinal lymphomas are most common in the stomach. The mucosa associated lymphatic tissue (MALT)-lymphoma which is closely associated with helicobacter pylori is very well known. In most cases, these malignancies are from B-cells origin. Another possible point of manifestation, although not well known, is the small bowel. Both tumors have enormous capabilities to enlarge in the abdominal cave. This is responding to their often asymptomatic manifestation. The symptoms, if they occur, are widespread and unspecific. Ileus, diarrhae, abdominal pain or bleeding will be observed, in rare cases also perforation or gastrointestinal or cutaneous fistulas. Diagnostic imaging often demonstrates a tumour of massive size by then, which is echopoor in the abdominal ultrasound. Our report concerns two cases of small intestine lymphomas, which were diagnosed by CT-scanning and treated in our clinic in only a short period of time. The first case was a low malignant jejunal lymphoma which was almost asymptomatic, whereas the second case had an ileus, due to compression of the intestine because of a high malignant lymphoma of the ileocecal region. (orig.)

67

Small bowel adenocarcinomas--existing evidence and evolving paradigms.  

Science.gov (United States)

Small bowel cancers account for 3% of all gastrointestinal malignancies and small bowel adenocarcinomas represent a third of all small bowel cancers. Rarity of small bowel adenocarcinomas restricts molecular understanding and presents unique diagnostic and therapeutic challenges. Better cross-sectional imaging techniques and development of enteroscopy and capsule endoscopy have facilitated earlier and more-accurate diagnosis. Surgical resection remains the mainstay of therapy for locoregional disease. In the metastatic setting, fluoropyrimidine and oxaliplatin-based chemotherapy has shown clinical benefit in prospective non-randomized trials. Although frequently grouped under the same therapeutic umbrella as large bowel adenocarcinomas, small bowel adenocarcinomas are distinct clinical and molecular entities. Recent progress in molecular characterization has aided our understanding of the pathogenesis of these tumours and holds potential for prospective development of novel targeted therapies. Multi-institutional collaborative efforts directed towards cogent understanding of tumour biology and designing sensible clinical trials are essential for developing improved therapeutic strategies. In this Review, we endeavour to outline an evidence-based approach to present-day management of small bowel adenocarcinoma, describe contemporary challenges and uncover evolving paradigms in the management of these rare 'orphan' neoplasias. PMID:23897080

Raghav, Kanwal; Overman, Michael J

2013-09-01

68

Small Bowel Obstruction Mimicking Acute ST-Elevation Myocardial Infarction  

Science.gov (United States)

We present a case of a 42-year-old female who presented to our institution with a small bowel obstruction and had emergent surgical decompression. Thirteen days postoperatively, the patient became tachycardic and had worsening epigastric pain. Electrocardiogram showed significant ST-segment elevations in leads II, III, aVF, and V3–V6, suggesting the possibility of acute inferolateral myocardial infarction. Subsequent workup revealed the cause of the ST-elevations to be due to recurrent small bowel obstruction. Although intra-abdominal causes of ST-elevation have been reported, our case may be the first to be associated with small bowel obstruction. PMID:25838963

Chang, Nai-Lun; Shulik, Oleg; DePasquale, Joseph; Shamoon, Fayez

2015-01-01

69

Small bowel enteroclysis using a hemodialysis blood pump  

International Nuclear Information System (INIS)

The purpose of this study is to describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. Over 1 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in 132 patients using a hemodialysis blood pump. Following incubation of the proximal jejunum, barium at a dilution of 50 % and 0.5 %-methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spot films of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopic time and complications were evaluated. It spite of the long fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation of small bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographs of good quality. (author). 18 refs., 2 tabs., 10 figs

70

Adnexal mass: an unusual presentation of small-bowel adenocarcinoma.  

Science.gov (United States)

Malignancy of the small bowel presents unique diagnostic and therapeutic challenges resulting in a delayed diagnosis in many cases. Small-bowel tumors respond poorly to most forms of treatment. Metastatic lesions to the ovaries comprise a small percentage of all ovarian malignant neoplasms. Ovarian metastases from primary small-bowel tumors are often difficult to differentiate from primary ovarian tumors. Only few reports have described ovarian metastases from small-bowel sources. A high index of suspicion can lead to an earlier diagnosis and can have an impact on the therapeutic options as well as the survival of the patients. The current report also underscores the importance of careful review of symptoms, investigative studies and pathology. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:16749659

Husain, Syed; Thompson, Daniel; Thomas, Louys; Donaldson, Brian; Sabbagh, Raja

2006-01-01

71

Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension  

International Nuclear Information System (INIS)

The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance. (orig.)

72

Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention  

International Nuclear Information System (INIS)

To assess the effect of the osmolarity for small bowel distension in MRI, ten volunteers ingested at two separate occasions negative oral contrast agents with different quantity and osmolarity: (1) a water solution combined with 2.0% sorbitol and 0.2% locus bean gum (LBG) with a quantity of 1500 ml and an osmolarity of 148 mOsmol/l, (2) a water solution combined with 2.0% sorbitol and 2.0% barium sulphate with a quantity of 1000 ml and an osmolarity of 194 mOsmol/l. Small bowel distension was quantified on coronal 2D-TrueFISP images by measuring the small bowel diameters. There were no statistically significant differences in mean small bowel diameter between both contrast agents. The mean small bowel distension was 19.2 mm after ingestion of 1500 ml of sorbitol-LBG solution and 19.0 mm after ingestion of 1000-ml sorbitol-barium sulphate solution. Furthermore, all volunteers found the ingestion of 1000-ml solution more pleasant than the 1500-ml solution. The ingestion of 1000 ml of sorbitol-barium sulphate solution led to a sufficient small bowel distension compared to 1500 ml of sorbitol-LBG solution. The side effect rate of both solutions was low. Based on these data, we recommend a quantity of 1000 ml of sorbitol-barium sulphate solution as an alternative for 1500-ml sorbitol-LBG solution for optimal bowel distension. (orig.)

73

Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention  

Energy Technology Data Exchange (ETDEWEB)

To assess the effect of the osmolarity for small bowel distension in MRI, ten volunteers ingested at two separate occasions negative oral contrast agents with different quantity and osmolarity: (1) a water solution combined with 2.0% sorbitol and 0.2% locus bean gum (LBG) with a quantity of 1500 ml and an osmolarity of 148 mOsmol/l, (2) a water solution combined with 2.0% sorbitol and 2.0% barium sulphate with a quantity of 1000 ml and an osmolarity of 194 mOsmol/l. Small bowel distension was quantified on coronal 2D-TrueFISP images by measuring the small bowel diameters. There were no statistically significant differences in mean small bowel diameter between both contrast agents. The mean small bowel distension was 19.2 mm after ingestion of 1500 ml of sorbitol-LBG solution and 19.0 mm after ingestion of 1000-ml sorbitol-barium sulphate solution. Furthermore, all volunteers found the ingestion of 1000-ml solution more pleasant than the 1500-ml solution. The ingestion of 1000 ml of sorbitol-barium sulphate solution led to a sufficient small bowel distension compared to 1500 ml of sorbitol-LBG solution. The side effect rate of both solutions was low. Based on these data, we recommend a quantity of 1000 ml of sorbitol-barium sulphate solution as an alternative for 1500-ml sorbitol-LBG solution for optimal bowel distension. (orig.)

Ajaj, Waleed; Kuehle, Christiane; Nuefer, Michael; Goehde, Susanne C.; Lauenstein, Thomas C. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Goyen, Mathias [Medical Center Hamburg-Eppendorf, Hamburg (Germany); Schneemann, Hubert [University Hospital Essen, Institute of Pharmacy and Pharmaceutical Sciences, Essen (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States)

2005-07-01

74

Small bowel metastases from esophageal and oropharyngeal cancers.  

Science.gov (United States)

Intestinal metastases are uncommon. Lungs and skin are the common sites of primary tumor. We report two men (52- and 67-year-old) with small bowel metastases from esophageal and oropharyngeal carcinomas. PMID:16041105

Arulraj, P; Damodaran, V; Raman, M L; Nagarajan, V; Tulasi, N R

2005-01-01

75

Interposition of the demucosed colon segment into the small bowel  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of this study is, could we transform demucosed colon into the small bowel? To find the answer, this study was investigated the surface changes of demucosed colon segment, interposed into the small bowel fashioned as a blind loop. This study was performed in five healthy young stray dogs. A blind loop was fashioned, using a 5 cm long demucosed colonic segment and a 20 cm long ileal segment. Ileal and colonic continuity were restored by primary anastomosis. Four weeks later, blind loop was resected and examined histologically under light microscopy. Histological findings revealed that demucosed colonic segment interposed into the small bowel fashioned as a blind loop, was covered with small bowel epithelium.

Sanal M

2007-01-01

76

Metastatic choriocarcinoma in the small bowel: a case report  

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Conclusion: In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage.

Zohreh Yousefi

2014-08-01

77

Mucosa-associated Lymphoid Tissue Lymphoma Presenting with Bowel Obstruction of the Duodenum and Small Bowels: A Case Report  

Energy Technology Data Exchange (ETDEWEB)

The occurrence of primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is extremely rare, and more so is the obstruction of the duodenum for the MALT lymphoma. We describe the small bowel follow through and CT findings in an uncommon case of MALT lymphoma presenting with bowel obstruction of the 2nd portion of the duodenum and small bowels.

Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang [Soonchunhyang University Hospital, Seoul (Korea, Republic of)

2010-01-15

78

Factors predisposing to radiation-related small-bowel damage  

International Nuclear Information System (INIS)

From 1970 through 1977, 92 patients with ovarian cancer received 20 Gy (2,000 rad) to the abdomen, followed by 30 Gy (3,000 rad) to the pelvis. Small-bowel obstruction developed in 7 (7.6%). The number of previous laparotomies, thin physique, and hypertension were significantly associated with complications. Two patients receiving isoniazid and 2 receiving Premarin had enteric complications. Pre-existing vascular damage may potentiate radiation damage to the small bowel

79

Primary small bowel lymphomas: clinico-radiological correlations  

International Nuclear Information System (INIS)

From 1987 to 1989, 7 patients were diagnosed as having a primary limphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IPSID limphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into limphoma but its prelymphomatous stage can be tratted and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country

80

CT findings of small bowel metastases from primary lung cancer  

International Nuclear Information System (INIS)

To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obut obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and pattern of small bowel metastases as well as in demonstrating their complication

81

CT findings of small bowel metastases from primary lung cancer  

Energy Technology Data Exchange (ETDEWEB)

To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and pattern of small bowel metastases as well as in demonstrating their complication.

Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

2002-11-01

82

Transient small bowel angioedema due to intravenous iodinated contrast media  

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Full Text Available Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM are presented. Computed tomography (CT images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum. The bowel wall was normal in non-enhanced images, and normal or inconspicuous in arterial phase enhanced images. In one of the three cases, the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images. No filling defect was seen in the lumen of the superior mesenteric artery and vein. No peritoneal effusion or mesentery abnormality was found. Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time. Only one patient suffered mild diarrhea after scanning which had resolved by the following day. The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms. Differential diagnosis may include inflammatory and ischemic bowel disease, as well as neoplasms. A three-phase CT protocol and good understanding of this disorder are fundamentally important in the diagnosis of this condition. The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions. The predilection location of transient anaphylactic bowel angioedema is the small intestine, particularly the proximal segment. A speculated cause may be the richer supply of vessels in the small intestine, ample mucous folds and loose connective tissue in the duodenum and the jejunum.

Xiu-Hua Hu

2012-01-01

83

Transient small bowel angioedema due to intravenous iodinated contrast media.  

Science.gov (United States)

Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented. Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum. The bowel wall was normal in non-enhanced images, and normal or inconspicuous in arterial phase enhanced images. In one of the three cases, the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images. No filling defect was seen in the lumen of the superior mesenteric artery and vein. No peritoneal effusion or mesentery abnormality was found. Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time. Only one patient suffered mild diarrhea after scanning which had resolved by the following day. The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms. Differential diagnosis may include inflammatory and ischemic bowel disease, as well as neoplasms. A three-phase CT protocol and good understanding of this disorder are fundamentally important in the diagnosis of this condition. The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions. The predilection location of transient anaphylactic bowel angioedema is the small intestine, particularly the proximal segment. A speculated cause may be the richer supply of vessels in the small intestine, ample mucous folds and loose connective tissue in the duodenum and the jejunum. PMID:22408362

Hu, Xiu-Hua; Gong, Xiang-Yang; Hu, Peng

2012-03-01

84

US features of transient small bowel intussusception in pediatric patients  

International Nuclear Information System (INIS)

To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5 ± 0.3 cm) diameters and with thin (mean, 3.5 ± 1 mm) outer rims along the course of the small bowel. The mean length was 1.8 ± 0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n 2). All patients discharged with improved condition. Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient smthose patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration

85

Dedifferentiated liposarcoma of the small bowel mesentery presenting as a submucosal mass  

OpenAIRE

Dedifferentiated liposarcoma (DDLPS) is a variant of liposarcoma but with a more aggressive course. It occurs most commonly in the retroperitoneum and rarely in any other anatomical location. We describe a case of DDLPS arising from the small bowel mesentery presenting as submucosal mass of the small bowel. The current case is unusual as the tumor originated from the small bowel mesentery and a dedifferentiated component transmurally invaded the small bowel wall, including the small bowel sub...

Eun-Jung Cha

2011-01-01

86

Dedifferentiated liposarcoma of the small bowel mesentery presenting as a submucosal mass  

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Full Text Available Dedifferentiated liposarcoma (DDLPS is a variant of liposarcoma but with a more aggressive course. It occurs most commonly in the retroperitoneum and rarely in any other anatomical location. We describe a case of DDLPS arising from the small bowel mesentery presenting as submucosal mass of the small bowel. The current case is unusual as the tumor originated from the small bowel mesentery and a dedifferentiated component transmurally invaded the small bowel wall, including the small bowel submucosa.

Eun-Jung Cha

2011-01-01

87

CT Findings of Small Bowel Anisakiasis: Analysis of Four Cases  

International Nuclear Information System (INIS)

We wanted to describe the CT findings of small bowel anisakiasis with the pathologic correlation. Four patients with surgically and pathologically proven small bowel anisakiasis were included in this retrospective study. They were three men and one woman and their ages ranged from 28 to 43 years (mean age: 38 years). We evaluated their clinical, CT and histological findings. All the patients had a history of ingesting raw fish within 24 hours from the time of symptom onset. They complained of abdominal pain (n=4), nausea (n=4), vomiting (n=2) and diarrhea (n=1). Physical examination revealed tenderness (n=4), rebound tenderness (n=4) and increased bowel sounds (n=3). Leukocytosis was noted in all the patients on the laboratory examination. None of the patients showed eosinophilia. The CT findings were segmental small bowel wall thickening with preserved layering (n=4), focal segmental luminal narrowing with proximal dilatation (n=4), peritoneal thickening (n=3), mesenteric or omental infiltration (n=4) and varying degrees of ascites (n=4). On the histopathologic examination, they revealed an infiltration of eosinophils (n=4) in all layers of the bowel wall with severe edema. The larvae were found on surgico-pathologic examination in all the cases. The CT findings may be helpful to make the specific diagnosis of small bowel anisakiasis in a patient with the clinical findings of an acute abdomen and a history of eating raw fish

88

Whirl sign as CT finding in small-bowel volvulus  

Energy Technology Data Exchange (ETDEWEB)

In three patients with ileus CT showed a whirl sign in which the bowel and mesenteric folds encircled the superior mesenteric vein in a whirl-like pattern. Two patients were confirmed surgically to have small-bowel volvulus arising from postoperative adhesions. The whirl sign is useful in decision-making about the need for surgery. A CT examination should be performed for patients with ileus of unknown cause. (orig.)

Fujimoto, K. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Nakamura, K. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Nishio, H. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Takashima, S. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Minakuchi, K. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Onoyama, Y. [Dept. of Radiology, Osaka City Univ. Medical School, Osaka (Japan); Nomura, K. [Dept. of Radiology, Higashi-Osaka Ikeda Hospital, Osaka (Japan); Hayata, S. [Dept. of Surgery, Higashi-Osaka Ikeda Hospital, Osaka (Japan)

1995-12-31

89

Whirl sign as CT finding in small-bowel volvulus  

International Nuclear Information System (INIS)

In three patients with ileus CT showed a whirl sign in which the bowel and mesenteric folds encircled the superior mesenteric vein in a whirl-like pattern. Two patients were confirmed surgically to have small-bowel volvulus arising from postoperative adhesions. The whirl sign is useful in decision-making about the need for surgery. A CT examination should be performed for patients with ileus of unknown cause. (orig.)

90

SMALL BOWELL BURKITT LYMPHOMA AT THE CHILD. CASE REPORT  

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Full Text Available Burkitt lymphoma localised at the small bowell is very rare. We present the case of a 7 years old child admitted into the hospital for acute appendicitis. During the surgical procedure we found a tumor localised on the last segment of the small bowell. We performed appendectomy associated with segmental resection of intestine were the tumor was, with end to end eneteroenterostomy. The microscopic pathological exam showed the infiltration of the intestinal wall with lymphocytes and macrophages with an overall appearance of „starry sky”. Immunehistochemistry revealed malignant B type lymphocytes CD 20 positive, CD 68 positive macrophages and a Ki-67 proliferation index rate of 85%. These findings certified the diagnosis of Burkitt lymphoma. The postoperative course was uneventful. Conclusion: The Burkitt lymphoma of the small bowell can be a „surprising” intraoperatively diagnosis. The treatment of this tumor is surgical procedure (resection of the intestine associated with chemotherapy.

?t. C. Chico?

2007-01-01

91

Merkel cell carcinoma metastatic to the small bowel mesentery  

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Full Text Available Merkel cell carcinoma (MCC is an uncommon cutaneous malignant tumor that presents as a rapidly growing skin nodule on sun-exposed areas of the body. MCC is aggressive with regional nodal and distant metastases to the skin, lung, and bones. There have been no reports of metastatic MCC to the mesentery and 6 reports describing metastasis to the small intestine. We present a case of metastatic MCC to the mesentery with infiltration to the small bowel, 8 years after original tumor resection. This is the 5th metastasis and it encased the small bowel resulting in a hair-pin loop contributing to the unusual clinical presentation. Although MCC metastatic to the bowel is uncommon, it is not rare. It is important to recognize the unusual manifestations of this disease as they are becoming more common in the future. Routine radiologic surveillance and thorough review of systems are important to patient follow-up.

Guang-Yu Yang

2011-03-01

92

Primary Small Bowel Tumour Presenting as Bowel Obstruction in a Patient with a Virgin Abdomen  

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Full Text Available Primary malignancies of the small bowel are rare and usually present with vague, non-specific symptoms. This leads to diagnostic difficulties for both physician and radiologists alike. We present a case of a 54-year-old lady with a virgin abdomen who initially presented to hospital with vague abdominal symptoms suggestive of gastroenteritis. She responded partially to conservative treatment but represented to hospital 3 weeks later with obstructive symptoms. Contrast CT was inconclusive with regards to diagnosis. A diagnostic laparoscopy was performed, revealing an infiltrative growth. Consequently, she underwent segmental laparoscopic-assisted small bowel resection and recovered well post-operatively. After further histological and endoscopic investigations, a final diagnosis of primary small bowel adenocarcinoma was given. As the prognosis of small bowel malignancy is stage-dependent, this case demonstrates a high index of suspicion is necessary to reach early diagnosis, especially for symptoms non-responsive to conventional treatment. Diagnostic laparoscopy should be considered early as a definitive diagnostic tool.

Xilin Wu

2011-11-01

93

Primary Small Bowel Tumour Presenting as Bowel Obstruction in a Patient with a Virgin Abdomen  

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Full Text Available Primary malignancies of the small bowel are rare and usually present with vague, non-specific symptoms. This leads to diagnostic difficulties for both physician and radiologists alike. We present a case of a 54-year-old lady with a virgin abdomen who initially presented to hospital with vague abdominal symptoms suggestive of gastroenteritis. She responded partially to conservative treatment but represented to hospital 3 weeks later with obstructive symptoms. Contrast CT was inconclusive with regards to diagnosis. A diagnostic laparoscopy was performed, revealing an infiltrative growth. Consequently, she underwent segmental laparoscopic-assisted small bowel resection and recovered well post-operatively. After further histological and endoscopic investigations, a final diagnosis of primary small bowel adenocarcinoma was given. As the prognosis of small bowel malignancy is stage-dependent, this case demonstrates a high index of suspicion is necessary to reach early diagnosis, especially for symptoms non-responsive to conventional treatment. Diagnostic laparoscopy should be considered early as a definitive diagnostic tool.

Xilin Wu

2013-06-01

94

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

Science.gov (United States)

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

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

2015-01-01

95

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

Science.gov (United States)

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

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

2015-01-01

96

Small bowel injury in low-dose aspirin users.  

Science.gov (United States)

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

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

2015-04-01

97

MR enterography in the evaluation of small bowel dilation  

Energy Technology Data Exchange (ETDEWEB)

Magnetic reasonance (MR) enterography enables high contrast resolution depiction of the location and cause of bowel obstruction through a combination of predictable luminal distension and multiplanar imaging capabilities. Furthermore, because the patient is not exposed to ionizing radiation, sequential 'dynamic' MR imaging can be performed repeatedly over time further facilitating depiction of the site and/or the cause of obstruction. With increasing availability of MR imaging and standardization of the oral contrast medium regimens, it is likely that this technique will assume an ever-increasing role in the evaluation of small bowel dilation in the coming years. We illustrate the utility of MR enterography in the evaluation of small bowel dilation, whether it be mechanical, functional (e.g., ileus), or related to infiltrative mural disease.

Cronin, C.G. [Department of Radiology, University College Hospital, Galway (Ireland)], E-mail: carmelcronin2000@hotmail.com; Lohan, D.G.; Browne, A.M.; Alhajeri, A.N.; Roche, C.; Murphy, J.M. [Department of Radiology, University College Hospital, Galway (Ireland)

2009-10-15

98

Small bowel ultrasound in patients with celiac disease  

Energy Technology Data Exchange (ETDEWEB)

Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease.

Bartusek, D. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: dbartusek@fnbrno.cz; Valek, V. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: v.valek@fnbrno.cz; Husty, J. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: jhusty@fnbrno.cz; Uteseny, J. [Department of Pediatric Internal Medicine, Masaryk University hospital Brno (Czech Republic)], E-mail: juteseny@fnbrno.cz

2007-08-15

99

Calcifiying fibrous pseudotumor of the small bowel mesentery - case report.  

Science.gov (United States)

Calcifiyng fibrous pseudotumor (CFPT) is a benign mesenchymal tumor diagnosed in children and young adults, located in the subcutaneous tissue of the trunk and limbs. Its intraabdominal localization is a unique rarity. The Authors of the study presented a case of a 48-year old female patient with an accidentally diagnosed small bowel mesentery tumor during surgery. PMID:25205701

Paszkiewicz, Izabela; I?ycka-?wieszewska, Ewa; Wysocki, Tomasz; Dobosz, Lukasz; Dobosz, Marek

2014-06-01

100

Calcifiying Fibrous Pseudotumor of the Small Bowel Mesentery – Case Report  

Directory of Open Access Journals (Sweden)

Full Text Available Calcifiyng fibrous pseudotumor (CFPT is a benign mesenchymal tumor diagnosed in children and young adults, located in the subcutaneous tissue of the trunk and limbs. Its intraabdominal localization is a unique rarity. The Authors of the study presented a case of a 48-year old female patient with an accidentally diagnosed small bowel mesentery tumor during surgery

Paszkiewicz Izabela

2014-06-01

101

A radiologist's guide to small bowel and multivisceral transplantation  

International Nuclear Information System (INIS)

This review will describe the indications for the various small bowel containing transplants. The importance of early referral will be highlighted. Radiologists play a central role in assessing these complex patients prior to transplantation. Furthermore, in the postoperative period, radiologists play an important part in diagnosing and treating complications

102

Small bowel ultrasound in patients with celiac disease  

International Nuclear Information System (INIS)

Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease

103

An Interesting Case of Recurrent Small Bowel Obstruction.  

Science.gov (United States)

Sclerosing mesenteritis is associated with a spectrum of diseases which include mesenteric lipodystrophy and mesenteric panniculitis. This inflammatory and fibrosing disorder can affect the small and large bowel wall and mesenteric vessels by exerting a mass effect. The following case highlights the difficulties with diagnosing and managing this unusual disease. A 64-year-old man presented with acute central abdominal pain, radiating to his back, and profuse vomiting. He was diagnosed clinically with small bowel obstruction. He had had an episode of small bowel obstruction 6 years earlier. At this time, he underwent an exploratory laparotomy, and a mass was identified in the small bowel mesentery. The features were thought to be in keeping with sclerosing mesenteritis. He had a dramatically favourable response to the initiation of prednisolone. He continued to be well and asymptomatic for a further 5 years on long-term maintenance low-dose steroids and 6-mercaptopurine. He re-presented in 2009 (six years after initial presentation) with very severe acute abdominal pain and vomiting. He had no recent change in weight or appetite, and had not had time off work. He underwent a second laparotomy and the tissue diagnosis was of metastatic carcinoid tumour involving the small bowel mesentery. This is the first case to our knowledge where sclerosing mesenteritis has been confirmed histologically on biopsy and then subsequently diagnosed with histologically proven carcinoid tumour. For this particular reason it must be always remembered that sclerosing mesenteritis is a 'pathological' and not a radiological diagnosis and that a large proportion of cases are associated with neoplasia. PMID:21103263

Allen, P B; De Cruz, P; Efthymiou, M; Fox, A; Taylor, A C F; Desmond, P V

2009-01-01

104

Small bowel evisceration through the anus – report of a case and review of literature  

OpenAIRE

An 84-year-old lady with a history of chronic recurrent rectal prolapse, presented to accident and emergency with a significant portion of small bowel and mesentery protruding out of her anus. The small bowel was not contained within peritoneum, nor was this a pararectal herniation. On examination of the rectum, a longitudinal tear was found in the anterior rectal wall, through which the small bowel had prolapsed. Hours after reducing the small bowel back into the anus, it prolapsed a second ...

Berwin, James Theo; Ho, T. K.; D’souza, Rovan

2012-01-01

105

Perforation of an adenocarcinoma of the small bowel affected by regional enteritis.  

OpenAIRE

This report is of a patient with long-term small bowel regional enteritis who presented with a perforation of an adenocarcinoma involving a diseased portion of ileum. Adenocarcinoma of the small bowel is rare. The incidence of small bowel adenocarcinoma may be higher in patients with regional enteritis, but a definite relationship cannot be established on the basis of data presently available. Small bowel adenocarcinoma in regional enteritis usually presents with obstructive symptoms.

Heathcote, J.; Knauer, C. M.; Oakes, D.; Archibald, R. W.

1980-01-01

106

Alveolar Soft Part Sarcoma Metastatic to Small Bowel Mucosa Causing Polyposis and Intussuseption  

OpenAIRE

A report of alveolar soft part sarcoma metastatic to the small bowel is presented. Hematogenous metastases to the small bowel from primary tumors outside the abdominal cavity are uncommon, and most remain asymptomatic and are not discovered until autopsy. However, small bowel metastases can lead to intestinal obstruction, intussuseption or even perforation. While metastases to the small bowel have been described for other tumor types, including melanoma and lung cancer, this is ex...

Brian Mcgrath; Brooks, John J.; Kraybill, William B.; Allan Litwin; Gibbs, John F.; Sabel, Michael S.

2001-01-01

107

Diffuse small bowel thickening in aids patient - a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Diarrhea is common in HIV/AIDS patients, caused by both classic enteric pathogens and different opportunistic agents. Infection with these different pathogens may lead to similar radiological findings, thus causing diagnostic confusion. Case presentation A 30-yr-old female with AIDS presented with chronic diarrhea of 4 months duration. She had diffuse small bowel thickening present on CT scan of her abdomen, with stool examination showing no parasites. She was erroneously diagnosed as abdominal tuberculosis and given antituberculosis drugs with which she showed no improvement. Repeat stool examination later at a specialized laboratory revealed Cryptosporidium parvum infection. The patient was given an extended course of nitazoxanide treatment, as her stool examination was positive for Cryptosporidium parvum even after 2 weeks of drug consumption. Parasite clearance was documented after 10 weeks of treatment. Interestingly, the bowel thickening reversed with parasitological clearance. Conclusions Cryptosporidium parvum may lead to small bowel thickening in AIDS patients. This small bowel thickening may reverse following parasitological clearance.

Hari Samriti

2010-10-01

108

Abnormalities of small bowel and colon in systemic sclerosis  

International Nuclear Information System (INIS)

A series of 21 subjects (2 males and 19 females) affected with systemic sclerosis, was examined by small bowel (oral and intubation methods) and colon enema. The underlying process responsible for abnormalities in the small bowel and colon in systemic sclerosis is a variable and pacthy destruction of the muscularis propria, that produces the structural and functional changes detected on X-ray: Pathologic condition is the same affecting the esophagus. The scout film of the abdomen often reveals colonic distension and fecal impaction, so that it may be quite difficult to prepare adequately the patients for a barium enema. Peristalsis may be virtually absent in short segments, and transit time may be several time longer than that in normal patients. For these reasons, intestinal pseudo-obstruction may appear in systemic sclerosis. The observed radiographic changes are: 1) in the small bowel: a) dilatation of the gut, especially in its proximal portions (duodenum and jejunum), in which the valvulae conniventes are straightened, normal or thinned; b) presence of diverticula, 2-4 cm in diameter, with hemispherical shape without the neck-like opening into the bowel lumen; 2) in the colon, the characteristic finding is an increase in size of individual haustra, forming sacculations or pseudo-diverticula, usually on the antemesenteric border of the transverse colon, better demonstrated on post-evacuation film. Moreover, loss of colonic haustration is also observed associated t haustration is also observed associated to colonic elongation and dilatation

109

[Small bowel perforation caused by magnetic toys].  

Science.gov (United States)

Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets. PMID:20549590

Schroepfer, E; Siauw, C; Hoecht, B; Meyer, T

2010-06-01

110

The lack of impact of pelvic irradiation on small bowel mobility: implications for radiotherapy treatment planning  

International Nuclear Information System (INIS)

Purpose: Small bowel contrast is frequently used during simulation for patients undergoing pelvic radiotherapy to assist in the design of blocks that exclude small bowel from the radiation field. In many instances, a large field is treated to 45 gray (Gy), followed by a field reduction to exclude the small bowel. This prospective study was designed to assess whether the position and mobility of the small bowel changed after the initial 45 Gy, thereby determining whether a special small bowel series done at initial simulation is applicable at the time of field reduction. Methods and Materials: Twelve patients undergoing pelvic irradiation were given small bowel contrast for their initial simulation. Radiographs were taken with the bladder empty and the bladder full. The location of the small bowel and its displacement with bladder distention was measured. This entire procedure was repeated prior to field reduction (after 39.6-46.0 Gy). Results: There was no demonstrable alteration in small bowel mobility after 39.6-46.0 Gy. The approximate position of the small bowel relative to bony landmarks was unchanged. Conclusion: The position and mobility of the small bowel appears not to be affected by 39.6-46.0 Gy of pelvic radiotherapy. Therefore, it is reasonable to design reduced pelvic fields to exclude the small bowel based on special small bowel series done at initial treatment simulation

111

Axial Torsion of Gangrenous Meckel's Diverticulum Causing Small Bowel Obstruction  

OpenAIRE

Meckel's diverticulum (MD) is a commonly encountered congenital anomaly of the small intestine. We report an extremely unusual case of an axially torted, gangrenous MD presenting as acute intestinal obstruction. A 26-year-old male patient presented to our emergency department with 3 days history of abdominal pain, distention and bilious vomiting. On laparotomy, there was minimal hemorrhagic fluid localized in right iliac fossa and small bowel loops were dilated. A MD was seen attached to the ...

Sasikumar, K.; Noonavath, Ravinder Naik; Sreenath, G. S.; Maroju, Nanda Kishore

2013-01-01

112

Giant mesenteric lymphatic malformation presenting as small bowel volvulus  

OpenAIRE

Abdominal pain with bilious emesis is an ominous clinical presentation with many possible causes. We describe a previously healthy 4-year-old boy who presented with these symptoms and ultrasound findings of fluid throughout most of the abdominal cavity. Computed tomography imaging revealed a large cystic mass (21-by-13 cm) associated with a small bowel obstruction due to volvulus. A laparoscopic exploration was undertaken, revealing a large mass arising from the small intestinal mesentery and...

Cauley, Christy E.; Spencer, Philip J.; Sagar, Pallavi; Goldstein, Allan M.

2013-01-01

113

Diarrhoea due to small bowel diseases  

OpenAIRE

Small intestinal diseases are a common, though often overlooked cause of diarrhoeal illness. Fully 1% of the Caucasian population are affected by coeliac disease and a substantial portion of children living in poverty in the developing world are affected by environmental enteropathy. These are but two examples of the many diseases that cause mucosal injury to the primary digestive and absorptive organ in our body. While diarrhoea may be a common, though not universally seen symptom of small b...

Murray, Joseph A.; Rubio-tapia, Alberto

2012-01-01

114

Small Bowel Volvulus Induced by Mesenteric Lymphangioma in an Adult: a Case Report  

Energy Technology Data Exchange (ETDEWEB)

Mesenteric lymphangiomas are rare abdominal masses that are seldom associated with small bowel volvulus, and especially in adult patients. We report here on an unusual case of small bowel volvulus that was induced by a mesenteric lymphangioma in a 43-year-old man who suffered from repeated bouts of abdominal pain. At multidetector CT, we noticed whirling of the cystic mesenteric mass and the adjacent small bowel around the superior mesenteric artery. Small bowel volvulus induced by the rotation of the mesenteric lymphangioma was found on exploratory laparotomy. Lymphangioma should be considered as a rare cause of small bowel volvulus in adult patients.

Jang, Jin Hee; Lee, Su Lim; Ku, Young Mi; An, Chang Hyeok; Chang, Eun Deok [Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

2009-06-15

115

Small Bowel Volvulus Induced by Mesenteric Lymphangioma in an Adult: a Case Report  

International Nuclear Information System (INIS)

Mesenteric lymphangiomas are rare abdominal masses that are seldom associated with small bowel volvulus, and especially in adult patients. We report here on an unusual case of small bowel volvulus that was induced by a mesenteric lymphangioma in a 43-year-old man who suffered from repeated bouts of abdominal pain. At multidetector CT, we noticed whirling of the cystic mesenteric mass and the adjacent small bowel around the superior mesenteric artery. Small bowel volvulus induced by the rotation of the mesenteric lymphangioma was found on exploratory laparotomy. Lymphangioma should be considered as a rare cause of small bowel volvulus in adult patients

116

Direct diverticular inguinal hernia  

Energy Technology Data Exchange (ETDEWEB)

Nineteen patients with direct diverticular inguinal hernia (DDIH) were examined with herniography and surgically explored. A lump medially in the groin and pain were the prominent clinical manifestations in 18 patients. Physical examination indicated the presence of a DDIH in 6 patients. In 16 patients herniography revealed hernial sacs protruding from the supravesical fossa in 5 and from the medial inguinal fossa in 11. At operation a circumscribed defect was found in the transverse fascia laterally and cranially to the pubic tubercle in all patients. In 16 patients peritoneal hernial sacs were demonstrated at surgery while in 3 only lipomas (fatty hernia) were contained within the defect. In our opinion DDIH is a specific variety of inguinal hernia with a fairly typical clinical presentation and radiographic appearance but probably often overlooked at surgery.

Ekberg, O.; Kullenberg, K.

117

Direct diverticular inguinal hernia  

International Nuclear Information System (INIS)

Nineteen patients with direct diverticular inguinal hernia (DDIH) were examined with herniography and surgically explored. A lump medially in the groin and pain were the prominent clinical manifestations in 18 patients. Physical examination indicated the presence of a DDIH in 6 patients. In 16 patients herniography revealed hernial sacs protruding from the supravesical fossa in 5 and from the medial inguinal fossa in 11. At operation a circumscribed defect was found in the transverse fascia laterally and cranially to the pubic tubercle in all patients. In 16 patients peritoneal hernial sacs were demonstrated at surgery while in 3 only lipomas (fatty hernia) were contained within the defect. In our opinion DDIH is a specific variety of inguinal hernia with a fairly typical clinical presentation and radiographic appearance but probably often overlooked at surgery. (orig.)

118

[A Feasibility Study of closing the small bowel with high-frequency welding device].  

Science.gov (United States)

This study aimed to evaluate the feasibility and effectiveness of closing the small bowel in an ex vivo porcine model with high-frequency welding device. A total of 100 porcine small bowels were divided into two groups, and then were closed with two different methods. The fifty small bowels in experimental group were closed by the high-frequency welding device, and the other fifty small bowels in comparison group were hand-sutured. All the small bowels were subjected to leak pressure testing later on. The speed of closure and bursting pressure were compared. The 50 porcine small bowels closed by the high-frequency welding device showed a success rate of 100%. Compared with the hand-sutured group, the bursting pressures of the former were significantly lower (Pwelding device has higher feasibility in closing the small bowel. PMID:25868254

Zhou, Huabin; Han, Shuai; Chen, Jun; Huang, Dequn; Peng, Liang; Ning, Jingxuan; Li, Zhou

2014-12-01

119

Large Intraluminal Ileal Hematoma Presenting as Small Bowel Obstruction in a Child  

Science.gov (United States)

Intraluminal small bowel hematoma has been rarely reported in children, as a rare cause of small bowel obstruction. We present a case of an intraluminal ileal hematoma presenting as small bowel obstruction in a child. Computed Tomography (CT) indicated a large intraluminal hyperdense lesion in the distal ileum as the cause of small bowel obstruction. Abdominal ultrasonography (US) showed an echogenic mass-like lesion with multiple septa in the distal ileum. Small bowel obstruction due to a complicated cystic mass was provisionally diagnosed. Histopathologic examination of the resected mass suggested a submucosal ileal hematoma. Although intraluminal small bowel hematoma is rare in children, it can present as an intraluminal cystic mass and should be considered as a rare cause of small bowel obstruction. The US and CT findings of submucosal ileal hematoma could be useful for the diagnosis of such cases in the future.

Lim, Yun Jung; Nam, So Hyun; Kim, Seon Jeong

2015-01-01

120

Small bowel volvulus in a primigravida woman: Case report  

OpenAIRE

Volvulus of the small bowel, although being rare, carries a high risk of strangulation and ischemic necrosis. Preoperative diagnosis is difficult and may be complicated by pregnancy, labor and the post-cesarean-section state. Delay in diagnosis and surgical intervention increases morbidity and mortality rates.We present a 20- year- old primigravida woman (GA=10 weeks) with massive intestinal necrosis. Her initial symptoms were abdominal pain and nausea. Her complaints were attributed to pregn...

Atossa Mahdavi; Nasim Yunesi

2007-01-01

121

Giant cystic lymphangioma of the small bowel mesentery: case report  

OpenAIRE

Cystic lymphangioma is an uncommon mesenteric tumor which is usually reported in children. We describe a case of a 12-years old girl who was admitted in our hospital with abdominal distension and pain. Physical examination showed an abdomino-pelvic mass. Preoperative studies including abdominal ultrasonography and computed tomography failed to determine the cause of the pain. Laparotomy found a giant cystic tumor of the small bowel mesentery. Histological studies confirm the diagnosis of cyst...

Khattala, Khalid; Rami, Mohamed; Elmadi, Aziz; Mahmoudi, Abdelhalim; Bouabdallah, Youssef

2011-01-01

122

A fatal case of adult small bowel volvulus.  

Science.gov (United States)

A 56-year-old man was hit by a car while riding a bicycle, immediately brought to the hospital, and treated. Four days after the accident, he reported abdominal pain and vomiting in the night, and he died the next day. A forensic autopsy was performed, and almost of the entire small bowel had gangrenous swelling. The mesentery was twisted 180° with clockwise rotation along the vascular axis, and pre-autopsy computed tomography scan showed a whirl sign. PMID:24916863

Hayakawa, Mutsumi; Makino, Yohsuke; Yajima, Daisuke; Inokuchi, Go; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Ishii, Namiko; Saitoh, Hisako; Iwase, Hirotaro

2014-09-01

123

An Interesting Case of Recurrent Small Bowel Obstruction  

OpenAIRE

Sclerosing mesenteritis is associated with a spectrum of diseases which include mesenteric lipodystrophy and mesenteric panniculitis. This inflammatory and fibrosing disorder can affect the small and large bowel wall and mesenteric vessels by exerting a mass effect. The following case highlights the difficulties with diagnosing and managing this unusual disease. A 64-year-old man presented with acute central abdominal pain, radiating to his back, and profuse vomiting. He was diagnosed clinica...

Allen, P. B.; Cruz, P.; Efthymiou, M.; Fox, A.; Taylor, A. C. F.; Desmond, P. V.

2009-01-01

124

Small bowel obstruction caused by congenital transmesenteric defect  

Directory of Open Access Journals (Sweden)

Full Text Available Transmesenteric hernias are extremely rare. A strangulated hernia through a mesenteric opening is a rare operative finding. Preoperative diagnosis still is difficult in spite of the imaging techniques currently available. The authors describe two cases of paediatric patients presenting with bowel obstruction resulting from a congenital mesenteric hernia. The first patient had a 3-cm wide congenital defect in the ileal mesentery through which the sigmoid colon had herniated. The second patient is a newborn infant who presented with symptoms and radiographic evidence of neonatal occlusion. At surgical exploration, a long segment of the small bowel had herniated in a defect in the ileal mesentery. A brief review of epidemiology and anatomy of transmesenteric hernias is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.

Nouira F

2011-01-01

125

Merkel cell carcinoma metastatic to the small bowel mesentery  

OpenAIRE

Merkel cell carcinoma (MCC) is an uncommon cutaneous malignant tumor that presents as a rapidly growing skin nodule on sun-exposed areas of the body. MCC is aggressive with regional nodal and distant metastases to the skin, lung, and bones. There have been no reports of metastatic MCC to the mesentery and 6 reports describing metastasis to the small intestine. We present a case of metastatic MCC to the mesentery with infiltration to the small bowel, 8 years after original tumor resection. Thi...

Guang-Yu Yang; Kuzel, Timothy M.; Linn, John G.; Ava Hosseini; Wayne, Jeffrey D.; Matkowskyj, Kristina A.

2011-01-01

126

Technical quality of CT colonography in relation with diverticular disease  

International Nuclear Information System (INIS)

Objective: The aim of the study is to explore how the technical quality of the examination was affected by diverticular disease. Materials and methods: We retrospectively evaluated a consecutive series of 78 subjects who underwent CTC for screening (n = 58) or staging (n = 20) colorectal cancer, 38 of them (49%) after an incomplete optical colonoscopy. Patients were administered a mild laxative and a iodinated contrast material for fecal tagging. We scored both the bowel preparation and the overall colon distension as poor, good, or optimal and measured the mean sigmoid colon diameter. We counted the number of diverticula and classified patients as having or not a severe diverticular disease (SDD). The number of the prompts of computer aided diagnosis (CAD) per patient was also considered. Mann–Whitney U and ?2 tests were performed. Results: No CTC complications occurred. The bowel cleansing was poor in 8 (10%) patients, good in 29 (37%) and optimal in 41 (53%); colon distension was poor in 7 (9%) patients, good in 38 (49%), and optimal in 33 (42%). Fifty-four (69%) showed diverticula and 30 (38%) had an SDD. Bowel cleansing and distension were not significantly impaired by neither diverticula (p > 0.590) nor the SDD (p > 0.110). Mean sigmoid colon diameter was reduced in presence of diverticula (28 mm versus 23 mm, p = 0.009) or SDD (26 mm versus 22 mm, p = 0.016). The mean number of CAD prompts per patient was not significantly increased by the presenc significantly increased by the presence of SDD (p = 0.829). Conclusions: Bowel cleansing and distension at CTC were not influenced by the presence of diverticular disease.

127

Application of nasointestinal decompression intubation in small bowel obstruction  

International Nuclear Information System (INIS)

Objective: To evaluate the nasointestinal decompression intubation in acute small intestinal obstruction. Methods: Ten patients with acute small bowel obstruction received nasointestinal decompression intubation under x-ray guidance. The nasointestinal decompression tube passing over a guidewire was inserted into small intestine near Tres ligament or further down distally with assistance of patients adopting in multi-physical positions. Results: The intubation of nasointestinal decompression tubes into small intestine was technically successful in all patients with average procedural time of 16 min. (10-35 min). After placement of the tube, all patients obtained various degrees of symptoms relief including abdominal pain, distention, vomiting, etc. Four patients with simple adhesive obstruction recovered completely and the tube was removed 2 weeks later. Three patients were referred to surgical operation, and 3 others gave up for further treatment. There were no complications such as bleeding or perforation related to intubation. Conclusion: Nasointestinal decompression intubation under guidance of X-ray is rather simple, less time consuming, especially with high efficiency for preoperative gastrointestinal decompression and treating simple adhesive bowel obstruction; ought to be recommended. (authors)

128

Closed loop obstruction of the small bowel: CT and sonographic findings  

Energy Technology Data Exchange (ETDEWEB)

Closed loop obstruction represent a surgical emergency, because this lesion leads to small bowel infraction, perforation, and peritonitis if not treated in time. We analyzed the CT and ultrasonographic findings of 4 patients prospectively and 2 patients retrospectively with surgically proven closed loop obstruction of the small bowel to evaluate the characteristic findings, the cause of the closed loop obstruction and predictive criteria for the viability of the involved bowel loop. The characteristic CT and sonographic features of the closed loop obstruction of the small bowel included; dilated fluid-filled bowel loops, the thickened bowel wall, absence of peristalsis, and ascites. In one case, closed loop obstruction originating from umbilical hernia was documented by CT and sonography. The possible criteria for the gangrenous changes could be the maximal thickness of bowel more than 7mm, and infiltration in the mesentery/omentum.

Choi, Hyun Ju; Kim, Ki Whang; Lee, Chan Wha; Lee, Yeon Hee [Yonsei University, College of Medicine, Seoul (Korea, Republic of)

1992-11-15

129

Closed loop obstruction of the small bowel: CT and sonographic findings  

International Nuclear Information System (INIS)

Closed loop obstruction represent a surgical emergency, because this lesion leads to small bowel infraction, perforation, and peritonitis if not treated in time. We analyzed the CT and ultrasonographic findings of 4 patients prospectively and 2 patients retrospectively with surgically proven closed loop obstruction of the small bowel to evaluate the characteristic findings, the cause of the closed loop obstruction and predictive criteria for the viability of the involved bowel loop. The characteristic CT and sonographic features of the closed loop obstruction of the small bowel included; dilated fluid-filled bowel loops, the thickened bowel wall, absence of peristalsis, and ascites. In one case, closed loop obstruction originating from umbilical hernia was documented by CT and sonography. The possible criteria for the gangrenous changes could be the maximal thickness of bowel more than 7mm, and infiltration in the mesentery/omentum

130

Small bowel obstruction in children: usefulness of CT for diagnosis and localization  

International Nuclear Information System (INIS)

To evaluate the usefulness of CT for the diagnosis of the cause and localization of small bowel obstruction. Out of a group of children who underwent a CT examination for a suspected small bowel obstruction, 19 patients with confirmed underlying disorders were identified and included in the study. Neonates and patients with duodenal obstruction were excluded from the study. The CT findings were analyzed for the location of obstruction site, abnormalities of the mesentery and mesenteric vessels, bowel wall thickening, closed loop obstruction, and strangulation. The obstruction site was divided into five parts. The preoperative CT diagnosis was compared with the final diagnosis. Causes of small bowel obstruction were intussusception (n = 6), appendiceal perforation (n = 4), transmesenteric internal hernia (n = 2), postoperative bands (n = 1), idiopathic multiple bands (n = 1), a foreign body (n = 1), a small bowel adenocarcinoma (n = 1), Meckel's diverticulitis (n = 1), tuberculous peritonitis (n = 1) and Salmonella enteritis with bowel perforation (n = 1). The CT findings showed mesenteric vascular prominence (n = 13), omental or mesenteric infiltration (n = 10), localized bowel wall thickening (n = 7) closed loops obstruction (n = 3) and strangulation (n = 1). The obstruction site was identified in all cases. The causes of obstruction could be diagnosed preoperatively in 14 cases, but a preoperative diagnosis was difficult in 5 cases. The causes of small bowel obstruc5 cases. The causes of small bowel obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction

131

Giant small bowel diverticulum presenting after percutaneous gastrostomy: case report  

Energy Technology Data Exchange (ETDEWEB)

The standard technique for percutaneous gastrostomy requires insufflation of air into the stomach via a nasogastric tube before percutaneous gastric puncture. We present a previously undescribed complication in which the insertion of a percutaneous gastrostomy tube resulted in the distention of a previously undiagnosed giant small bowel diverticulum. This led to discomfort for the patient, further radiologic investigation and a delay in discharge. Symptoms resolved with conservative management. We suggest a strategy for avoiding this complication, as well as for reducing the incidence of post-procedure ileus. (author)

Robinson, G.J.; Clark, J.A.; Pugash, R.A. [St. Michael' s Hospital, Wellesley Central Site, Dept. of Medical Imaging, Toronto, Ontario (Canada)

2000-10-01

132

Severe large and small bowel fibrosis clinically mimicking gross splenomegaly.  

Science.gov (United States)

The case of an 18-year-old female, with mild left hypochondrial pain and an abdominal mass mimicking gross splenomegaly, with severe small and large bowel fibrosis and adhesions and numerous mononuclear cellular infiltrate on histology, is presented. A clear picture of intestinal obstruction only unfolded terminally. She died within 48 hours of presentation. Our patient illustrates the fact that severe intestinal adhesions may present with very mild symptoms and signs and therefore a high index of suspicion is necessary, to reduce the attendant high mortality in intestinal obstruction in our environment. PMID:8347448

Olubodun, J O; Ikerionwu, S E; Kuti, J A; Jaiyesimi, A E; Talabi, O A; Adefuye, B O

1993-01-01

133

Delayed Presentation of Trichobezoar with Small Bowel Obstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Small bowel obstruction is a common surgical emergency but trichobezoar as an etiology, rarely reported. A seven year old school going female child presented with acute intestinal obstruction with a palpable and mobile mass in the abdomen. At exploration, a 10 cm long trichobezoar was found in the distal ileum which was removed through enterotomy. Postoperative course remained uneventful. Further probing revealed that child used to eat her own scalp hairs at the age of 2 years and the habit persisted for about 18 months which resulted in alopecia at that time. Later on she started showing normal behavior.

Soofia Ahmed

2011-03-01

134

Small bowel obstruction complicating colonoscopy: a case report  

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Full Text Available Abstract Introduction This report describes a rare complication of colonoscopy and reviews the literature with regard to other rare causes of acute abdominal presentations following colonoscopy. Case presentation After a therapeutic colonoscopy a 60-year-old woman developed an acute abdomen. At laparotomy she was discovered to have small bowel obstruction secondary to incarceration through a congenital band adhesion. Conclusion Although there is no practical way in which such rare complications can be predicted, this case report emphasises the wide array of pathologies that can result in acute abdominal symptoms following colonoscopy.

Hunter Iain A

2008-05-01

135

Small bowel adenocarcinoma mimicking a large adrenal tumor  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. Adenocarcinoma of the small bowel is a rare gastrointestinal neoplasm usually affecting the distal duodenum and proximal jejunum. Because of their rarity and poorly defined abdominal symptoms, a correct diagnosis is often delayed. Case Outline. We present a 43-year-old woman admitted at the Clinic for Endocrinology due to a large tumor (over 7 cm of the left adrenal gland. The tumor was detected by ultrasound and confirmed by CT scan. The patient complained of abdominal pain in the left upper quadrant, fatigue and septic fever. Normal urinary catecholamines excluded pheochromocytoma. The endocrine evaluations revealed laboratory signs of subclinical hypercorticism: midnight cortisol 235 nmol/L, post 1 mg - overnight Dexamethasone suppression test for cortisol 95.5 nmol/L and basal ACTH 4.2 pg/mL. Plasma rennin activity and aldosterone were within the normal range. Surgery was performed. Intraoperative findings showed signs of acute peritonitis and a small ulceration of the jejunum below at 70 cm on the anal side from the Treitz’s ligament. Adrenal glands were not enlarged. Patohistology and immunochemistry identified adenocarcinoma of the jejunum without infiltration of the lymphatic nodules. The extensive jejunal resection and lavage of the peritoneum were performed. Due to complications of massive peritonitis, the patient died seven days after surgery. Conclusion. Poorly defined symptoms and a low incidence make the diagnosis of small bowel carcinoma, particularly of the jejunal region, very difficult in spite of the new endoscopic techniques.

Ivovi? Miomira

2013-01-01

136

Intestinal anisakiasis as a rare cause of small bowel obstruction.  

Science.gov (United States)

Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. The patient underwent urgent laparotomy because strangulated small bowel obstruction was suspected. A localized portion of the intestine around jejunoileal junction was found to be erythematous, edematous, and hardened, which was resected. The resected specimen showed a linear whitish worm, Anisakis simplex, penetrating into the intestinal mucosa. It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish. PMID:23786678

Kojima, Gotaro; Usuki, Shinichiro; Mizokami, Ken; Tanabe, Marianne; Machi, Junji

2013-09-01

137

Small bowel volvulus in a primigravida woman: Case report  

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Full Text Available Volvulus of the small bowel, although being rare, carries a high risk of strangulation and ischemic necrosis. Preoperative diagnosis is difficult and may be complicated by pregnancy, labor and the post-cesarean-section state. Delay in diagnosis and surgical intervention increases morbidity and mortality rates.We present a 20- year- old primigravida woman (GA=10 weeks with massive intestinal necrosis. Her initial symptoms were abdominal pain and nausea. Her complaints were attributed to pregnancy and she came with acute surgical abdomen. Emergent laparotomy was performed. Gangrenous, distended loops of small intestine passed through a defect in the mesentery were resected. Primary end to end anastomosis of jejunum and ileum was done and the defect causing volvulus was repaired. It is concluded that surgical acute abdomen must be considered in differential diagnosis of abdominal discomfort in pregnancy. In the case of small bowel volvulus early surgery is mandatory to reduce the risk of gangrene, which is known as doubling the mortality rate.

Atossa Mahdavi

2007-05-01

138

Double-Balloon Enteroscopy to Remove a Strangulated Enteroclysis Catheter from the Small Bowel  

OpenAIRE

We present the case of a 77-year-old male who was referred for magnetic resonance (MR) enteroclysis because of small bowel subobstruction. To optimise small bowel distention during MR, a nasojejunal balloon catheter was placed to perfuse iso-osmotic water solution into the small bowel. However, after deflation of the balloon, the catheter could not be removed by gentle traction. Subsequently, computed tomography (CT) of the abdomen revealed that the catheter was strangulated deep in the jejun...

Moreels, Tom G.; Op Beeck, Bart; Pelckmans, Paul A.

2008-01-01

139

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

OpenAIRE

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 inspec...

Ghosh, Sc; Nolan, Gj; Simpson, Rr

2013-01-01

140

Protection from radiation-associated small bowel injury with the aid of an absorbable mesh  

Energy Technology Data Exchange (ETDEWEB)

Radiation associated small bowel injury results from aggressive treatment of pelvic malignancies with radiation therapy. The incidence increases when radiation therapy follows pelvic surgery due to adhesions that form between the small bowel and the operated site. Application of an absorbable polyglycolic acid mesh to keep the small bowel from descending into the pelvis and around the operated site prevents this complication. Use to date in humans and non-human primates has not been associated with any complications.

Devereux, D.F.

1986-01-01

141

Protection from radiation-associated small bowel injury with the aid of an absorbable mesh  

International Nuclear Information System (INIS)

Radiation associated small bowel injury results from aggressive treatment of pelvic malignancies with radiation therapy. The incidence increases when radiation therapy follows pelvic surgery due to adhesions that form between the small bowel and the operated site. Application of an absorbable polyglycolic acid mesh to keep the small bowel from descending into the pelvis and around the operated site prevents this complication. Use to date in humans and non-human primates has not been associated with any complications

142

Pyogenic granuloma: An unusual cause of massive gastrointestinal bleeding from the small bowel  

OpenAIRE

Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal...

Moffatt, Dana C.; Warwryko, Paul; Singh, Harminder

2009-01-01

143

Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report  

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Full Text Available Abstract Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.

Rauf Fozia

2011-09-01

144

Small-bowel carcinoid presenting with acute bleeding detected upon wireless capsule endoscopy  

International Nuclear Information System (INIS)

Background. Intestine carcinoid usually presents with clinical symptoms and signs deriving from its endocrinological influences and rarely bleeds profusely. Case report. We present a patient with intestinal bleeding of unknown origin. After conventional diagnostic procedures only wireless capsule endosopy was able to discover a tumour of small bowel, which was the reason of bleeding. On patohistological examination after the surgical resection it proved to be a small bowel carcinoid. Conclusions. There are indications that WCE, besides being the first small bowel imaging technique, is a very important diagnostic tool, deserving consideration in the early phases of diagnosing small-bowel disease, especially in less intensive or occult bleeding. (author)

145

Multislice computed tomography angiography findings of chronic small bowel volvulus with jejunal diverticulosis.  

Science.gov (United States)

A volvulus, which is torsion of the bowel and its mesentery, is a medical emergency. Small bowel volvulus rarely occurs in adults, although it has been reported in the presence of small bowel diverticulum. Multislice computed tomography (CT) angiography, by demonstrating the mesenteric vessels, can be of help in the diagnosis of small bowel volvulus, especially when CT or gastrointestinal studies fail to show the diverticulum. We present the multislice CT angiography findings of a 64-year-old woman with chronic intermittent volvulus resulting from jejunal diverticulosis, surgically confirmed. To our knowledge, no similar case has been reported previously in the literature. PMID:20661698

Li, Xiao-Bing; Guan, Wen-Xian; Gao, Yuan

2010-07-01

146

Small bowel obstruction in children: usefulness of CT for diagnosis and localization  

Energy Technology Data Exchange (ETDEWEB)

To evaluate the usefulness of CT for the diagnosis of the cause and localization of small bowel obstruction. Out of a group of children who underwent a CT examination for a suspected small bowel obstruction, 19 patients with confirmed underlying disorders were identified and included in the study. Neonates and patients with duodenal obstruction were excluded from the study. The CT findings were analyzed for the location of obstruction site, abnormalities of the mesentery and mesenteric vessels, bowel wall thickening, closed loop obstruction, and strangulation. The obstruction site was divided into five parts. The preoperative CT diagnosis was compared with the final diagnosis. Causes of small bowel obstruction were intussusception (n = 6), appendiceal perforation (n = 4), transmesenteric internal hernia (n = 2), postoperative bands (n = 1), idiopathic multiple bands (n = 1), a foreign body (n = 1), a small bowel adenocarcinoma (n = 1), Meckel's diverticulitis (n = 1), tuberculous peritonitis (n = 1) and Salmonella enteritis with bowel perforation (n = 1). The CT findings showed mesenteric vascular prominence (n = 13), omental or mesenteric infiltration (n = 10), localized bowel wall thickening (n = 7) closed loops obstruction (n = 3) and strangulation (n = 1). The obstruction site was identified in all cases. The causes of obstruction could be diagnosed preoperatively in 14 cases, but a preoperative diagnosis was difficult in 5 cases. The causes of small bowel obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction.

Lee, Young Cheol; Kim, Young Tong; Bae, Won Kyung; Kim, Il Young [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

2007-12-15

147

Utility of CT in the diagnosis and management of small-bowel obstruction in children  

International Nuclear Information System (INIS)

CT is often used in the diagnosis and management of small-bowel obstruction in children. To determine sensitivity of CT in delineating presence, site and cause of small-bowel obstruction in children. We retrospectively reviewed the CT scans of 47 children with surgically proven small-bowel obstruction. We noted any findings of obstruction and the site and cause of obstruction. Presence, absence or equivocal findings of bowel obstruction on abdominal radiographs performed prior to CT were also noted. We reviewed patient charts for clinical details and surgical findings, including bowel resection. Statistical analysis was performed using Fisher exact test to determine which CT findings might predict bowel resection. CT correctly diagnosed small-bowel obstruction in 43/47 (91.5%) cases. CT correctly indicated site of obstruction in 37/47 (78.7%) cases and cause of obstruction in 32/47 (68.1%) cases. Small-bowel feces sign was significantly associated with bowel resection at surgery (P = 0.0091). No other CT finding was predictive of bowel resection. Out of 41 children who had abdominal radiographs before CT, 29 (70.7%) showed unequivocal obstruction, six (14.6%) showed equivocal findings and six (14.6%) were unremarkable. CT is highly sensitive in diagnosing small-bowel obstruction in children and is helpful in determining the presence of small-bowel obstruction in many clinically suspected cases with equivocal or normal plain radiographs. CT also helps to determine the diographs. CT also helps to determine the site and cause of the obstruction with good sensitivity. (orig.)

148

Utility of CT in the diagnosis and management of small-bowel obstruction in children  

Energy Technology Data Exchange (ETDEWEB)

CT is often used in the diagnosis and management of small-bowel obstruction in children. To determine sensitivity of CT in delineating presence, site and cause of small-bowel obstruction in children. We retrospectively reviewed the CT scans of 47 children with surgically proven small-bowel obstruction. We noted any findings of obstruction and the site and cause of obstruction. Presence, absence or equivocal findings of bowel obstruction on abdominal radiographs performed prior to CT were also noted. We reviewed patient charts for clinical details and surgical findings, including bowel resection. Statistical analysis was performed using Fisher exact test to determine which CT findings might predict bowel resection. CT correctly diagnosed small-bowel obstruction in 43/47 (91.5%) cases. CT correctly indicated site of obstruction in 37/47 (78.7%) cases and cause of obstruction in 32/47 (68.1%) cases. Small-bowel feces sign was significantly associated with bowel resection at surgery (P = 0.0091). No other CT finding was predictive of bowel resection. Out of 41 children who had abdominal radiographs before CT, 29 (70.7%) showed unequivocal obstruction, six (14.6%) showed equivocal findings and six (14.6%) were unremarkable. CT is highly sensitive in diagnosing small-bowel obstruction in children and is helpful in determining the presence of small-bowel obstruction in many clinically suspected cases with equivocal or normal plain radiographs. CT also helps to determine the site and cause of the obstruction with good sensitivity. (orig.)

Wang, Qiuyan; Chavhan, Govind B. [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto (Canada); Babyn, Paul S. [Royal University Hospital, Department of Medical Imaging, Saskatoon (Canada); Tomlinson, George [Toronto General Hospital, University of Toronto, Department of Public Health Sciences, Toronto (Canada); Langer, Jacob C. [The Hospital for Sick Children and University of Toronto, Division of General and Thoracic Surgery, Toronto (Canada)

2012-12-15

149

Inter-observer agreement for detection of small bowel Crohn's disease with capsule endoscopy  

DEFF Research Database (Denmark)

OBJECTIVE: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. MATERIAL AND METHODS: Thirty patients with suspected or known CD were included in the study. Observers were blind to patient histories, the results of ileo-colonoscopies, and small bowel examinations. More than three ulcerations (aphthous lesions or ulcers) or the presence of stenosis caused by inflammation or fibrosis was diagnostic of small bowel CD. Three observers with experience in gastrointestinal endoscopy and CE participated in the study. RESULTS: The presence or absence of small bowel CD was determined with complete agreement in 23 patients, nine patients with and 14 without small bowel CD. The inter-observer agreement was substantial for the diagnosis (kappa = 0.68) and moderate for the localization of CD (kappa = 0.44). Aphthous lesions were detected with only fair agreement (kappa = 0.38). The time intervals to passage of the pylorus and ileo-caecal valve were detected with excellent intra-class correlation. CONCLUSIONS: CE is performed with substantial inter-observer agreement for detection of small bowel CD. In the majority of patients, the presence or absence of small bowel CD is unequivocal. However, in patients with few or minor lesions, the diagnosis is observer dependent.

Jensen, Michael Dam; Nathan, Torben

2010-01-01

150

Small bowel MRI imaging in the DGH — Are you doing it yet?  

International Nuclear Information System (INIS)

The aim of this article is to illustrate the spectrum of disease visualized at small bowel magnetic resonance imaging (MRI) in the district general hospital (DGH) setting. The advantages and disadvantages of small bowel MRI, technique, and service implementation are discussed.

151

Barium impaction as a cause of small bowel obstruction in an infant with cystic fibrosis  

International Nuclear Information System (INIS)

Small bowel obstruction in children with cystic fibrosis due to the impaction of barium is an unusual occurrence. This is the report of an 8.5-month-old black male who had an upper GI series on the day of discharge from the hospital, and returned the next day with a distal small bowel obstruction due to a barium impaction. (orig.)

152

The clinical value of MRI in the diagnosis of small-bowel diseases  

International Nuclear Information System (INIS)

Objective: To evaluate the feasibility and the clinical value of MRI in the diagnosis of small-bowel disease. Methods: Sixty-three patients with suspected small-bowel diseases and 3 volunteers without signs of small bowel disease underwent MRI examination. Thirty-one patients whose diagnoses were confirmed by pathology or clinical results were categorized into two groups (neoplastic and nonneoplastic). The conspicuity of bowel wall, the sensitivity of MRI in detecting small-bowel lesions, and the accuracy rate of diagnosis were calculated. The average bowel wall thickness between the two groups was assessed by using Wilcoxon signed-rank test. Enlarged mesenteric lymph nodes, mesenteric infiltration, and small-bowel stenosis were analyzed by using Fisher's exact test in each group respectively. Results: MRI examinations of all 66 subjects were successfully performed. Images were rated on a continuous 4-point scale. Sixty-two cases (93.9%) were scored as 2 or 3. The diagnoses of 31 patients (neoplastic group (n=10) and nonneoplastic group (n=21) were confirmed by pathology or clinical results. The sensitivity, accuracy of MRI in identifying small bowel diseases were 100% (31/31) and 77.4% (24/31) respectively. The average bowel wall thickness of the two groups was 23 mm (7.0-65.0 mm) and 5 mm(2.0-35.0 mm) respectively, and there was a statistically significant difference between the two groups (Z=-2.949, P0.05). Conclusion: MRI can depict the location and extension of the small-bowel disease accurately and it is an effective method in the diagnosis of small-bowel disease. (authors)

153

Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction  

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Full Text Available Abstract Background Carcinoma of the colon may present with perforation proximal to the site of malignancy. Caecum is the commonest site of perforation if the ileocecal valve is patent and the jejunal and ileal perforations are very rare. Case presentation A 35 year male presented with intestinal obstruction. Emergency laparotomy revealed carcinoma of the transverse colon with multiple pinpoint perforations along antimesenteric border of ileum, which were wrapped with omentum, and no peritoneal contamination was present. Extended right hemicolectomy with jejunocolic anastomosis was done. Patient made uneventful recovery in postoperative period and was treated with adjuvant chemotherapy. Conclusion Patients with colonic carcinoma and incompetent ileocecal valve may present with intestinal perforation. Increased intraluminal pressure and closed loop obstruction may lead to ischemia and perforation of the small bowel.

Khanna Rahul

2006-09-01

154

Telemetry system for slow wave measurement from the small bowel.  

Science.gov (United States)

A telemetry capsule system was designed and implemented to measure the slow wave activity of the small bowel, which is an important parameter for the diagnosis of gastric diseases. The capsule amplified the slow wave signal from the intraluminal electrodes, and transmitted the digitally sampled data by means of a radio frequency transmitter. The implemented capsule (11 x 21 mm(2)) was smaller than a commercially available capsule endoscope, and it can remain active for more than 18 h. The feasibility of using this capsule was investigated by conducting in vitro experiments, and the average motility signals of the ileum, jejunum, and colon were measured as 6.1, 10.2, and 1.5 cycles per minute, respectively. PMID:20039141

Woo, S H; Cho, J H

2010-03-01

155

Alveolar Soft Part Sarcoma Metastatic to Small Bowel Mucosa Causing Polyposis and Intussuseption  

Science.gov (United States)

A report of alveolar soft part sarcoma metastatic to the small bowel is presented. Hematogenous metastases to the small bowel from primary tumors outside the abdominal cavity are uncommon, and most remain asymptomatic and are not discovered until autopsy. However, small bowel metastases can lead to intestinal obstruction, intussuseption or even perforation. While metastases to the small bowel have been described for other tumor types, including melanoma and lung cancer, this is extremely uncommon for sarcoma, especially alveolar soft part sarcoma. We describe a 42-year-old male with a long history of alveolar soft part sarcoma, metastatic to the lung and brain, who developed an intussuseption from metastases to the small bowel. PMID:18521439

Sabel, Michael S.; Litwin, Allan; Mcgrath, Brian; Kraybill, William B.; Brooks, John J.

2001-01-01

156

An unusual cause of small bowel obstruction: Gossypiboma – case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The term "gossypiboma" denotes a mass of cotton that is retained in the body following surgery. Gossypiboma is a medico-legal problem especially for surgeons. To the best of our knowledge, the patient presented herein is the second reported patient in whom the exact site of migration of a retained surgical textile material into the intestinal lumen could be demonstrated by preoperative imaging studies. Case presentation A 74-year-old woman presented with symptoms of small bowel obstruction due to incomplete intraluminal migration of a laparotomy towel 3 years after open cholecystectomy and umbilical hernia repair. Plain abdominal radiography did not show any sign of a radio-opaque marker in the abdomen. However, contrast enhanced abdominal computerized tomography revealed a round, well-defined soft-tissue mass with a dense, enhanced wall, containing an internal high-density area with air-bubbles in the mid-abdomen. A fistula between the abscess cavity containing the suspicious mass and gastrointestinal tract was identified by upper gastrointestinal series. The presence of a foreign body was considered. It was surgically removed with a partial small bowel resection followed by anastomosis. Conclusions Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of acute mechanical intestinal obstruction in patients who underwent laparotomy previously. The best approach in the prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio-opaque marker.

Inceoglu Resit

2003-09-01

157

Usefulness of helical CT in the diagnosis of strangulation in small bowel obstruction  

Energy Technology Data Exchange (ETDEWEB)

We wished to evaluate the usefulness of helical CT for the diagnosis of strangulation of the dilated small bowels. The CT scans of 31 patients with small bowel obstruction from various causes were reviewed retrospectively. Thirteen of these patients were confirmed as small bowel strangulation by surgery and pathology. Fourteen patients underwent surgery, but they had no strangulation. Three patients were reduced by using a nasogastric tube and one infant with intussusception was reduced by air reduction. The following CT findings of strangulation were evaluated: reduced bowel wall enhancement by visual assessment and measuring the HU, ascites, thickening of bowel wall, abnormal mesenteric vessel location and whirlpool appearance, and mesenteric venous engorgement. For the precise evaluation of reduced bowel wall enhancement, the HUs were measured by 1 mm{sup 2} of ROI, and the differences of HUs between the well enhanced bowel and poorly enhanced bowel were compared. For the diagnosis of strangulation, measurement of HU of the bowel wall could improve the sensitivity from 69% to 100%. The specificity of both methods, by visual assessment and measurement of HU, was 94%. Ascites had a sensitivity of 69% and specificity of 44%. Thickening of bowel wall had a sensitivity of 38% and specificity of 78%. Abnormal mesenteric vessel location and whirlpool appearance had a sensitivity of 38% and specificity of 83%. Mesenteric venous engorgement had a sensitivity of 31% and specificity of 72%. Measurement of HU of the bowe wall after contrast enhancement can be a useful method in the differential diagnosis between the strangulated and non-strangulated bowels in patients with small bowel obstruction.

Kang, Young Hye; Kim, Won Hong; Jeon, Yong Sun; Shin, Dong Jae; Cho, Soon Gu; Lee, Chang Keun; Choi, Sun Keun [College of Medicine, Inha Univ., Incheon (Korea, Republic of)

2004-12-01

158

Usefulness of helical CT in the diagnosis of strangulation in small bowel obstruction  

International Nuclear Information System (INIS)

We wished to evaluate the usefulness of helical CT for the diagnosis of strangulation of the dilated small bowels. The CT scans of 31 patients with small bowel obstruction from various causes were reviewed retrospectively. Thirteen of these patients were confirmed as small bowel strangulation by surgery and pathology. Fourteen patients underwent surgery, but they had no strangulation. Three patients were reduced by using a nasogastric tube and one infant with intussusception was reduced by air reduction. The following CT findings of strangulation were evaluated: reduced bowel wall enhancement by visual assessment and measuring the HU, ascites, thickening of bowel wall, abnormal mesenteric vessel location and whirlpool appearance, and mesenteric venous engorgement. For the precise evaluation of reduced bowel wall enhancement, the HUs were measured by 1 mm2 of ROI, and the differences of HUs between the well enhanced bowel and poorly enhanced bowel were compared. For the diagnosis of strangulation, measurement of HU of the bowel wall could improve the sensitivity from 69% to 100%. The specificity of both methods, by visual assessment and measurement of HU, was 94%. Ascites had a sensitivity of 69% and specificity of 44%. Thickening of bowel wall had a sensitivity of 38% and specificity of 78%. Abnormal mesenteric vessel location and whirlpool appearance had a sensitivity of 38% and specificity of 83%. Mesenteric venous engorgement had a sensitivity of 31% ands engorgement had a sensitivity of 31% and specificity of 72%. Measurement of HU of the bowe wall after contrast enhancement can be a useful method in the differential diagnosis between the strangulated and non-strangulated bowels in patients with small bowel obstruction

159

Scintigraphic diagnosis of inflammatory small bowel stenoses in Crohn's disease using 111In-labelled leucocytes  

International Nuclear Information System (INIS)

17 patients with known small bowel involvement in Crohn's disease (clinically active, n=14; clinically inactive, n=3) were examined within 8 days via barium enemas of the small bowel (Pansdorf's method or enteroclysma) and by 111In-oxin labelled leucocytes. From 19 radiologically diagnosed small bowel stenoses 14 were classified as inflammatory and 5 as non-inflammatory. The leucocyte scan also showed 14 inflammatory stenoses. The not inflamed stenoses could not be diagnosed scintigraphically. The barium enemas of the small bowel and the leukocyte scans both correctly diagnosed the acute inflamed segments. The inability to show non-inflamed segments (n=5) and to localise small bowel stenoses exactly is disadvantageous in the scan. The advantage of the leucocyte scan is a non invasive examination without specific bowel preparation and the possibility to diagnose additionally inflamed large bowel segments (n=4), fistulas and abscesses (n=2). The leucocyte scan offers a useful expansion of the diagnostic tools in small bowel diseases, especially in radiological problems in patients with Crohn's disease. (orig.)

160

Sclerosing mesenteritis presenting with small bowel obstruction and subsequent retroperitoneal fibrosis.  

Science.gov (United States)

Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery of unknown aetiology. It poses a diagnostic challenge for clinicians, as it can be mistaken for malignancy. We report a case of sclerosing mesenteritis initially presented with abdominal pain, tender abdominal mass and small bowel obstruction. Emergency laparotomy revealed fibrous thickening of the small bowel mesentery mimicking small bowel lymphoma. An ileo-ileal bypass procedure was performed. Six months later, the patient developed retroperitoneal fibrosis, manifesting as bilateral obstructive uropathy. Our case is unique, as it describes retroperitoneal fibrosis developing in a patient with small bowel retractile mesenteritis, with no evidence of colonic or other anatomical involvement. Furthermore, the patient had no risk factors for this condition. We conclude that the presence of sclerosing mesenteritis should cue clinicians to search for other coexisting inflammatory disorders that can have serious sequelae. PMID:17099377

Lim, Chung S; Singh Ranger, Gurpreet; Tibrewal, Saket; Jani, Bhautesh; Jeddy, Taleb A; Lafferty, Kevin

2006-12-01

161

Small bowel sparing effect of small bowel displacement system in 3D-CRT and IMRT for cervix cancer  

Energy Technology Data Exchange (ETDEWEB)

In radiotherapy for cervix cancer, both 3-dimensional radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. Ten consecutive uterine cervix cancer, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and prescribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using paired t-tests. The SBDS significantly reduced the mean SB volume from 522 to 262 cm{sup 3} (49.8% reduction). The SB volumes that received a dose of 10 {approx} 50 Gy were significantly reduced in 3D-CRT (65 {approx} 80% reduction) and IMRT plans (54 {approx} 67% reduction) using the SBDS. When the SB volumes that received 20 {approx} 50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6{approx} 7%, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1% when using the SBDS. The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.

Kang, Min Kyu; Huh, Seung Jae; Han, Young Yih [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)] (and others)

2004-06-15

162

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

International Nuclear Information System (INIS)

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 standards maximal bowel displacement from standard pelvic radiotherapy fields

163

Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters. Report of two cases.  

Science.gov (United States)

Knotting of a peritoneal catheter around a loop of bowel is a rare occurrence, which may lead to bowel obstruction. The incomplete removal of two ventriculoperitoneal shunts resulted in two cases of iatrogenically knotted peritoneal catheters. One patient underwent a laparotomy for relief of obstruction and the other was successfully treated by uncoiling the catheter by means of a wire passed into its lumen. A plan for management of a knotted peritoneal catheter is outlined. PMID:7760179

Sanan, A; Haines, S J; Nyberg, S L; Leonard, A S

1995-06-01

164

Intestinal gangrene due to small bowel volvulus masquerading as strangulated inguinal hernia – A diagnostic dilemma.  

Directory of Open Access Journals (Sweden)

Full Text Available Complicated inguinal hernia is a common surgical emergency. Rarely, hernias may pose a great surprise and complexity in their management.We report a 55 year old gentleman witha long standing history of irreducible right inguinal hernia who presented in shock with sudden increase in size of scrotum and obstipation for 1 day.A diagnosis of strangulated inguinal hernia was made and the patient was taken up for emergency surgery.On exploration the content in the sac was normal small bowel and faeculant smelling fluid. Abdomen was explored for inspecting the proximal bowel and to facilitate reduction of contents.But as a surprise small bowel volvuluswith gangrenous bowel was noted. Resection and anastomosis was done.This paper stresses the importance of having a high index of suspicion in all cases of strangulated hernia of a concomitant small bowel volvulus as its recognition and early surgical intervention is paramount in reducing the mortality associated with it.

Janhavi V

2013-07-01

165

Uterine Perforation With Subtotal Small Bowel Prolapse – A Rare Complication of Dilatation and Curettage  

Directory of Open Access Journals (Sweden)

Full Text Available Uterine perforation is the well known complication of induced abortion. We report a rare case of uterine perforation with subtotal prolapse of small bowel following first trimester abortion by an unqualified physician. Early surgical exploration with resection and anastomosis of bowel performed. Patient discharged uneventfully after postoperative recovery.

Jagannath Mala Sherigar

2005-05-01

166

Sclerosing mesenteritis presenting with complete small bowel obstruction, abdominal mass and hydronephrosis.  

Science.gov (United States)

Sclerosing mesenteritis is an uncommon and poorly understood inflammatory condition of the bowel mesentery which can often be confused with neoplasia, Crohn's disease and other inflammatory conditions. We describe a case of complete small bowel obstruction and right sided hydronephrosis due to sclerosing mesenteritis. PMID:20506043

Hassan, T; Balsitis, M; Rawlings, D; Shah, A A

2012-09-01

167

Goblet Cell Carcinoid Tumor of the Appendix with Small Bowel Obstruction: A Case Report  

International Nuclear Information System (INIS)

Goblet cell carcinoid tumor of the appendix (GCTA) is a tumor with histological features of both adenocarcinoma and carcinoid tumors. The most common clinical presentation of GCTA is acute appendicitis, although small bowel obstruction has been reported as a rare clinical symptom of GCTA. However, to the best of our knowledge, the CT feature of small bowel obstructions in patients with GCTA has not been reported to date. Here, we present a case of small bowel obstruction in a patient with GCTA caused by extensive tumor infiltration at the terminal ileum and distal ileum

168

Small bowel volvulus in children. Its appearance on the barium enema examination  

Energy Technology Data Exchange (ETDEWEB)

Two children with small bowel volvulus diagnosed on barium enema examination are reported. In one patient the volvulus was associated with malrotation and in the other patient there was a post-operative peritoneal adhesion. In both cases the diagnosis was based on beaking of the head of the barium column at the site of volvulus. Radiographic demonstration of a beak sign in the small bowel on barium enema examination should suggest a diagnosis of small bowel volvulus, and indicates the need for immediate surgery.

Siegel, M.J.; Shackelford, G.D.; McAlister, W.H.

1980-01-01

169

Idiopathic Superior Mesenteric Vein Thrombosis Resulting in Small Bowel Ischemia in a Pregnant Woman  

OpenAIRE

Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was pe...

Hao Lin; Wan-Ting Huang; Chih-Che Lin

2011-01-01

170

Adenocarcinoma of the small bowel in a patient with occlusive Crohn’s disease  

Directory of Open Access Journals (Sweden)

Full Text Available A 40-year-old male, diagnosed with mild Crohn’s disease (CD 11 years ago but with no prior abdominal surgeries, was diagnosed with a small bowel stricture, due to ongoing abdominal pain and intolerance of enteral diet, and referred for surgical treatment. Exploratory laparoscopy revealed a white solid mass causing a near total jejunal obstruction with significant proximal dilatation. An adjacent small node was sampled for frozen biopsy, revealing a lymph node infiltrated with adenocarcinoma. Laparoscopic assisted small bowel resection and appendectomy were carried out. Final pathological results supported the initial report of diffuse small bowel adenocarcinoma. In conclusion, once a small bowel stricture associated with CD is suspected, rapid action should be considered to avoid late diagnosis of a neoplasia.

Lior Drukker

2012-01-01

171

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

Science.gov (United States)

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

Desteli, Güldeniz Aksan; Gürsu, Tvrkan; Bircan, Hüseyin Yüce; K?z?lk?l?ç, Ebru; Demiralay, Ebru; Timurkaynak, Funda

2013-12-01

172

Recurrent small bowel obstruction in a 60-year-old celiac patient: a rare entity of a common disease.  

Science.gov (United States)

A 60-year-old woman with a medical history of celiac disease was evaluated due to recurrent episodes of small bowel obstruction. Upper and lower endoscopies were normal. The small bowel pathology consisted of celiac disease, and the anti-endomysial antibody was positive. Dilatation of small bowel loops was demonstrated on abdominal computed tomography. Further evaluation was conducted using video capsule endoscopy that demonstrated regional narrowing and severe ulceration in the middle of the small bowel. Upper and lower double balloon endoscopies failed to demonstrate the lesion. On explorative laparotomy a small bowel mass in the proximal ileum was excised. Pathology revealed ulcerated, well to moderately differentiated adenocarcinoma without regional nodal involvement. We discuss the etiology and treatment of small bowel carcinoma. This case emphasizes that a high level of suspicion is required in order to diagnose early stage small bowel adenocarcinoma in celiac patients. PMID:24733274

Har-Noy, Ofir; Amitai, Michal; Carter, Dan

2014-01-01

173

Ultrasound in Crohn's disease of the small bowel  

International Nuclear Information System (INIS)

Objective: The purpose of this work is to prospectively evaluate high resolution ultrasonography with graded compression in the ability to detect Crohn's disease of the small bowel (CDSB) together with its complications and activity signs, compared with enteroclysis, CT and immunoscintigraphy in the mirror of the final diagnosis. Methods and material: In a series of 73 consecutive patients, who were referred for enteroclysis with suspected Crohn's disease of the small bowel computed tomography (CT), ultrasound (US), immunoscintigraphy with 99mTc labeled monoclonal antigranulocyte antibody (AGAb) examinations were performed within 10 days from each other. For the final evaluation the diagnosis of CDSB was based on combination of clinical and enteroclysis findings (73 cases) and in 17 cases additional surgical and pathological data were available. The results of other modalities were blinded to the radiologists performing and reading out the exams. The diagnostic values of each modality was assessed also in those 18 patients, who had early Crohn's disease. In the group of 43 patients with proven CDSB who had all the four imaging modalities, the modalities were compared in their ability to demonstrate various pathological conditions related to CD. Increased (>500 ml/min) flow measured by Doppler US in the superior mesenteric artery and increased color signs in the gut wall seen by power Doppler sonography were compared to CDAI. Results: Of the 73 patients the to CDAI. Results: Of the 73 patients the combination of enteroclysis and clinical tests demonstrated CDSB in 47. The sensitivity, specificity and accuracy of ultrasound were 88.4, 93.3 and 90.4%, respectively. Enteroclysis was the most accurate method. CT was more sensitive than US, but less specific. The accuracy of US, CT and scintigraphy were similar. In the group of 18 patients, who had early CDSB, the sensitivity of US decreased to only 67%, CT and scintigraphy had higher values. Intra- and perimural abscesses, and sinus tracts were also more frequently visualized by US, especially if they were small. US was superior than CT in detecting stenoses and skip lesions, but inferior to enteroclysis. US and CT detected more fistulas, than enteroclysis. Compared to CT, US detected more cases with mesenteric lymphadenopathy, equal cases with abscesses and free peritoneal fluids. In detecting mesenteric inflammatory proliferation CT, and in detecting colonic involvement CT and immunoscintigraphy were slightly superior than graded compression US. Patterns of mural stratification detected by ultrasound correlated well with the enteroclysis severity stages. There was only 59% agreement between increased superior mesenteric artery flow detected by Doppler sonography and CDAI, and 60.5% agreement between increased number of Color pixels in the gut wall measured by power Doppler and increased CDAI. Conclusion: High resolution graded compression sonography is a valuable tool for detecting small intestinal Crohn's disease. It has similar diagnostic values as CT. However in early disease the sensitivity substantially decreases. In known Crohn's disease for following disease course, evaluating relapses and extramural manifestations US is an excellent tool. Doppler and Power Doppler activity measurements do not correlate well with the more widespread clinical activity index

174

Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity  

Energy Technology Data Exchange (ETDEWEB)

Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. Included in the study were 37 children (22 girls and 15 boys; age range 7-15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and {tau}2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children. (orig.)

Alexopoulou, Efthymia; Loggitsi, Dimitra; Economopoulos, Nikos; Papakonstantinou, Olympia; Kelekis, Nikolaos L. [National and Kapodistrian University of Athens, General University Hospital, Second Department of Radiology, Athens (Greece); Roma, Eleftheria; Panagiotou, Ioanna; Pahoula, Ioanna [National and Kapodistrian University of Athens, Aghia Sofia Children' s Hospital, First Department of Paediatrics, Athens (Greece)

2009-08-15

175

Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity  

International Nuclear Information System (INIS)

Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. Included in the study were 37 children (22 girls and 15 boys; age range 7-15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and ?2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children. (orig.)

176

Thinking beyond the colon-small bowel Involvement in clostridium difficile infection  

OpenAIRE

Abstract Small intestinal Clostridium difficile seems to be increasing in incidence. The spectrum of Clostridium difficile infection (CDI) has definitely expanded with small bowel involvement. They are more frequently reported in patients with inflammatory bowel disease (IBD) who have undergone total colectomy or patients with Ileal anal pouch anastomosis. The most common presentation is increased ileostomy output with associated dehydration. High clinical suspicion, early recognition and app...

Navaneethan Udayakumar; Giannella Ralph A

2009-01-01

177

High sensitivity of quick view capsule endoscopy for detection of small bowel Crohn's disease  

DEFF Research Database (Denmark)

Capsule endoscopy (CE) has a high sensitivity for diagnosing small bowel Crohn's disease, but video analysis is time consuming. The quick view (qv) function is an effective tool to reduce time consumption. The aim of this study was to determine the rate of missed small bowel ulcerations with qv-CE compared to standard view and the diagnostic accuracy of qv-CE in suspected Crohn's disease.

Halling, Morten Lee; Nathan, Torben

2014-01-01

178

Small bowel perforation due to CMV enteritis infection in an HIV-positive patient  

OpenAIRE

Abstract Background Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS). Although small bowel infection is less common than infection of other parts of the gastrointestinal system, it may lead to perforation, an acute complication, with dreadful results. Case presentation This article reports a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunode...

Michalopoulos Nick; Triantafillopoulou Konstantina; Beretouli Eleni; Laskou Styliani; Papavramidis Theodossis S; Pliakos Ioannis; Hytiroglou Prodromos; Papavramidis Spiros T

2013-01-01

179

Small bowel angioedema induced by angiotensin converting enzyme (ACE) inhibitor: US and CT findings.  

Science.gov (United States)

Small bowel angioedema induced by angiotensin converting enzyme (ACE) inhibitors is a rare and often-unrecog- nized condition that presents with transient abdominal pain, nausea and vomiting. We report a case diagnosed in a 36 year-old female. Ultrasound and CT showed segmental small bowel wall thickening and straightening associated with marked submucosal edema and ascites. Laboratory tests only revealed mild leukocytosis. The patient improved spontaneously. PMID:25603633

Coelho, M L; Amaral, R; Curvo-Semedo, L; Caseiro-Alves, F

2014-01-01

180

Small Bowel Adenocarcinoma – Report of Two Cases and Review of Literature  

OpenAIRE

Although accounting for 90 % of the intestinal surface area, small bowel adenocarcinomas are not common. The majority of these lesions are incidentally detected during laparotomy for intestinal obstruction or perforation. The symptoms associated with these lesions are not very specific and preoperative diagnosis is rare. We report two cases of jejunal adenocarcinomas detected in patients undergoing laparotomy for acute abdomen and review the literature for small bowel adenocarcinomas.

Umman, Philip; Adiyodi, Vineeth; Narayan, Chanchal

2012-01-01

181

Characterization of a new small bowel adenocarcinoma cell line and screening of anti-cancer drug against small bowel adenocarcinoma.  

Science.gov (United States)

Small bowel adenocarcinoma (SBA) is a rare, aggressive malignancy with a poor prognosis, and the mechanisms of carcinogenesis in SBA remain unclear. Our aims were to investigate the molecular mechanisms underlying SBA and to identify treatments by establishing and characterizing an SBA cell line and performing anti-cancer drug screening. SIAC1 cells, established from jejunal SBA, showed epithelial characteristics and formed organoids in 3D culture. SIAC1 cells had a heterozygous ?-catenin deletion mutation, resulting in a stable ?-catenin protein with enhanced Wnt/?-catenin activity. SIAC1 cells lacked MLH1 and MSH6 expression, and target genes such as TGFBR2 and ACVR2 showed frameshift mutations. Among 10 clinical SBA samples, 2 (20%) had interstitial deletions in ?-catenin, expression of mismatch repair protein was aberrant in 4 (40%), and heterozygous frameshift mutations of three target genes were found in all 10 samples. On screening assay using 140 compounds, eribulin significantly inhibited SIAC1 cell growth both in vitro and in vivo by inhibition of the Wnt/?-catenin pathway via enhanced degradation of ?-catenin. In conclusion, we established an SBA cell line with molecular characteristics similar to those of clinical SBA samples, including ?-catenin deletion and mismatch repair protein deficiency, that will be useful for SBA research. Eribulin might be a candidate for SBA treatment due to its inhibitory effect on Wnt/?-catenin signaling. PMID:25478808

Suzuki, Hirobumi; Hirata, Yoshihiro; Suzuki, Nobumi; Ihara, Sozaburo; Sakitani, Kosuke; Kobayashi, Yuka; Kinoshita, Hiroto; Hayakawa, Yoku; Yamada, Atsuo; Watabe, Hirotsugu; Tateishi, Keisuke; Ikenoue, Tsuneo; Yamaji, Yutaka; Koike, Kazuhiko

2015-02-01

182

Developing a new measure of small bowel peristalsis with dynamic MR: a proof of concept study  

International Nuclear Information System (INIS)

Background. Small bowel peristalsis is a complex of many individual motion elements. Although each element of peristalsis can be measured there is no current global measure of peristalsis. Purpose. To examine the feasibility of automated computerized assessment of global small bowel motility using simple computational methods. Material and Methods. Coronal dynamic MR images were obtained from five healthy volunteers who had fasted for 9 h and drunk 1.5 L of water. Images were taken using single breath-hold and ECG triggering. Acquisitions were repeated at 10 and 20 min after an intramuscular injection of hyoscine butylbromide. Parametric maps were generated representing the mean change in signal amplitude (MSA) per voxel for each dynamic acquisition. Two observers independently assessed thresholding for optimal segmentation of small bowel from other sources of signal. Total voxel activity (TVA) for each study was calculated as a sum of MSA per slice and whole examination and TVA profiles were generated. Results. Independent observations suggest that the automated segmentation method described usefully segments small bowel activity from other signal. Small bowel movement represented as TVA varied three-fold in the five volunteers and was inhibited by anti-muscarinic injection. Conclusion. It is possible to develop a new measure, based on automated segmentation of mean signal amplitude changes, of small bowel peristalsis using dynamic MRynamic MR

183

Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery  

International Nuclear Information System (INIS)

To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO). Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2. Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018). In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. (orig.)

184

Non-emergency small bowel obstruction: assessment of CT findings that predict need for surgery  

Energy Technology Data Exchange (ETDEWEB)

To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO). Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2. Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018). In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. (orig.)

Deshmukh, Swati D.; Shin, David S.; Willmann, Juergen K.; Rosenberg, Jarrett; Shin, Lewis; Jeffrey, R.B. [Stanford University, School of Medicine, Department of Radiology, Stanford, CA (United States)

2011-05-15

185

Developing a new measure of small bowel peristalsis with dynamic MR: a proof of concept study  

Energy Technology Data Exchange (ETDEWEB)

Background. Small bowel peristalsis is a complex of many individual motion elements. Although each element of peristalsis can be measured there is no current global measure of peristalsis. Purpose. To examine the feasibility of automated computerized assessment of global small bowel motility using simple computational methods. Material and Methods. Coronal dynamic MR images were obtained from five healthy volunteers who had fasted for 9 h and drunk 1.5 L of water. Images were taken using single breath-hold and ECG triggering. Acquisitions were repeated at 10 and 20 min after an intramuscular injection of hyoscine butylbromide. Parametric maps were generated representing the mean change in signal amplitude (MSA) per voxel for each dynamic acquisition. Two observers independently assessed thresholding for optimal segmentation of small bowel from other sources of signal. Total voxel activity (TVA) for each study was calculated as a sum of MSA per slice and whole examination and TVA profiles were generated. Results. Independent observations suggest that the automated segmentation method described usefully segments small bowel activity from other signal. Small bowel movement represented as TVA varied three-fold in the five volunteers and was inhibited by anti-muscarinic injection. Conclusion. It is possible to develop a new measure, based on automated segmentation of mean signal amplitude changes, of small bowel peristalsis using dynamic MR.

Farghal, Aser; Kasmai, Bahman; Malcolm, Paul N.; Toms, Andoni P. [Dept. of Radiology, Norfolk and Norwich Univ. Hospital NHS Trust, Norwich (United Kingdom)], E-mail: andoni.toms@nnuh.nhs.uk; Graves, Martin J. [Univ. Dept. of Radiology, Addenbrooke' s Hospital, Cambridge (United Kingdom)

2012-07-15

186

CT diagnosis of traumatic small bowel perforation without pneumoperitoneum or oral contrast leak  

Energy Technology Data Exchange (ETDEWEB)

To determine the most helpful abdominal CT findings in patients with small bowel perforation without pneumoperitoneum or oral contrast leakage after blunt trauma. We retrospectively analyzed the abdominal CT findings of 51 patients with small bowel perforation without pneumoperitoneum or oral contrast leakage. A score of 2 was assigned if bowel wall thickening of more than 5 mm or enhancement of the bowel wall was definite, and 1 if equivocal thickenting or enhancement of the bowel wall, mesenteric infiltration, sentinel clotting, intermesenteric fluid, or ileus were observed. According to the score, each finding was classified as strongly positive(5-8), possibly positive(3-4), or probably negative(1-2), and the accuracy of each classification was evaluated. We decided which findings would be most helpful when attempting to diagnose small bowel perforation. Forty one bowel perforations and four mesenteric injuries were identified in 45 laparatomies among 51 patients. In all 20 patents with a score of more than 5, small bowel perforation was found on surgery. The prevalence rate of bowel wall thickening and enhancement was significantly different between patients with perforation(88%, 80% respectively) and those without (20%, 40% respectively)(p<0.05). The sensitivity, specificity and accuracy of each criterion were compared (sum of scoring of all CT findings{>=}3D3:82.9% {center_dot} 40% {center_dot} 74.5%;scoring of bowel wall thickening and enhancement {>=}3D 2:82.9% {center_dot} 80% {center_dot} 82.4%), and it was found that for specificity and accuracy, the latter was superior to the former. ROC analysis using the scores of each criterion as cut-off value also showed that the curve of the latter showed a more marked upward trend and was the most helpful parameter. When diagnosing small bowel perforation in the absence of pneumoperitonemum or oral contrast leakage after blunt abdominal trauma, bowel wall thickening and enhancement were more helpful parameters than the sum of all CT findings.=20.

Lee, Jin Hee; Kim, Hong; Kim, Jung Sik [Keimyung Univ. Dongsan Medical Center, Taegu (Korea, Republic of)

1998-10-01

187

CT diagnosis of traumatic small bowel perforation without pneumoperitoneum or oral contrast leak  

International Nuclear Information System (INIS)

To determine the most helpful abdominal CT findings in patients with small bowel perforation without pneumoperitoneum or oral contrast leakage after blunt trauma. We retrospectively analyzed the abdominal CT findings of 51 patients with small bowel perforation without pneumoperitoneum or oral contrast leakage. A score of 2 was assigned if bowel wall thickening of more than 5 mm or enhancement of the bowel wall was definite, and 1 if equivocal thickenting or enhancement of the bowel wall, mesenteric infiltration, sentinel clotting, intermesenteric fluid, or ileus were observed. According to the score, each finding was classified as strongly positive(5-8), possibly positive(3-4), or probably negative(1-2), and the accuracy of each classification was evaluated. We decided which findings would be most helpful when attempting to diagnose small bowel perforation. Forty one bowel perforations and four mesenteric injuries were identified in 45 laparatomies among 51 patients. In all 20 patents with a score of more than 5, small bowel perforation was found on surgery. The prevalence rate of bowel wall thickening and enhancement was significantly different between patients with perforation(88%, 80% respectively) and those without (20%, 40% respectively)(p<0.05). The sensitivity, specificity and accuracy of each criterion were compared (sum of scoring of all CT findings?3D3:82.9% · 40% · 74.5%;scoring of bowel wall thickening and enhancement ?3D 2:82.9% · 80% · 82.4%), anent ?3D 2:82.9% · 80% · 82.4%), and it was found that for specificity and accuracy, the latter was superior to the former. ROC analysis using the scores of each criterion as cut-off value also showed that the curve of the latter showed a more marked upward trend and was the most helpful parameter. When diagnosing small bowel perforation in the absence of pneumoperitonemum or oral contrast leakage after blunt abdominal trauma, bowel wall thickening and enhancement were more helpful parameters than the sum of all CT findings.=20

188

The value of MR enteroclysis with air infusion in the diagnosis of small bowel disease  

International Nuclear Information System (INIS)

Objective: To investigate the value of MR enteroclysis with air infusion in the diagnosis of small bowel disease. Methods: Sixteen patients with suspected small bowel disease, but without acute inflammatory disease or bowel obstruction, received MR enteroclysis with air infusion. There were 12 males and 4 females, and their age ranged from 17 to 75 years. 10 patients had abdominal pain, 4 with melena or blood stool, and 2 with diarrhea. The longest course was 7 years, and the shortest 1 week. Before MR imaging, a nasoenteric catheter was inserted into the distal part of duodenum, and about 1000 ml of air was infused through the tube to distend the small bowel. 20 mg of IV anisodamine was given to reduce small-bowel peristalsis. All patients were imaged with fat-saturated Gd-DTPA enhanced coronal and axial T1-weighted spin-echo (SE) sequence and fast spoiled gradient echo (FSPGR) sequence. Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed to assess the sensitivity and specificity of MRI. Results: 5 cases were normal, 6 with Crohn disease, 2 with gastric intestinal stromal tumor (GIST), and 1 each of lymphoma, tuberculosis and irritable bowel syndrome. The lumen of normal small bowel in MR enteroclysis was no signal, the wall was outlined as middle signal by intraluminal air and surrounding air-distended bowel and was between 1-3 mm thick, and the diameter of the lumen was between 17-28 mm. Crohn disease shoen was between 17-28 mm. Crohn disease showed segmental mural thickening, increased enhancement, luminal stricture, and even extraluminal inflammatory mass or fistula. Intestinal tuberculosis invaded the distal section of ileum, cecum, and the proximal ascending colon, the wall thickened and enhanced apparently, and cecum and proximal ascending colon shortened. GIST showed a mass that was iso-signal on T1WI, high signal on T2WI, and enhanced significantly after IV Gd-DTPA. 1 recurrent lymphoma of ileum showed mural thickening and increased enhancement but no stenosis. 1 irritable bowel syndrome is disfunction, so its shape and signal is normal. Except 1 Crohn disease, which showed a large mass, was misdiagnosed as lymphoma and no abnormality was found in 1 irritable bowel syndrome, the other diagnosis of MRI was correct. The sensitivity in diagnosing small intestinal disease was 100%, and the specificity was 83%. Conclusion: MR enteroclysis with air infusion is a sensitive method in diagnosing the small bowel disease, especially in Crohn disease and tumor. It can clearly display the mural thickening and the extraluminal inflammatory mass

189

Cine Magnetic Resonance Imaging of the Small Bowel: Comparison of Different Oral Contrast Media  

International Nuclear Information System (INIS)

Purpose: To evaluate several substances regarding small bowel distension and contrast on balanced steady-state free precession (bSSFP) cine magnetic resonance (MR) images. Material and Methods: Luminal contrast was evaluated in 24 volunteers after oral application of two different contrast agent groups leading to either bright lumen (pineapple, blueberry juice) or dark lumen (tap water, orange juice) on T1-weighted images. Bowel distension was evaluated in 30 patients ingesting either methylcellulose or mannitol solution for limiting intestinal absorption. Fifteen patients with duodeno-jejunal intubation served as the control. Quantitative evaluation included measurement of luminal signal intensities and diameters of four bowel segments, qualitative evaluation assessed luminal contrast and distension on a five-point scale. Results: Quantitative and qualitative evaluation of the four contrast agents revealed no significant differences regarding luminal contrast on bSSFP images. Quantitative evaluation revealed significantly lower (P<0.05) small bowel distension for three out of four segments (qualitative evaluation: two out of four segments) for methylcellulose in comparison to the control. Mannitol was found to be equal to the control. Conclusion: Oral ingestion of tap water or orange juice in combination with mannitol is recommended for cine MR imaging of the small bowel regarding luminal contrast and small bowel distension on bSSFP sequencesn bSSFP sequences

190

Cine Magnetic Resonance Imaging of the Small Bowel: Comparison of Different Oral Contrast Media  

Energy Technology Data Exchange (ETDEWEB)

Purpose: To evaluate several substances regarding small bowel distension and contrast on balanced steady-state free precession (bSSFP) cine magnetic resonance (MR) images. Material and Methods: Luminal contrast was evaluated in 24 volunteers after oral application of two different contrast agent groups leading to either bright lumen (pineapple, blueberry juice) or dark lumen (tap water, orange juice) on T1-weighted images. Bowel distension was evaluated in 30 patients ingesting either methylcellulose or mannitol solution for limiting intestinal absorption. Fifteen patients with duodeno-jejunal intubation served as the control. Quantitative evaluation included measurement of luminal signal intensities and diameters of four bowel segments, qualitative evaluation assessed luminal contrast and distension on a five-point scale. Results: Quantitative and qualitative evaluation of the four contrast agents revealed no significant differences regarding luminal contrast on bSSFP images. Quantitative evaluation revealed significantly lower (P<0.05) small bowel distension for three out of four segments (qualitative evaluation: two out of four segments) for methylcellulose in comparison to the control. Mannitol was found to be equal to the control. Conclusion: Oral ingestion of tap water or orange juice in combination with mannitol is recommended for cine MR imaging of the small bowel regarding luminal contrast and small bowel distension on bSSFP sequences.

Asbach, P.; Breitwieser, C.; Diederichs, G.; Eisele, S.; Kivelitz, D.; Taupitz, M.; Zeitz, M.; Hamm, B.; Klessen, C. [Charite - Universitatsmedizin Berlin, Charite Campus Mitte, Berlin (Germany). Dept. of Radiology

2006-11-15

191

Diverticular bile duct lesion in chronic active hepatitis.  

DEFF Research Database (Denmark)

Liver needle biopsies from patients with non-A, non-B chronic active hepatitis and so-called abnormal bile duct epithelium were studied with a three-dimensional method. Photographs of bile duct structures in serial sections were transferred to acrylic plates. Five bile duct lesions of a not previously described diverticular type were revealed. The diverticuli were of varying shape with a diameter of 30 to 110 microns and a length of 75 to 150 microns budding from small (12 to 25 microns), slightly ectatic bile ducts. The diverticular epithelium was disordered. Some cells appeared as bile duct cells, but most were larger, with rounded nuclei, prominent nucleoli and abundant eosinophilic cytoplasm, sometimes with periodic acid-Schiff-positive, diastase-resistant granules. The lesions were only partly surrounded by a basement membrane. They were all embedded in a tight mononuclear inflammatory infiltrate associated with pronounced periportal piecemeal necrosis. In two cases, a germinal center was adjacent to the epithelium. The pathogenesis of the diverticular bile duct lesion is unknown, but the diverticuli probably represent Hering ducts and groups of periportal liver cells which have escaped the piecemeal necrosis.

Vyberg, M

1989-01-01

192

Congenital internal hernia presented with life threatening extensive small bowel strangulation.  

Science.gov (United States)

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

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

2013-09-01

193

Atypical small bowel obstruction following repair of inguinal hernia: a case of intestinal stenosis of Garre.  

Science.gov (United States)

We report an atypical case of small bowel obstruction 10 days after the repair of an inguinal hernia that had been recurrently reduced. A preoperative diagnosis of the rare intestinal stenosis of Garre is difficult, and was based on the clinical, operative and pathological findings. Forced reduction of a hernia is not recommended because of the risk of rendering its contents ischaemic with subsequent fibrotic stenosis, or reducing a strangulated bowel into the abdominal cavity with subsequent perforation and peritonitis. PMID:23796681

Weledji, Elroy P; Theophile, Nana

2013-04-01

194

Chylous ascites and obstructive lymphoedema of the small bowels following abdominal radiotherapy  

International Nuclear Information System (INIS)

The case history of a patient who developed chylous ascites following abdominal radiotherapy for recurrent carcinoma of the colon was presented. Laparotomy revealed generalized radiation damage of the small bowel with a particularly severely affected segment of jejunum, from the serosal surface of which chyle was seen to be leaking. Mesenteric lymphangiography revealed an obstruction to lymphatic drainage in the mesentery. Resection of the worst affected segment of bowel prevented further development of chylous ascites. (author)

195

Fecal impaction: a cause of isolated small bowel dilatation on abdominal radiographs  

Energy Technology Data Exchange (ETDEWEB)

Objective: The purpose of this study was to assess the frequency of isolated small bowel dilatation on abdominal radiographs in patients with colonic fecal impaction and also to elucidate the cause of this finding. Methods: A computerized search of radiology files revealed 515 patients with colonic fecal impaction on abdominal radiographs. The radiologic reports described isolated small bowel dilatation not related to other known causes of ileus or obstruction in 18 (3.5%) of the 515 patients. The films were reviewed to determine the distribution of fecal impaction and the degree and extent of small bowel dilatation. In 16 cases, medical records were reviewed to determine the clinical presentation, treatment, and course. Finally, follow-up radiographs were reviewed in four cases to determine the response to treatment of the impaction. Results: All 16 patients with available medical records had abdominal symptoms. The average diameter of the dilated small bowel on abdominal radiographs was 3.7 cm. Fourteen patients (78%) had a diffuse colonic fecal impaction (nine) or a predominantly right-sided fecal impaction (five) that involved the cecum, and the remaining four (22%) had a left-sided colonic fecal impaction. All 12 patients with clinical follow-up had resolution of symptoms and all four with follow-up radiographs had resolution of small bowel dilatation after treatment of the underlying impaction. Conclusion: Fecal impaction should be considered in the differential diagnosis of small bowel dilatation on abdominal radiographs, as treatment of the underlying impaction usually produces a dramatic clinical response with resolution of the small bowel dilatation on follow-up radiographs.

Torigian, Drew A.; Levine, Marc S. E-mail: levine@oasis.rad.upenn.edu; Rubesin, Stephen E.; Laufer, Igor

2001-10-01

196

Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis.  

Science.gov (United States)

Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB. PMID:24290774

Kalra, N; Agrawal, P; Mittal, V; Kochhar, R; Gupta, V; Nada, R; Singh, R; Khandelwal, N

2014-03-01

197

Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis  

International Nuclear Information System (INIS)

Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB

198

Use of methylcellulose in small-bowel follow-through examination : comparison with enteroclysis and conventional series in normal subjects  

International Nuclear Information System (INIS)

To evaluate the efficacy of a modified small bowel follow-through (SBFT) and to optimize this technique. Ninety-nine subjects without small bowel pathology underwent modified SBFT using oral administration of methylcellulose after taking 100ml of 120% or 100, 150, or 200ml of 70% barium. Thirty-three and 39 normal subjects undergoing enteroclysis or conventional SBFT, respectively, were also evaluated for comparison of image qualities and transit time. Enteroclysis was the most successful of three types of small bowel examination for obtaining the best quality of bowel transradiency and distension. Modified SBFT was, however much superior to the conventional series for obtaining good bowel transradiency and rapid transit time (mean, 37-49 minutes). The use of 150ml of 70% barium was better than the other three modified techniques in achieving good bowel transradiency, rapid transit time, and less flocculaton. Our modified SBFT is a simple and safe method for easily improving bowel transradiency and transit time

199

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  

Energy Technology Data Exchange (ETDEWEB)

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.

Banerjee, Robyn, E-mail: robynbanerjee@gmail.com [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Chakraborty, Santam; Nygren, Ian; Sinha, Richie [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)

2013-04-01

200

MRI of small bowel Crohn's disease: determining the reproducibility of bowel wall gadolinium enhancement measurements  

Energy Technology Data Exchange (ETDEWEB)

This study aims to determine inter- and intra-observer variation in MRI measurements of relative bowel wall signal intensity (SI) in Crohn's disease. Twenty-one small bowel MRI examinations (11 male, mean age 40), including T1-weighted acquisitions acquired 30 to 120s post-gadolinium, were analysed. Maximal bowel wall SI (most avid, conspicuous contrast enhancement) in designated diseased segments was measured by two radiologists and two trainees using self-positioned ''free'' regions of interest (ROIs) followed by ''fixed'' ROIs chosen by one radiologist, and this procedure was repeated 1 month later. Relative enhancement (post-contrast SI minus pre-contrast SI/pre-contrast SI) was calculated. Data were analysed using Bland-Altman limits of agreement and intra-class correlation. Inter-observer agreement for relative enhancement was poor (spanning over 120%) using a free ROI - 95% limits of agreement -0.69, 0.70 and -0.47, 0.74 for radiologists and trainees, respectively, only marginally improved by use of a fixed ROI -0.60, 0.67 and -0.59, 0.49. Intra-class correlation ranged from 0.46 to 0.72. Intra-observer agreement was slightly better and optimised using a fixed ROI - 95% limits of agreement -0.52, 0.50 and -0.34, 0.28 for radiologists and trainees, respectively. Intra-class correlation ranged from 0.49 to 0.86. Relative bowel wall signal intensity measurements demonstrate wide limits of observer agreement, unrelated to reader experience but improved using fixed ROIs. (orig.)

Sharman, A.; Zealley, I.A. [Ninewells Hospital, Dundee (United Kingdom); Greenhalgh, R.; Taylor, S.A. [University College Hospital, Department of Imaging, London (United Kingdom); Bassett, P. [Stats Consultancy, Ruislip (United Kingdom)

2009-08-15

201

X-ray findings of small bowel taeniasis: A clinical and experimental study  

International Nuclear Information System (INIS)

Unlike ascariasis of the small bowel, taeniasis can be detected radiologically with much difficulty because of the basic difference between the morphological features of each helminth. However once the characteristics of tape worms are appreciated and kept in mind, radiological diagnosis is fairly accurately made. In the present study we have reported typical radiological features of the small bowel taeniasis as observed in 6 adults patients seen at the Department of Radiology of St. Mary's Hospital and Holy Family Hospital, Catholic Medical College. Tapering tape-like or ribbon -like radiolucent shadows in distal small bowel appear unique. Compression spot film study of the ileum is most important in revealing such findings. An animal experiment using the swine small intestine and parasitological specimen of evacuated worm of taenia saginata was designed to help understand radiological manifestation in vivo

202

A survived case of tardive small bowel injury resulting from radiotherapy for ovarial tumor  

International Nuclear Information System (INIS)

In a patient who underwent surgical excision of recurrent tumor of ovarian disgerminoma, small bowel injury following radiotherapy was treated by extensive excision of the small intestine followed by intravenous hyperalimentation (I.V.H.) and hyperbaric oxygen therapy. From its clinical course and treatment, we concluded that 1) In small bowel complication due to radiation injury, especially perforation of the small bowel, radical excision of the diseased segment is most promising, if the general and local conditions permit. 2) I.V.H. is effective for protecting and improving postoperative malnutrition after extensive excision of the small bowel. 3) Hyperbaric oxygen therapy is very effective for postoperative paralytic ileus in the case in which surgical operation cannot be performed. 4) Zinc deficiency as a complication of prolonged I.V.H. therapy must be protected. 5) It is necessary to study pathophysiology of short bowel syndrome following the extensive excision and to continue treatment and careful long-term follow-up. (Ueda, J.)

203

Reduction of Acute Rejection by Bone Marrow Mesenchymal Stem Cells during Rat Small Bowel Transplantation  

Science.gov (United States)

Background Bone marrow mesenchymal stem cells (BMMSCs) have shown immunosuppressive activity in transplantation. This study was designed to determine whether BMMSCs could improve outcomes of small bowel transplantation in rats. Methods Heterotopic small bowel transplantation was performed from Brown Norway to Lewis rats, followed by infusion of BMMSCs through the superficial dorsal veins of the penis. Controls included rats infused with normal saline (allogeneic control), isogeneically transplanted rats (BN-BN) and nontransplanted animals. The animals were sacrificed after 1, 5, 7 or 10 days. Small bowel histology and apoptosis, cytokine concentrations in serum and intestinal grafts, and numbers of T regulatory (Treg) cells were assessed at each time point. Results Acute cellular rejection occurred soon after transplantation and became aggravated over time in the allogeneic control rats, with increase in apoptosis, inflammatory response, and T helper (Th)1/Th2 and Th17/Treg-related cytokines. BMMSCs significantly attenuated acute cellular rejection, reduced apoptosis and suppressed the concentrations of interleukin (IL)-2, IL-6, IL-17, IL-23, tumor necrosis factor (TNF)-?, and interferon (IFN)-? while upregulating IL-10 and transforming growth factor (TGF)-? expression and increasing Treg levels. Conclusion BMMSCs improve the outcomes of allogeneic small bowel transplantation by attenuating the inflammatory response and acute cellular rejection. Treatment with BMMSCs may overcome acute cellular rejection in small bowel transplantation. PMID:25500836

Zhang, Wen; Wu, Ben-Juan; Fu, Nan-Nan; Zheng, Wei-Ping; Don, Chong; Shen, Zhong-Yang

2014-01-01

204

Small bowel obstruction caused by congenital transmesenteric defect  

OpenAIRE

Transmesenteric hernias are extremely rare. A strangulated hernia through a mesenteric opening is a rare operative finding. Preoperative diagnosis still is difficult in spite of the imaging techniques currently available. The authors describe two cases of paediatric patients presenting with bowel obstruction resulting from a congenital mesenteric hernia. The first patient had a 3-cm wide congenital defect in the ileal mesentery through which the sigmoid colon had herniated. The second patient...

Nouira F; Dhaou Ben; Charieg A; Ghorbel S; Jlidi S; Chaouachi B

2011-01-01

205

Contrast radiography in small bowel obstruction. A randomized trial of barium sulfate and a nonionic low-osmolar contrast medium  

International Nuclear Information System (INIS)

Thirty-six adult patients clinically suspected of small bowel obstruction underwent small bowel contrast radiography with either barium sulfate or a nonionic low-osmolar contrast medium after randomization. Films were taken after 2, 4, and 8 hours and later when needed. No difference as regards visualization and diagnostic quality was found between the 2 media. It is concluded that a nonionic low-osmolar contrast medium is an alternative to barium sulfate for small bowel contrast radiography where small bowel obstruction is suspected. (orig.)

206

CT findings in acute small bowel diverticulitis; Computertomographie bei akuter Duenndarmdivertikulitis  

Energy Technology Data Exchange (ETDEWEB)

Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are non-specific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum. (orig.) [German] Die akute Duenndarmdivertikulitis ist eine seltene Ursache eines akuten Abdomens. Ausgehend von den erworbenen Divertikeln des Jejunums, seltener des Ileums, oder von einem Meckel-Divertikel, manifestiert sich die Divertikulitis klinisch durch eine unspezifische Symptomatik, die zuerst an die haeufigeren, akutentzuendlichen Erkrankungen des Abdomens wie z. B. Appendizitis, Cholezystitis oder Kolondivertikulitis denken laesst. Die Duenndarmdivertikulitis kann praeoperativ nur durch radiologische Verfahren gesichert werden, wobei die CT die Methode der Wahl darstellt. Das vorwiegend in Form von Kasuistiken beschriebene Spektrum der CT-Morphologie der akuten Duenndarmdivertikulitis variiert je nach Ausmass des Entzuendungsprozesses. Als typische CT-Befunde finden sich ein entzuendetes Divertikel, peridivertikulaere Fettgewebsinfiltrationen, extraluminale Luftansammlungen als Zeichen einer gedeckten Perforation und ein Wandoedem des betroffenen Duenndarmsegmentes mit vermehrter Distanzierung der Darmschlingen. In sehr seltenen Faellen kann auch ein Enterolith in einem entzuendeten Divertikel nachweisbar sein. An Komplikationen koennen Abszesse, Fisteln, ein Ileus und eine freie Perforation mit Peritonitis auftreten. Diagnostische Probleme bereitet die Duenndarmdivertikulitis von allem bei Lokalisation im terminalen Ileum und im Meckel-Divertikel. Zur Sicherung der computertomographischen Verdachtsdiagnose einer akuten Duenndarmdivertikulitis koennen ein Enteroklysma bzw. beim Meckel-Divertikel eine 99m-Technetium-Pertechnetat-Szintigraphie eingesetzt werden. Wir beschreiben die CT-Befunde zweier Patientinnen mit akuter Jejunumdivertikulitis und eines Patienten mit Meckel-Divertikulitis und vergleichen die Ergebnisse mit den Angaben aus der Literatur. (orig.)

Ferstl, F.J.; Obert, R. [Radiologisch-Nuklearmedizinisches Zentrum (RNZ) am St. Theresienkrankenhaus Nuernberg (Germany)

2004-02-01

207

What I Need to Know about Diverticular Disease  

Science.gov (United States)

... PDF, 341 KB)????? Alternate Language URL Español What I need to know about Diverticular Disease Page Content ... the end of the colon. [ Top ] What can I do about diverticular disease? Eat a high-fiber ...

208

Ileus and Small Bowel Obstruction in an Emergency Department Observation Unit: Are there Outcome Predictors?  

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Full Text Available Introduction: The purpose of our study was to describe the evaluation and outcome of patients with ileus and bowel obstruction admitted to an emergency department (ED observation unit (OU and to identify predictors of successful management for such patients. Methods: We performed a retrospective chart review of 129 patients admitted to a university-affiliated, urban, tertiary hospital ED OU from January 1999 through November 2004. Inclusion criteria were all adult patients admitted to the OU with an ED diagnosis of ileus, partial small bowel obstruction, or small bowel obstruction, and electronic medical records available for review. The following variables were examined: ED diagnosis, history of similar admission, number of prior abdominal surgeries, surgery in the month before, administration of opioid analgesia at any time after presentation, radiographs demonstrating air–fluid levels or dilated loops of small bowel, hypokalemia, use of nasogastric decompression, and surgical consultation. Results: Treatment failure, defined as hospital admission from the OU, occurred in 65 (50.4% of 129 patients. Only the use of a nasogastric tube was associated with OU failure (21% discharged versus 79% requiring admission, P ¼ 0.0004; odds ratio, 5.294; confidence interval, 1.982–14.14. Conclusion: Half of the patients admitted to our ED OU with ileus or varying degrees of small bowel obstruction required hospital admission. The requirement of a nasogastric tube in such patients was associated with a greater rate of observation unit failure. [West J Emerg Med. 2011;12(4:404–407.

Charles L. Emerman

2011-05-01

209

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

International Nuclear Information System (INIS)

There is evidence for both humans and rats that malnutrition frequently occurs when ethanol is chronically ingested. Small bowel 14C-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

210

The use of a biodegradable mesh to prevent radiation-associated small-bowel injury  

International Nuclear Information System (INIS)

Radiation-associated small bowel injury occurs in up to 50% of patients receiving postoperative radiotherapy following pelvic cancer surgery. We describe our experience using a biodegradable mesh that allows the small bowel to be supported above the pelvic inlet and is totally absorbed following radiation therapy. Between 1985 and 1989, 45 procedures were performed in patients with carcinoma of the rectum (anterior resection in 15 patients, abdominoperineal resection in 23 patients, pelvic exenteration in six patients, and proctocolectomy in one patient). In 30 patients a polyglycolic acid (Dexon) mesh was used, and in 15 patients a polyglactin 910 (Vicryl) mesh was used. Forty-four patients received postoperative radiotherapy. The mean (+/- SEM) dose was 56.8 +/- 18.4 Gy. There were no immediate complications related to the mesh. Follow-up ranged from 12 to 53 months (median follow-up, 34 months). With the exception of two patients who had a polyglactin 910 mesh and who developed bowel obstruction due to adhesions under the anterior abdominal wall, there has been no documented incidence of clinical radiation-associated small bowel injury. The use of the absorbable mesh may permit us to use higher doses of postoperative radiotherapy without the associated hazard of radiation-associated small bowel injury

211

The use of a biodegradable mesh to prevent radiation-associated small-bowel injury  

Energy Technology Data Exchange (ETDEWEB)

Radiation-associated small bowel injury occurs in up to 50% of patients receiving postoperative radiotherapy following pelvic cancer surgery. We describe our experience using a biodegradable mesh that allows the small bowel to be supported above the pelvic inlet and is totally absorbed following radiation therapy. Between 1985 and 1989, 45 procedures were performed in patients with carcinoma of the rectum (anterior resection in 15 patients, abdominoperineal resection in 23 patients, pelvic exenteration in six patients, and proctocolectomy in one patient). In 30 patients a polyglycolic acid (Dexon) mesh was used, and in 15 patients a polyglactin 910 (Vicryl) mesh was used. Forty-four patients received postoperative radiotherapy. The mean (+/- SEM) dose was 56.8 +/- 18.4 Gy. There were no immediate complications related to the mesh. Follow-up ranged from 12 to 53 months (median follow-up, 34 months). With the exception of two patients who had a polyglactin 910 mesh and who developed bowel obstruction due to adhesions under the anterior abdominal wall, there has been no documented incidence of clinical radiation-associated small bowel injury. The use of the absorbable mesh may permit us to use higher doses of postoperative radiotherapy without the associated hazard of radiation-associated small bowel injury.

Dasmahapatra, K.S.; Swaminathan, A.P. (Comprehensive Surgical Associates, Perth Amboy, NJ (USA))

1991-03-01

212

A case of Churg-Strauss vasculitis complicated by small bowel necrosis.  

OpenAIRE

A case of Churg-Strauss syndrome causing mesenteric intestinal ischaemia and small bowel necrosis is described in a 29-year-old man. Despite conservative management, the patient's condition deteriorated and he underwent five laparotomies. Small and medium-sized arteries within the mesentery and lymph nodes showed necrotizing vasculitis. Currently he is doing well on oral nutrition and medical management.

Schoretsanitis, G. N.; Wakely, D. M.; Maddox, T.; Wastell, C.

1993-01-01

213

Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To examine the predictive factors of capsule endoscopy (CE completion rate (CECR including the effect of inpatient and outpatient status. METHODS: We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005. Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the procedure. CE exams were reviewed by two physicians who were unaware of the study hypotheses. After retrospective analysis, 21 cases were excluded due to capsule malfunction, prior gastric surgery, endoscopic capsule placement or insufficient data. Of the remaining 334 exams [264 out-patient (OP, 70 in-patient (IP], CE indications, findings, location of the patients [IP vs OP and intensive care unit (ICU vs general medical floor (GMF] and gastrointestinal transit times were analyzed. Statistical analysis was completed using SPSS version 17 (Chicago, IL. Chi-square, t test or fisher exact-tests were used as appropriate. Multivariate logistic regression analysis was used to identify variables associated with incomplete CE exams. RESULTS: The mean age for the entire study population was 54.7 years. Sixty-one percent of the study population was female, and gender was not different between IPs vs OPs (P = 0.07. The overall incomplete CECR was 14% in our study. Overt obscure gastrointestinal bleeding (OGB was significantly more common for the IP CE (P = 0.0001, while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams (P = 0.002 and P = 0.01, respectively. Occult OGB was the most common indication and arteriovenous malformations were the most common finding both in the IPs and OPs. The capsule did not enter the small bowel (SB in 6/70 IPs and 8/264 OPs (P = 0.04. The capsule never reached the cecum in 31.4% (22/70 of IP vs 9.5% (25/ 264 of OP examinations (P < 0.001. The mean gastric transit time (GTT was delayed in IPs compared to OPs, 98.5 ± 139.5 min vs 60.4 ± 92.6 min (P = 0.008. Minimal SB transit time was significantly prolonged in the IP compared to the OP setting [IP = 275.1 ± 111.6 min vs OP = 244.0 ± 104.3 min (P = 0.037]. CECR was also significantly higher in the subgroup of patients with OGB who had OP vs IP exams (95% vs 80% respectively, P = 0.001. The proportion of patients with incomplete exams was higher in the ICU (n = 7/13, 54% as compared to the GMF (n = 15/57, 26% (P = 0.05. There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture, and the remaining incomplete SB exams were due to slow transit. Medications which affect gastrointestinal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients (ICU and GMF and were not predictive of incomplete capsule passage (P > 0.05. Patient location (IP vs OP and GTT were independent predictors of incomplete CE exams (P < 0.001 and P = 0.008, respectively. CONCLUSION: Incomplete CE is a multifactorial problem. Patient location and related factors such as severity of illness and sedentary status may contribute to incomplete exams.

Cemal Yazici

2012-01-01

214

Small bowel obstruction secondary to migration of a fragment of lithobezoar: a case report.  

LENUS (Irish Health Repository)

INTRODUCTION: Small bowel obstruction is a common world-wide condition that has a range of etiological factors. The management is largely dependent on the cause of the obstruction. Small bowel obstruction caused by foreign body ingestion is rare; many items have been reported as responsible, but there are no reports implicating polyurethane foam. CASE PRESENTATION: We report the case of a 44-year-old Irish male who presented following ingestion of polyurethane foam. He was asymptomatic on presentation but developed a small bowel obstruction shortly thereafter. CONCLUSION: Patients presenting following ingestion of polyurethane foam should be scheduled for elective laparotomy, gastrotomy, and retrieval of the cast on the next available theatre list - given that they are suitable for surgery.

Medani, Mekki

2009-01-01

215

Excess anticoagulation as a cause of small-bowel obstruction: a report of two cases.  

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Spontaneous intramural haemorrhage is a rare cause of small-bowel obstruction, occurring most commonly in those who are anticoagulated. We describe two cases that presented with a history and imaging suggestive of small-bowel obstruction; both had International Normalized Ratios of above 10 on admission. The first case, a 62-year-old lady on warfarin for atrial fibrillation, was managed conservatively with good effect. In contrast, the second case, a 57-year-old gentleman on warfarin for his metallic aortic valve, underwent diagnostic laparotomy that revealed a 30-cm segment of proximal jejunum with spontaneous intramural haemorrhage. In this study, we emphasize the merit of conservative management for this rare cause of small-bowel obstruction. PMID:25858268

Creasy, Henrietta; Meleagros, Luke

2015-01-01

216

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

International Nuclear Information System (INIS)

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

217

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

1986-12-01

218

Bombesin stimulates enterocyte turnover following massive small bowel resection in a rat.  

Science.gov (United States)

Recent evidence suggests that bombesin (BBS) is involved in modulation of growth and differentiation of normal small intestine. The purpose of the present study was to evaluate the effects of BBS on enterocyte turnover after massive small bowel resection in a rat. Male Sprague-Dawley rats were divided into three experimental groups: Sham rats underwent bowel transection and re-anastomosis, short bowel syndrome (SBS) rats underwent a 75% small bowel resection, and SBS-BBS rats underwent bowel resection and were treated with BBS given subcutaneously at a dose of 20 mug/kg, once daily, from postoperative day 3 through 14. Parameters of intestinal adaptation (bowel and mucosal weights, mucosal DNA and protein, villus height and crypt depth), enterocyte proliferation and enterocyte apoptosis were determined in jejunum and ileum on day 15 following operation. RT-PCR technique was used to determine Bax and Bcl-2 gene expression in ileal mucosa. Statistical analysis was performed using the non-parametric Kruskal-Wallis ANOVA test, with P less than 0.05 considered statistically significant. Treatment with BBS resulted in a significant increase in ileal bowel and mucosal weight, ileal mucosal DNA and protein, jejunal and ileal villus height, jejunal crypt depth, and jejunal and ileal proliferation index compared to SBS-animals. SBS rats showed a significant increase in Bax and Bcl-2 expression in ileum that was accompanied by a significant increase in cell apoptosis compared to sham animals. SBS-BBS rats demonstrated a significant decrease in Bax and Bcl-2 expression in ileum and a decrease in apoptotic index compared to SBS-animals. In conclusion, in a rat model of SBS, BBS enhances enterocyte turnover and stimulates structural intestinal adaptation. Decreased Bax expression may be responsible for the inhibitory effect of BBS on enterocyte apoptosis. PMID:17440764

Sukhotnik, Igor; Slijper, Nadav; Karry, Rachel; Shaoul, Ron; Coran, Arnold G; Lurie, Michael; Shiloni, Eitan; Mogilner, Jorge G

2007-05-01

219

Alterations in myoelectric activity of the small bowel in rabbits after transarterial embolization  

International Nuclear Information System (INIS)

Objective: To explore alterations in myoelectric activity of the small bowel in rabbits after transarterial embolization and provide academic basis for assessing bowel viability and management. Methods: Twenty normal rabbits were selected and divided into three groups (2 mg group, n=10; 6 mg group, n=5; control group, n=5). Members of 2 mg group were embolized with PVA 2 mg, those of 6 mg group with PVA 6 mg, and the control group with normal saline 2 ml. After microcatherization embolization, myoelectric activity of the small bowel was recorded for 24 hr using chronically implanted electrodes in conscious rabbits. Results: In 2 mg group, the frequency and the amplitude of slow wave of proximal jejunum were significantly lower in post-embolization period than pre-embolization period [(17.83±0.55) cpm vs (11.59±0.23) cpm(P0.05) and (0.1632±0.002) mV vs (0.1606±0.003) mV (P>0.05), respectively]. ConclumV (P>0.05), respectively]. Conclusions: Embolization with PVA evokes significant and passive effect on basal electrical rhythm of small bowel. It could provide academic basis for assessing bowel viability to interventional embolization. (authors)

220

Microscopy of bacterial translocation during small bowel obstruction and ischemia in vivo – a new animal model  

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Full Text Available Abstract Background Existing animal models provide only indirect information about the pathogenesis of infections caused by indigenous gastrointestinal microflora and the kinetics of bacterial translocation. The aim of this study was to develop a novel animal model to assess bacterial translocation and intestinal barrier function in vivo. Methods In anaesthetized male Wistar rats, 0.5 ml of a suspension of green fluorescent protein-transfected E. coli was administered by intraluminal injection in a model of small bowel obstruction. Animals were randomly subjected to non-ischemic or ischemic bowel obstruction. Ischemia was induced by selective clamping of the terminal mesenteric vessels feeding the obstructed bowel loop. Time intervals necessary for translocation of E. coli into the submucosal stroma and the muscularis propria was assessed using intravital microscopy. Results Bacterial translocation into the submucosa and muscularis propria took a mean of 36 ± 8 min and 80 ± 10 min, respectively, in small bowel obstruction. Intestinal ischemia significantly accelerated bacterial translocation into the submucosa (11 ± 5 min, p E. coli were visible in frozen sections of small bowel, mesentery, liver and spleen taken two hours after E. coli administration. Conclusions Intravital microscopy of fluorescent bacteria is a novel approach to study bacterial translocation in vivo. We have applied this technique to define minimal bacterial transit time as a functional parameter of intestinal barrier function.

Hafner Mathias

2002-08-01

221

Dietary Sulfur Amino Acid Supplementation Reduces Small Bowel Thiol/Disulfide Redox State and Stimulates Ileal Mucosal Growth after Massive Small Bowel Resection in Rats12  

OpenAIRE

Following massive small bowel resection in animal models, the remnant intestine undergoes a dynamic growth response termed intestinal adaptation. Cell growth and proliferation are intimately linked to cellular and extracellular thiol/disulfide redox states, as determined by glutathione (GSH) and GSH disulfide (GSSG) (the major cellular redox system in tissues), and cysteine (Cys) and its disulfide cystine (CySS) (the major redox system in plasma), respectively. The study was designed to deter...

Shyntum, Yvonne; Iyer, Smita S.; Tian, Junqiang; Hao, Li; Mannery, Yanci O.; Jones, Dean P.; Ziegler, Thomas R.

2009-01-01

222

Extramedullary plasmacytoma of small bowel mesentery in associated with cecal cancer: a case report  

Energy Technology Data Exchange (ETDEWEB)

Extramedullary plasmacytoma is a rare disease that is histopathologically defined as a solitary tumor composed of a monoclonal proliferation of cells with plasmacytic differentiation in an extramedullary site. Most of these tumors occur in the submucosa of the upper aerodigestive tract, and they rarely occur in the small bowel mesentery. We report here on a case of extramedullary plasmacytoma of the small bowel mesentery that was in association with a cecal cancer. Abdominal ultrasound and CT revealed a lobulated soft tissue mass with a cystic portion and peripheral calcification. In this case, the preoperative radiological diagnosis was difficult due to accompanying cecal cancer.

Kim, Sung Kyu; Kim, Yong Soo; Kim, Young Sun; Cho, On Koo; Koh, Byung Hee; Rhim, Hyun Chul; Park, Choog Ki; Park, Dong Woo [Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Yong Wook; Oh, Young Ha [Hanyang University Guri Hospital, Guri (Korea, Republic of)

2005-07-15

223

Whipple's disease demonstrated by double contrast small bowel enema with barium and methylcellulose  

Energy Technology Data Exchange (ETDEWEB)

The radiologic findings on small bowel enema examination using barium and methylcellulose (SBE+Ba+MC) in a patient with Whipple's disease before and after treatment are described. The changes on SBE+Ba+MC corresponded well to the clinical and morphologic picture. The advantages of this double contrast technique compared to the enteroclysis with barium alone are demonstrated. The SBE+Ba+MC is a good method to demonstrate the manifestations of Whipple's disease involving the small bowel and the mesentery.

Antes, G.; Kruis, W.

1982-08-01

224

Small bowel exclusion from the pelvis by a polyglycolic acid mesh sling  

International Nuclear Information System (INIS)

Radiation enteritis is seen in patients receiving radiation therapy for various pelvic malignancies. Attempts to prevent this have included various surgical as well as nutritional approaches with little success. The use of a polyglycolic acid mesh sling sewn above the pelvic inlet has prevented small bowel descent into the true pelvis in rats and in humans. The technique has been successful in both with no attendant morbidity during an 11-month follow up. Several patients have received additional doses of radiation therapy that would not have been given if the small bowel were not removed from the area to be irradiated

225

Small bowel exclusion from the pelvis by a polyglycolic acid mesh sling  

Energy Technology Data Exchange (ETDEWEB)

Radiation enteritis is seen in patients receiving radiation therapy for various pelvic malignancies. Attempts to prevent this have included various surgical as well as nutritional approaches with little success. The use of a polyglycolic acid mesh sling sewn above the pelvic inlet has prevented small bowel descent into the true pelvis in rats and in humans. The technique has been successful in both with no attendant morbidity during an 11-month follow up. Several patients have received additional doses of radiation therapy that would not have been given if the small bowel were not removed from the area to be irradiated.

Devereux, D.F.; Kavanah, M.T.; Feldman, M.I.; Kondi, E.; Hull, D.; O' Brien, M.; Deckers, P.J.; Mozden, P.J.

1984-06-01

226

[Small bowel obstruction caused by immunosuppressive therapy after a liver transplant.  

Science.gov (United States)

This case report describes an extremely rare cause of small bowel obstruction. A female patient who was liver transplanted seven years earlier and had been in immunosuppressive therapy since then presented with clinical and radiological manifest small bowel obstruction and surgery followed. The surgical finding was a segment near the terminal ileum with three separate stenoses in which the most oral was causing the obstruction. Histology evaluation of the stenoses revealed infiltration of lymphoid tissue and the stenoses tested positive on Epstein-Barr virus. The patient was later confirmed to be suffering from post-transplant lymphoproliferative disease. PMID:25354009

Schmiegelow, Amalie; Klein, Mads

2014-10-27

227

Ileo-colonic intussusception secondary to small-bowel lipomatosis: a case report.  

Science.gov (United States)

Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%. Because the lipomas are diffusely distributed in the intestine, most patients are symptom-free, and invasive intervention is not advised by most doctors. Here, we describe a case with intussusception due to small-bowel lipomatosis. Partial small bowel resection and anastomosis were performed because the intestinal wall was on the verge of perforation. This case indicates that regular follow-up is necessary and endoscopic treatment should be considered to avoid surgical procedures if the lipoma is large enough to cause intestinal obstruction. PMID:24587685

Gao, Peng-Ji; Chen, Lei; Wang, Fu-Shun; Zhu, Ji-Ye

2014-02-28

228

Ileo-colonic intussusception secondary to small-bowel lipomatosis: A case report  

OpenAIRE

Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04% to 4.5%. Because the lipomas are diffusely distributed in the intestine, most patients are symptom-free, and invasive intervention is not advised by most doctors. Here, we describe a case with intussusception due to small-bowel lipomatosis. Partial small bowel resection and anastomosis were performed because the intestinal wall was on the verge of perforation. This case indicates that regular follow-up is...

Gao, Peng-ji; Chen, Lei; Wang, Fu-shun; Zhu, Ji-ye

2014-01-01

229

Small bowel adenocarcinoma and Crohn's disease: Any further ahead than 50 years ago?  

Science.gov (United States)

This review of the literature on small bowel carcinoma associated with Crohn’s disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn’s disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn’s disease. PMID:25206256

Cahill, Caitlin; Gordon, Philip H; Petrucci, Andrea; Boutros, Marylise

2014-01-01

230

Ileo-anal pouch necrosis secondary to small bowel volvulus: A case report  

OpenAIRE

Abstract Introduction Small bowel volvulus is a rare occurrence in the Western world and its occurrence after ileo-anal ouch formation is even rarer. Case Presentation We report a case of a 26 year old lady who presented with small bowel volvulus and subsequent ischaemia and necrosis of her ileo-anal pouch created 5 years previously. Conclusion This case illustrates a rare but potentially devastating complication of ileo-anal pouch formation and as such the diagnosis should be borne in mind w...

Hewes Jim; Gurjar Shashank; Salotera Gurcharan; Patel Sandeep; Ahmed Ibrahim; Andrews Brian

2008-01-01

231

Ileo-anal pouch necrosis secondary to small bowel volvulus: A case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Small bowel volvulus is a rare occurrence in the Western world and its occurrence after ileo-anal ouch formation is even rarer. Case Presentation We report a case of a 26 year old lady who presented with small bowel volvulus and subsequent ischaemia and necrosis of her ileo-anal pouch created 5 years previously. Conclusion This case illustrates a rare but potentially devastating complication of ileo-anal pouch formation and as such the diagnosis should be borne in mind when a patient with a pouch presents with an acute abdomen.

Hewes Jim

2008-05-01

232

Small-bowel Diverticulosis: Imaging Findings and Review of Three Cases  

Directory of Open Access Journals (Sweden)

Full Text Available Complicated small-bowel diverticulosis is a rather uncommon cause of upper abdominal pain. It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. As the presentation is often similar to other pathologies (acute appendicitis, pancreatitis, or acute cholecystis and in many cases diagnosis is made on basis of surgical findings, careful analysis of the imaging landmarks may be warranted to aid in the early stages of detection. In this report, we present clinical and morphological findings in three patients where small-bowel diverticulitis was surgically proven. The relevant literature is reviewed, and typical imaging properties are discussed.

B. De Peuter

2009-01-01

233

EVICEL glue-induced small bowel obstruction after laparoscopic gastric bypass.  

Science.gov (United States)

Small bowel obstruction is a complication of laparoscopic Roux-en-Y gastric bypass (LRYGB) frequently caused by adhesions and internal hernia. In addition, anastomotic leak that complicates LRYGB surgery contributes to the mortality of this procedure. Fibrin glue is commonly used intraoperatively for prevention of anastomotic leak and to secure hemostasis. We describe 2 cases of morbidly obese women who underwent LRYGB surgery for weight loss and developed early postoperative small bowel obstruction related to the use of the "EVICEL" fibrin sealant. Of note is that both patients required surgical intervention for this complication. PMID:23386172

Ofikwu, Godwin I; Sarhan, Mohammad; Ahmed, Leaque

2013-02-01

234

Immune-mediated hemolytic anemia in children after liver and small bowel transplantation.  

Science.gov (United States)

Four children who underwent ABO-compatible combined liver and small bowel transplantation developed severe immune-mediated hemolytic anemia. The main management strategies were early and aggressive treatment with steroids, the introduction of rituximab (an anti-CD20 monoclonal antibody), and the use of plasma exchange together with compatible but minimal blood transfusions. Three of the 4 children developed thrombi in the major vessels. In small bowel transplant patients, the early recognition of hemolytic anemia and intensified management with anticoagulation are necessary for the prevention of this complication. PMID:21472974

Czubkowski, Piotr; Williams, Mike; Bagia, Seema; Kelly, Deirdre; Gupte, Girish

2011-08-01

235

Hemorragia digestiva secundaria a enfermedad diverticular del yeyuno: Reporte de caso y revisión de la literatura / Gastrointestinal Hemorrhaging Secondary to Diverticular Disease of the Jejunum: Case Report and Literature Review  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish Los divertículos del intestino delgado son una entidad poco común. Se presentan, por lo general, durante la séptima década de la vida; son de cinco a ocho veces más habituales en el yeyuno que en el íleon y son múltiples en el 75% de los pacientes. Aún más raras son sus complicaciones, aunque estas [...] tienen una gran relevancia, por el riesgo vital que pueden conllevar. Entre dichas complicaciones se encuentra la hemorragia, descrita, hasta 2000, en menos de 70 casos. En el presente artículo se presenta el caso de una paciente de 80 años con un cuadro de shock hipovolémico secundario a enfermedad diverticular hemorrágica del yeyuno, que requirió politransfusión y manejo quirúrgico; con posterioridad al diagnóstico, realizado por enteroscopia, se presenta una breve revisión de la literatura, donde se destaca la importancia de la enteroscopia para el estudio y el manejo este tipo de patología Abstract in english Small bowel diverticula are rare and usually occur in the seventh decade of life. They are five to eight times more common in the ileum than in the jejunum. More than one diverticula occur together in 75 % of patients. Although they occur infrequently, they are highly relevant because of the potenti [...] al lethal risks include bleeding. Until the year 2000 less than 70 cases had been described. In this paper we present the case of an 80 year old patient suffering from hypovolemic shock secondary to jejunal hemorrhaging due to diverticular disease. This required multiple transfusions and surgical management after diagnosis by enteroscopy. This article presents a brief review of the literature highlighting the importance of enteroscopy for the study and handling this type of pathology

John, Ospina Nieto.

2013-12-30

236

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

International Nuclear Information System (INIS)

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 fiel 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

237

Capsule impaction presenting as acute small bowel perforation: a case series  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Perforation caused by capsule endoscopy impaction is extremely rare and, at present, only five cases of perforation from capsule endoscopy impaction are reported in the literature. Case presentation We report here two cases of patients with undiagnosed small bowel stenosis presenting with acute perforation after capsule endoscopy. Strictures in the small bowel were likely the inciting mechanism leading to acute small bowel obstruction and subsequent distension and perforation above the capsule in the area of maximal serosal tension. Case 1 was a 55-year-old Italian woman who underwent capsule endoscopy because of recurrent postprandial cramping pain and iron deficiency anemia, in the setting of negative imaging studies including an abdominal ultrasound, upper endoscopy, colonoscopy and small bowel follow-through radiograph. She developed a symptomatic bowel obstruction approximately 36 hours after ingestion of the capsule. Emergent surgery was performed to remove the capsule, which was impacted at a stenosis due to a previously undiagnosed ileal adenocarcinoma, leading to perforation. Case 2 was a 60-year-old Italian man with recurrent episodes of abdominal pain and diarrhea who underwent capsule endoscopy after conventional modalities, including comprehensive blood and stool studies, computed tomography, an abdominal ultrasound, upper endoscopy, colonoscopy, barium enema and small bowel follow-through, were not diagnostic. Our patient developed abdominal distension, acute periumbilical pain, fever and leukocytosis 20 hours after capsule ingestion. Emergent surgery was performed to remove the capsule, which was impacted at a previously undiagnosed ileal Crohn’s stricture, leading to perforation. Conclusions The present report shows that, although the risk of acute complication is very low, the patient should be informed of the risks involved in capsule endoscopy, including the need for emergency surgical exploration.

De Palma Giovanni D

2012-05-01

238

Small bowel perforation in a hernia sac after TVT placement at the time of colpocleisis.  

Science.gov (United States)

Tension-free vaginal tape (TVT) is commonly considered as the first line of treatment for stress urinary incontinence (SUI) with demonstrated efficacy and limited complications. An 82-year-old woman with complete uterine procidentia and SUI underwent a Le Forte colpocleisis, TVT, posterior repair, and cystoscopy. A 4-cm bulge was noted over the site of the left TVT incision on postoperative day 1. On postoperative day 3, she developed bilious vomiting with slight abdominal distention. Computed tomography scan showed a strangulated left inguinal hernia. An immediate exploratory laparotomy noted an inguinal hernia displaced medially with loops of small bowel in the hernia sac. Although properly positioned, one loop of bowel was perforated by the sling mesh. A small bowel resection was performed and the mesh trimmed below the resection on involved side. At 2 months postoperative visit, the patient was asymptomatic, denied stress or urge incontinence. Vaginal examination noted well-supported vaginal walls. PMID:19641837

Gurshumov, Emil L; Klapper, Allan S; Sierecki, Ava R

2010-03-01

239

Primer trasplante de intestino en Chile: Caso clínico / Small bowel transplantation: Report of a single case  

Scientific Electronic Library Online (English)

Full Text Available [...] Abstract in english Small bowel transplantation is associated with a patient survival at one and five years, of 80% and 63%, respectively. We repon a 36 year-old female with short bowel syndrome, subjected to the first small bowel transplantation performed in Chile. A cadaveric gran was used. Immunosuppression was achi [...] eved by means of alemtuzumab, tacrolimus, sirolimus, micofenolate mofetil and steroids. Serial endoscopies and biopsies were performed during seven months after transplantation. The most important ¡ate complications were a drug induced renal failure, infections caused by opportunistic agents and a gastrointestinal bleedingprobably induced by drugs. After 29 months of follow up, the patient is ambulatory, on oral diet only and with no evidence of graft rejection.

Erwin, Buckel G; Mario, Ferrario B; Mario, Uribe M; Gloria, González G; Jorge, Godoy L; Fernando, Fluxá G; Rodrigo, Quera P; Verner, Codoceo R; Jorge, Morales B; David, Benavente M; María Teresa, Santander D; Cristina, Herzog O.

2009-02-01

240

Primer trasplante de intestino en Chile: Caso clínico Small bowel transplantation: Report of a single case  

Directory of Open Access Journals (Sweden)

Full Text Available Small bowel transplantation is associated with a patient survival at one and five years, of 80% and 63%, respectively. We repon a 36 year-old female with short bowel syndrome, subjected to the first small bowel transplantation performed in Chile. A cadaveric gran was used. Immunosuppression was achieved by means of alemtuzumab, tacrolimus, sirolimus, micofenolate mofetil and steroids. Serial endoscopies and biopsies were performed during seven months after transplantation. The most important ¡ate complications were a drug induced renal failure, infections caused by opportunistic agents and a gastrointestinal bleedingprobably induced by drugs. After 29 months of follow up, the patient is ambulatory, on oral diet only and with no evidence of graft rejection.

Erwin Buckel G

2009-02-01

241

Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma–Case report  

Science.gov (United States)

Introduction In blunt abdominal trauma, lesions of the small bowell and mesentery are often underdiagnosed; although unusual, they represent the third most injured organ, with increasing morbidity and mortality. Presentation of case The authors present the case of a 68 years old male, admitted to the emergency department after being hit by a bale of straw, weighing around 300 kg, in the abdomen. After successful ressuscitation, a CT scan was performed, suggesting hemoperitoneum because of vascular lesion of the right colon bleeding. An exploratory laparotomy was performed, confirming the presence of blood in the abdominal cavity and identifying jejunal perforation, an apparently innocent hematoma of the small bowel mesentery (beside the bowel wall) distally to the first lesion and a laceration of the sigmoid serosa; a segmental jejunal resection and suture of the colon serosa were performed. In the early post-operative period, an enteric discharge was noticed, mandating surgical reexploration; a previously unnoticed bowel perforation, in the mesenteric border where the hematoma was identified, justified an additional enterectomy, after what the patients recovery progressed uneventfully. Discussion In this case, a sudden increase in abdominal pressure could explain that missed rupture of the mesenteric border of the jejunum, also causing the mesenteric hematoma, or, in spite of that, a state of low perfusion could have lead to total wall ischemia of an already irrigation compromised segment. Only noted after surgical exploration, despite prior evaluation with a computed tomography. Small bowell and mesenteric injuries are potentially missed due to decreased exploratory laparotomies for blunt abdominal trauma. Conclusion Although uncommon, small bowel and mesenteric injuries are associated with high morbidity and mortality. High clinical suspicion is essential for an early diagnosis PMID:25576959

Pimenta de Castro, J.; Gomes, G.; Mateus, N.; Escrevente, R.; Pereira, L.; Jácome, P.

2014-01-01

242

Dislocation of small bowel volume within box pelvic treatment fields, using new 'up down table' device  

International Nuclear Information System (INIS)

Purpose: To present the impact of a novel minimization device, the up down table (UDT), on the volume of small bowel included within a 4-field pelvic irradiation plan. Methods: A polystyrene bowel displacement standard mold was created and added to a customized vacuum cushion (Vac Lok) formed around the abdomen and legs of each patient in the prone position. Two hundred seventy-seven consecutive patients with pelvic malignancies treated with the UDT device were compared with 1 historic series (68 cases) treated at our division. Small bowel contrast dyes at the time of simulation were used in all patients. Results: The average volume of small bowel within the planning target volume (high-dose volume, calculated with Gallagher method) was 100 cm3 (median 49±114) in the series treated with standard box technique and 23 cm3 (median 0±64) in the series treated with the UDT (p3 (median 447±338) and 158 cm3 (median 69±207), respectively (p<0.001). The incidence of G1, G2, and G3 acute enteric toxicity (Radiation Therapy Oncology Group criteria) in the UDT series was 16%, 15%, and 1.5%; in the standard box technique, it was 28%, 25%, and 3%, respectively (p<0.05). The incidence of acute enteric toxicity directly correlated with the irradiated small bowel volume. In the UDT series, the 5-year actuarial incidence of G3 chronic enteric toial incidence of G3 chronic enteric toxicity was 1.8%. The setup procedures, analyzed in 18 cases, revealed no systematic errors and a standard deviation equal to ±5 mm for random errors. Conclusions: The UDT technique is comfortable, inexpensive, highly reproducible, and permits an almost full bowel displacement from standard radiotherapy fields

243

Non-invasive quantification of small bowel water content by MRI: a validation study  

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Substantial water fluxes across the small intestine occur during digestion of food, but so far measuring these has required invasive intubation techniques. This paper describes a non-invasive magnetic resonance imaging (MRI) technique for measuring small bowel water content which has been validated using naso-duodenal infusion. Eighteen healthy volunteers were intubated, with the tube position being verified by MRI. After a baseline MRI scan, each volunteer had eight 40 ml boluses of a non-absorbable mannitol and saline solution infused into their proximal small bowel with an MRI scan being acquired after each bolus. The MRI sequence used was an adapted magnetic resonance cholangiopancreatography sequence. The image data were thresholded to allow for intra- and inter-subject signal variations. The MRI measured volumes were then compared to the known infused volumes. This MRI technique gave excellent images of the small bowel, which closely resemble those obtained using conventional radiology with barium contrast. The mean difference between the measured MRI volumes and infused volumes was 2% with a standard deviation of 10%. The maximum 95% limits of agreement between observers were -15% to +17% while measurements by the same operator on separate occasions differed by only 4%. This new technique can now be applied to study alterations in small bowel fluid absorption and secretion due to gastrointestinal disease or drug interventio000.

Hoad, C L [Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD (United Kingdom); Marciani, L [Wolfson Digestive Diseases Centre, QMC, Nottingham University Hospitals, University of Nottingham, Nottingham (United Kingdom); Foley, S [Wolfson Digestive Diseases Centre, QMC, Nottingham University Hospitals, University of Nottingham, Nottingham (United Kingdom); Totman, J J [Brain and Body Centre, University of Nottingham, Nottingham (United Kingdom); Wright, J [Division of GI Surgery, QMC, Nottingham University Hospitals, University of Nottingham, Nottingham (United Kingdom); Bush, D [Division of GI Surgery, QMC, Nottingham University Hospitals, University of Nottingham, Nottingham (United Kingdom); Cox, E F [Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD (United Kingdom); Campbell, E [Wolfson Digestive Diseases Centre, QMC, Nottingham University Hospitals, University of Nottingham, Nottingham (United Kingdom); Spiller, R C [Wolfson Digestive Diseases Centre, QMC, Nottingham University Hospitals, University of Nottingham, Nottingham (United Kingdom); Gowland, P A [Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, NG7 2RD (United Kingdom)

2007-12-07

244

Laparoscopic repair of a small bowel herniation through a broad ligament defect  

OpenAIRE

A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful.

Buero, Agusti?n; Silberman, Ezequiel A.; Medina, Pablo; Morra, Matias E.; Bogetti, Diego J.; Porto, Eduardo A.

2014-01-01

245

Use of a preparation of galactomannane for translucent small bowel presentation  

International Nuclear Information System (INIS)

An improvement of radiological small bowel examination is achieved by a specially composed contrast medium, the use of a galactomannane based non methylcellulose containing distention medium and a specially adapted instillation technique. The distention of the terminal ileum can be supported pharmacologically by ceruletid. (orig.)

246

Ileoscopy reduces the need for small bowel imaging in suspected Crohn's disease  

DEFF Research Database (Denmark)

In suspected Crohn's disease (CD), current diagnostic guidelines recommend additional small bowel imaging irrespective of the findings at ileocolonoscopy. Magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) are regarded first line imaging techniques and should generally precede capsule endoscopy.

Jensen, Michael Dam; Nathan, Torben

2012-01-01

247

Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection  

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Aim: To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. Patients and methods: In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. Results: Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p = 0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. Conclusion: Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease.

Maconi, G. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy)]. E-mail: giovanni.maconi@unimi.it; Radice, E. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Greco, S. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Bezzio, C. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy); Bianchi Porro, G. [Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan (Italy)

2007-08-15

248

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

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Full Text Available 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.

Mihai Rimba?, M?d?lina Marinescu, Mihail Radu Voiosu, Cristian R?svan B?icu?, Simona Caraiola, Adriana Nicolau, Doina Ni?escu, Georgeta Camelia Badea, Magda Ileana Pârvu

2011-02-01

249

Transient small-bowel intussusceptions in adults: significance of ultrasonographic detection  

International Nuclear Information System (INIS)

Aim: To investigate the frequency, clinical significance, and outcome of small-bowel intussusceptions in adults detected using ultrasound in an outpatient setting. Patients and methods: In two different retrospective (January 2001 to April 2003) and prospective (May 2003 to June 2005) periods, 33 small-bowel intussusceptions were found in 32 patients (13 females; mean age: 38.1 years) with known or suspected intestinal disease. Patients underwent diagnostic work-up to assess any organic disease. Patients with self-limiting intussusception were submitted to clinical and ultrasonographic follow-up. Results: Of the 32 patients with small-bowel intussusception, 25 were identified in the prospective series of 4487 examinations (0.53%) and seven in the retrospective series of 5342 examinations (0.15%; p = 0.002). Four patients had persistent and 28 self-limiting intussusceptions. Self-limiting intussusceptions were idiopathic in 11 patients (39%) or associated with organic diseases in 17 (Crohn's disease in 11 patients, celiac disease in three, ulcerative colitis in one patient, and previous surgery for cancer in two). Self-limiting intussusceptions were asymptomatic in 25% of patients. Conclusion: Small-bowel intussusceptions in adults are not rare and are frequently self-limiting, idiopathic, or related to organic diseases, mainly Crohn's disease and coeliac disease

250

Strongyloides stercoralis hyperinfection presenting as subacute small bowel obstruction following immunosuppressive chemotherapy for multiple myeloma.  

Science.gov (United States)

We report the case of a 59-year-old Afro-Caribbean woman who presented with symptoms of anorexia, lethargy, abdominal distension and vomiting on the background of newly diagnosed multiple myeloma, treated with one cycle of cyclophosphamide-thalidomide-dexamethasone chemotherapy 20 days previously. A diagnosis of subacute bowel obstruction was made; however, the aetiology of the obstruction remained elusive. Common electrolyte abnormalities were excluded and a midline laparotomy revealed minimal intra-abdominal adhesions. Histological examination of a small bowel mesentery biopsy showed inflammatory cell infiltrate composed of lymphocytes, eosinophils and occasional plasma cells with a foreign body giant cell reaction suggestive of worm infection. A postoperative stool sample revealed heavy infestation with the rhabditiform larvae of Strongyloides stercoralis. The patient recovered following ivermectin treatment. In the absence of other causality, we attribute the subacute bowel obstruction to S stercoralis hyperinfection, triggered by immunosuppression secondary to chemotherapy and multiple myeloma. PMID:24469840

Shields, Adrian Matthew; Goderya, Rashida; Atta, Mustafa; Sinha, Prakash

2014-01-01

251

Small and large bowel volvulus: Clues to early recognition and complications  

International Nuclear Information System (INIS)

Small and large bowel volvulus are uncommon causes of bowel obstruction with nonspecific clinical manifestations which may delay the diagnosis and increase morbidity. Therefore, radiologists play an important role in promptly establishing the diagnosis, recognizing underlying congenital or acquired risk factors and detecting potentially life-threatening complications. Multidetector CT performed with intravenous contrast is currently the preferred modality for the evaluation of volvulus, which is best appreciated when imaging is perpendicular to the axis of bowel rotation, hence the benefit of multiplanar reformations. In this pictorial essay we review the pathophysiology of the different types of intestinal volvulus, discuss diagnostic criteria for prompt diagnosis of volvulus and emphasize early recognition of the complications.

252

Small and large bowel volvulus: Clues to early recognition and complications  

Energy Technology Data Exchange (ETDEWEB)

Small and large bowel volvulus are uncommon causes of bowel obstruction with nonspecific clinical manifestations which may delay the diagnosis and increase morbidity. Therefore, radiologists play an important role in promptly establishing the diagnosis, recognizing underlying congenital or acquired risk factors and detecting potentially life-threatening complications. Multidetector CT performed with intravenous contrast is currently the preferred modality for the evaluation of volvulus, which is best appreciated when imaging is perpendicular to the axis of bowel rotation, hence the benefit of multiplanar reformations. In this pictorial essay we review the pathophysiology of the different types of intestinal volvulus, discuss diagnostic criteria for prompt diagnosis of volvulus and emphasize early recognition of the complications.

Lepage-Saucier, Marianne [Departement de radiologie, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal (CHUM), 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada); Tang, An [Departement de radiologie, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal (CHUM), 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada)], E-mail: duotango@gmail.com; Billiard, Jean-Sebastien; Murphy-Lavallee, Jessica; Lepanto, Luigi [Departement de radiologie, Hopital Saint-Luc, Centre Hospitalier Universitaire de Montreal (CHUM), 1058 rue Saint-Denis, Montreal, Quebec, H2X 3J4 (Canada)

2010-04-15

253

Peripheral Primitive Neuroectodermal Tumor with Osseous Component of the Small Bowel Mesentery: A Case Study  

OpenAIRE

A case of peripheral primitive neuroectodermal tumor of the small bowel mesentery with osseous component is reported. A 23-year-old man was admitted to our hospital because of acute severe abdominal pain. Abdominal computed tomography revealed a large solid and cystic, oval shaped mass, measuring 11.0×6.0 cm in the pelvic cavity. Histologically the resected lesion consisted of sheets of undifferentiated small round cells forming Homer-Wright rosettes and perivascular pseudorosettes, and show...

Kim, Joon Mee; Chu, Young Chae; Choi, Chang Hwan; Kim, Lucia; Choi, Suk Jin; Park, In Suh; Han, Jee Young; Kim, Kyung Rae; Choi, Yoon-la; Kim, Taeeun

2013-01-01

254

Small bowel haemorrhage associated with partial midgut malrotation in a middle-aged man  

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Full Text Available Abstract We describe a case of life-threatening small bowel haemorrhage in a 56 year old man, who was found to have partial midgut malrotation at laparotomy. An association between congenital malrotation and gastrointestinal haemorrhage has not previously been reported in this age group. We discuss the association between gut malrotation and small intestinal pathology and describe the principles of management in these patients.

Peddu Praveen

2009-01-01

255

Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?  

OpenAIRE

Abstract Background Small intestinal bacterial overgrowth (SIBO) is a condition in which excessive levels of bacteria, mainly the colonic-type species are present in the small intestine. Recent data suggest that SIBO may contribute to the pathophysiology of Irritable bowel syndrome (IBS). The purpose of this study was to identify potential predictors of SIBO in patients with IBS. Methods Adults with IBS based on Rome II criteria who had predominance of bloating and flatulence underwent a gluc...

McCallum Richard W; Sostarich Sandra; Reddymasu Savio C

2010-01-01

256

Mucosal healing effect of mesalazine granules in naproxen-induced small bowel enteropathy  

OpenAIRE

AIM: To investigate the effect of mesalazine granules on small intestinal injury induced by naproxen using capsule endoscopy (CE). METHODS: This was a single center, non-randomized, open-label, uncontrolled pilot study, using the PillCam SB CE system with RAPID 5 software. The Lewis Index Score (LIS) for small bowel injury was investigated to evaluate the severity of mucosal injury. Arthropathy patients with at least one month history of daily naproxen use of 1000 mg and proton pump inhibitor...

Xe Cz, Istv Xe N. R.; Szalai, Mil Xe N.; Valéria Kovács; Czi, Henriett Reg X.; Gyöngyi Kiss; Horv Xe Th, Zolt Xe N.

2013-01-01

257

Chlamydia trachomatis antigens in enteroendocrine cells and macrophages of the small bowel in patients with severe irritable bowel syndrome  

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Full Text Available Abstract Background Inflammation and immune activation have repeatedly been suggested as pathogentic factors in irritable bowel syndrome (IBS. The driving force for immune activation in IBS remains unknown. The aim of our study was to find out if the obligate intracellular pathogen Chlamydia could be involved in the pathogenesis of IBS. Methods We studied 65 patients (61 females with IBS and 42 (29 females healthy controls in which IBS had been excluded. Full thickness biopsies from the jejunum and mucosa biopsies from the duodenum and the jejunum were stained with a monoclonal antibody to Chlamydia lipopolysaccharide (LPS and species-specific monoclonal antibodies to C. trachomatis and C. pneumoniae. We used polyclonal antibodies to chromogranin A, CD68, CD11c, and CD117 to identify enteroendocrine cells, macrophages, dendritic, and mast cells, respectively. Results Chlamydia LPS was present in 89% of patients with IBS, but in only 14% of healthy controls (p C. trachomatis major outer membrane protein (MOMP. Staining for C. pneumoniae was negative in both patients and controls. Chlamydia LPS was detected in enteroendocrine cells of the mucosa in 90% of positive biopsies and in subepithelial macrophages in 69% of biopsies. Biopsies taken at different time points in 19 patients revealed persistence of Chlamydia LPS up to 11 years. The odds ratio for the association of Chlamydia LPS with presence of IBS (43.1; 95% CI: 13.2-140.7 is much higher than any previously described pathogenetic marker in IBS. Conclusions We found C. trachomatis antigens in enteroendocrine cells and macrophages in the small bowel mucosa of patients with IBS. Further studies are required to clarify if the presence of such antigens has a role in the pathogenesis of IBS.

Sandström Gunnar

2010-02-01

258

MR imaging of the small bowel in Crohn's disease  

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MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantage of these techniques over tradition barium fluoroscopic examinations secondary to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure [Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84]. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility [Froehlich JM, Patak MA, von Weymarn C, Juli CF, Zollikofer CL, Wentz KU. Small bowel motility assessment with magnetic resonance imaging. J Magn Reson Imaging 2005;21:370-75]. A recent study showed that certain subgroups of patients with Crohn's disease may be exposed to higher doses of radiation; those diagnosed at an early age, those with upper tract inflammation, penetrating disease, requirement of intravenous steroids, infliximab or multiple surgeries [Desmond AN, O'Regan K, Curran C, et al. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut 2008;57:1524-29]. Therefore it has been suggested that techniques that can reduce or eliminate radiation exposure should be considered for imaging [Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84]. Owing to the excellent softtissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing radiation and availability of a variety of oral contrast agents, MR is well suited to play a critical role in the imaging of small bowel disorders. In this article we will review the technical issues related to the performance of MR enterography and enteroclysis and discuss the role and controversies of using MR in the assessment of inflammatory bowel disease.

Siddiki, Hassan [Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (United States); Fidler, Jeff [Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (United States)], E-mail: fidler.jeff@mayo.edu

2009-03-15

259

PDGF-? stimulates intestinal epithelial cell turnover after massive small bowel resection in a rat.  

Science.gov (United States)

Numerous cytokines have been shown to affect epithelial cell differentiation and proliferation through epithelial-mesenchymal interaction. Growing evidence suggests that platelet-derived growth factor (PDGF) signaling is an important mediator of these interactions. The purpose of this study was to evaluate the effect of PDGF-? on enterocyte turnover in a rat model of short bowel syndrome (SBS). Male rats were divided into four groups: Sham rats underwent bowel transection, Sham-PDGF-? rats underwent bowel transection and were treated with PDGF-?, SBS rats underwent a 75% bowel resection, and SBS-PDGF-? rats underwent bowel resection and were treated with PDGF-?. Parameters of intestinal adaptation, enterocyte proliferation and apoptosis were determined at euthanasia. Illumina's Digital Gene Expression analysis was used to determine PDGF-related gene expression profiling. PDGF-? and PDGF-? receptor (PDGFR-?) expression was determined by real-time PCR. Western blotting was used to determine p-ERK, Akt1/2/3, bax, and bcl-2 protein levels. SBS rats demonstrated a significant increase in PDGF-? and PDGFR-? expression in jejunum and ileum compared with sham animals. SBS-PDGF-? rats demonstrated a significant increase in bowel and mucosal weight, villus height, and crypt depth in jejunum and ileum compared with SBS animals. PDGF-? receptor expression in crypts increased in SBS rats (vs. sham) and was accompanied by an increased cell proliferation following PDGF-? administration. A significant decrease in cell apoptosis in this group was correlated with lower bax protein levels. In conclusion, in a rat model of SBS, PDGF-? stimulates enterocyte turnover, which is correlated with upregulated PDGF-? receptor expression in the remaining small intestine. PMID:22461028

Sukhotnik, Igor; Mogilner, Jorge G; Pollak, Yulia; Blumenfeld, Shiri; Bejar, Jacob; Coran, Arnold G

2012-06-01

260

Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass  

International Nuclear Information System (INIS)

Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass

261

Double-balloon enteroscopy in small bowel tumors: A Chinese single-center study  

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Full Text Available AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and operation results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400; the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78, gastrointestinal stromal tumor (24.4%, 19/78 and lymphoma (15.4%, 12/78 were the most common tumors. Among the 78 tumors, 60.3% (47/78 were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78. DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4% and abdominal pain (24.4%. The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78, which was higher than that of a computed tomography scan (72.9%, 51/70. Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.

Wen-Guo Chen

2013-01-01

262

Effect of viscous fiber (guar) on postprandial motor activity in human small bowel.  

Science.gov (United States)

Both caloric value and chemical composition of a meal have been shown to regulate postprandial small bowel motility in dog. In the same species, duration of and contractile activity within the postprandial period also depends on mean viscosity. It is unknown, however, whether meal viscosity and fiber content also regulate small bowel motor activity in man. In human volunteers, we therefore studied the effect of guar gum on small bowel motor response to liquid and solid meals. Twenty-six prolonged ambulatory small bowel manometry studies were performed in 12 volunteers. A total of 620 hr of recording were analyzed visually for phase III of the MMC and a validated computer program calculated the incidence and amplitude of contractions after ingestion of water (300 ml), a pure glucose drink (300 ml/330 kcal) or a solid meal (530 kcal) with and without 5 g of guar gum. Addition of 5 g of guar gum did not significantly delay reappearance of phase III after ingestion of water (59 +/- 11 vs 106 +/- 21 min; P = 0.09). However, guar gum significantly prolonged duration of postprandial motility pattern both after the glucose drink (123 +/- 19 vs 199 +/- 24 min; P meal (310 +/- 92 vs 419 +/- 22 min; P = 0.005). Contractile activity during these periods was not affected by guar gum. This was true for mean incidence of contractions after water (1.9 +/- 0.3 vs 1.8 +/- 0.5 min-1), after the glucose drink (1.6 +/- 0.4 vs. 1.7 +/- 0.3 min-1) and after the solid meal (2.4 +/- 0.4 vs 2.6 +/- 0.4 min-1). Likewise, mean amplitude of contractions was not affected by guar gum after water (22.8 +/- 1.4 vs 20.9 +/- 1.9 mm Hg), after the glucose drink (20.5 +/- 1.4 vs 21.3 +/- 1.2), and after the solid meal (20.3 +/- 1.5 vs 21.5 +/- 1.6 mm Hg). Thus a guar gum-induced increase in chyme viscosity markedly prolonged duration of postprandial motor activity in the human small bowel. Contractile activity within the postprandial period, however, was not affected. We suggest that the postprandial motility pattern persisted longer after the more viscous meals, because gastric emptying and intestinal transit were delayed by guar gum. We conclude that it is essential to define meal viscosity and fiber contents when studying postprandial small bowel motility. PMID:9286225

Schönfeld, J; Evans, D F; Wingate, D L

1997-08-01

263

Pathological and clinical significance of increased intraepithelial lymphocytes (IELs) in small bowel mucosa.  

Science.gov (United States)

Intestinal intraepithelial lymphocytes (IELs) belong to a unique T-cell population interspersed between epithelial cells of both the small and large intestine. It is becoming increasingly recognised that an increased number of IELs with a normal villous architecture is within the wide spectrum of histological abnormalities observed in coeliac disease. An increased number of IELs is the earliest pathological change following gluten challenge and a high IEL count may be the only sign of gluten sensitivity. Therefore, the finding of a raised IEL count with normal villous architecture is of sufficient clinical importance to be reported in routine small bowel biopsies. However, it is evident that not all small intestinal biopsy specimens showing increased IELs are explained by gluten sensitivity. Increased IELs in small bowel mucosa have also been associated with autoimmune disorders, tropical sprue, food protein intolerance, Helicobacter pylori-associated gastritis, peptic duodenitis, parasitic and viral infections, as well as the development of intestinal lymphoma. Histological examination of a biopsy specimen of the small bowel remains the diagnostic gold standard for coeliac disease. There will be an ever increasing demand for histological confirmation of gluten sensitivity in patients in whom the classic microscopic appearance of flattened villi may not have fully developed. The more widespread recognition by histopathologists of the pattern of injury manifested by increased numbers of IELs in intestinal biopsy specimens will certainly help in early diagnosis of coeliac disease, lessen diagnostic confusion and influence the modern practice of gastrointestinal tract medicine. This review discusses some of the recent developments in clinical pathology pertaining to increased IELs in small bowel mucosal biopsies. PMID:15996156

Chang, Fuju; Mahadeva, Ula; Deere, Harriet

2005-06-01

264

14C-oxalic acid resorption in patients with small bowel resection, jejunoileal bypass, Crohn's disease, and chronic pancreatitis  

International Nuclear Information System (INIS)

The enteric absorption of oxalic acid was determined with 14C-oxalic acid in patients with small bowel resection, jejunoileal bypass, Crohn's disease and chronic pancreatitis in comparison to the control group. Extreme hyperoxaluria was found in small bowel resections above 100 cm, after bypass operations and in ileocolitis Crohn with signs of clinical activity. Small bowel resections and relapses of Crohn's disease increase the absorption of oxalic acid. The significance of 14C-oxalic acid absorption test is the recognition of enteric hyperoxaluria. (author)

265

Efficacy and efficiency of small bowel double contrast enema  

International Nuclear Information System (INIS)

The double contrast examination is the most effective morphological screening method for the evaluation of the whole small intestine. Its sensitivity is 85%, its specifity 96.7%. In specific clinical problems the number of pathological roentgen rises: from 34,4% when all indications are taken into consideration to 58% in indications specific to the small intestine such as Morbus Crohn or the malabsorption syndrome. Search for tumors and the double contrast of the small intestine in unclear gastro-intestinal bleeding are unproductive. The weak point of this screening method is the lower part of the small intestine. Therefore, the selective peroral or retrograde analysis of the terminal ileum supplement the contrast method. A precondition for good results is an adequate technical standard. Besides the clinical results some technical results are therefore discussed such as contrast medium quantities, examination and X-ray time, radiation exposure and influences on the image quality. (orig.)

266

Dynamic computed tomography of angioedema of the small bowel induced by iodinated contrast medium: prompted by coughing-related motion artifact.  

Science.gov (United States)

Small bowel angioedema is a rare adverse effect of iodinated contrast medium. Here, we report the first case of contrast medium-induced small bowel angioedema with concurrent respiratory tract symptoms. A patient with colon cancer underwent CT scanning for preoperative staging. After injection of the contrast medium, a persistent cough developed and CT images showed that the small bowel wall was abnormally thickened. It returned to normal by the follow-up. The persistent coughing that developed right after the CT and small bowel wall thickening on the contrast-enhanced CT suggested the diagnosis of small bowel angioedema induced by the contrast medium. PMID:22726981

Chen, Chun-Ku; Chang, Hsiao-Ting; Chen, Chi-Wen; Lee, Rheun-Chuan; Sheu, Ming-Huei; Wu, Mei-Han; Chou, Hsiao-Ping; Shen, Yen-Chun; Chiu, Nai-Chi; Chang, Cheng-Yen

2012-01-01

267

Bariumexaminations of the small intestine and the colon in inflammatory bowel disease  

International Nuclear Information System (INIS)

This article gives an overview of the possibilities of conventional radiography in the diagnosis of inflammatory bowel disease of the small intestine and colon.Material and methods For more than 25 years we examine the small bowel employing enteroclysis with barium and methylcellulose and the colon with the usual double-contrast method. In the last 152 months 1560 small bowel enemas were performed. In the last 40 months 410 examinations of the colon were performed. There is a thirty percent decrease in enteroclysis examinations within the past 5 years,however, the rate of examinations with positive results increased from 46 to 57%.The proportion of the inflammatory small intestinal diseases (not only Crohn's disease) remained constant with 18%.Concerning the examinations of the colon for inflammatory disease we confirmed the diagnosis in seven cases.The radiation exposure for the enteroclysis in inflammatory diseases was 7mSv, for colon examinations 14 mSv. Barium examinations, especially of the stomach and colon are decreasing in frequency.Therefore the art of performance and interpretation might get lost.Enteroclysis, however, is still the method of reference for the other imaging methods.The advantages compared to the other imaging methods are the excellent presentation of the details of the mucosal surface and the observation of functional disorders. (orig.)

268

Experience with an alternative contrast medium in oral small bowel imaging  

International Nuclear Information System (INIS)

Purpose: The image quality of oral small bowel imaging is often poor on account of the small bowel enema. A new contrast medium should increase the image quality due to better compliance of patient because of the better taste of substance. The loading of patient with radiation or time should not increase. Methods and patients: We investigated prospectively 40 patients, randomized in two groups of 20 patients each. Two different substances were used as contrast medium: barium-methylcellulose and Barium-Mucofalk trademark, respectively. The quality of the double contrast, profile of the mucosa, duration of radiation, duration of examination, dose-area product, and taste of the substance were judged for significance. Results: The taste of the new contrast medium was judged to be better: twice as often as ''good'' and five times less often as ''bad'', the difference was not significant due to the small number of patients. There is no significant difference in the other criterias. Conclusion: Mucofalk trademark is an alternative contrast medium for oral small bowel radiology in cases of difficult placement of the tube for enema. The quality of double contrast and visualization of the profile of mucosa are the same while the taste is better. (orig.)

269

Propagation of small bowel migrating motor complex activity fronts varies with anastomosis type.  

Science.gov (United States)

Fasting small intestine motility (migrating motor complex or MMC) occurs in humans and dogs in four phases. Activity fronts during phase III consist of high amplitude contractions propagating aborally and are interrupted by transection of the small intestine. To study the effect of anastomosis type on MMC propagation six dogs underwent resection of a 15-cm segment of bowel 45 cm distal to the ligament of Treitz and single layer hand sewn end-to-end (EE) anastomosis. Single layer end-to-side (ES) or side-to-side (SS) anastomoses were hand sewn 15 cm distal to the transection in six other dogs. Eight force transducer strain gauges were placed at 10-cm intervals about each anastomosis. At least 7 days after operation, small bowel contractions were recorded in fasted animals, and recordings were visually inspected. Only 1 of 36 activity fronts propagated across the end-to-end anastomosis within 45 days of surgery. However, after 60 days 25 of 39 phase III activity fronts propagated. There was no propagation of MMC activity across the ES anastomosis and only 10% of activity fronts propagated across the SS anastomosis. We conclude phase III MMC activity front propagation is interrupted by small bowel transection. Propagation regenerates after EE anastomosis, but not after ES or after SS anastomoses, even after prolonged healing. PMID:1943088

Arnold, J H; Alevizatos, C A; Cox, S E; Richards, W O

1991-12-01

270

Posterolateral diaphragmatic hernia with small-bowel incarceration in an adult  

Scientific Electronic Library Online (English)

Full Text Available Bochdalek hernia (BH), a closing defect ofthe peripheral posterior aspect ofthe diaphragm, is the most common ofthe congenital diaphragmatic hernias and is usually diagnosed in neonates. Symptomatic presentation of a right-sided diaphragmatic hernia in an adult is unusual. Owing to their rarity and [...] varied presentation, these hernias can pose a diagnostic challenge. A right-sided BH in a 40-year-old woman who presented with respiratory distress associated with abdominal pain and symptoms of small-bowel obstruction is reported. Midline laparotomy revealed necrotic small bowel and faecothorax of the pleural cavity. Diaphragmatic hernias should be included in the differential diagnosis of patients with acute or chronic gastrointestinal, or less frequently respiratory, symptoms.

G, Wenzel-Smith.

271

Posterolateral diaphragmatic hernia with small-bowel incarceration in an adult.  

Science.gov (United States)

Bochdalek hernia (BH), a closing defect of the peripheral posterior aspect of the diaphragm, is the commonest of the congenital diaphragmatic hernias and is usually diagnosed in neonates. Symptomatic presentation of a right-sided diaphragmatic hernia in an adult is unusual. Owing to their rarity and varied presentation, they can pose a diagnostic challenge. A right-sided BH in a 40-year-old woman who presented with respiratory distress associated with abdominal pain and symptoms of small-bowel obstruction is reported. Midline laparotomy revealed necrotic small bowel and faecothorax of the pleural cavity. Diaphragmatic hernias should be included in the differential diagnosis of patients with acute or chronic gastrointestinal, or less frequently respiratory, symptoms. PMID:23725897

Wenzel-Smith, Gisela

2013-05-01

272

Intestinal Radiation-Induced Stricture Favours Small Bowel Obstruction by Phytobezoar: Report of a Case  

Directory of Open Access Journals (Sweden)

Full Text Available Bezoars represent the fifth most frequent cause of acute small bowel obstruction. Phytobezoar is the most common type of bezoar. It is a concretion of undigestible fibers derived from ingested vegetables and fruits. We report a case of a woman with a 1-year history of recurrent epigastric and periumbilical abdominal pain with intermittent vomiting caused by phytobezoar of the terminal ileum. After careful investigation of the case and review of literature, we identified the factor involved in bezoar formation as radiation-induced ileal stenosis due to previous treatment for a pelvic tumour. This report provides evidence to consider phytobezoar as a possible cause of small bowel obstruction in patients previously treated with abdominal radiotherapy.

Alessandra Quercioli

2009-01-01

273

Thinking beyond the colon-small bowel Involvement in clostridium difficile infection  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Small intestinal Clostridium difficile seems to be increasing in incidence. The spectrum of Clostridium difficile infection (CDI has definitely expanded with small bowel involvement. They are more frequently reported in patients with inflammatory bowel disease (IBD who have undergone total colectomy or patients with Ileal anal pouch anastomosis. The most common presentation is increased ileostomy output with associated dehydration. High clinical suspicion, early recognition and appropriate treatment are the keys to successful resolution. The increase in the number of these patients may actually reflect an increase in the rising incidence of CDI in general or increasing virulence of the organism. Heightened public awareness and initiation of prompt preventive measures are the keystones to control of this infection. This disease is no longer limited to the colon and physicians should be educated to think beyond the colon in patients with CDI.

Navaneethan Udayakumar

2009-03-01

274

Imaging of small bowel-related complications following major abdominal surgery  

Energy Technology Data Exchange (ETDEWEB)

To recognize and document the small bowel reactions following major abdominal surgery is an important key for a correct diagnosis. Usually, plain abdominal radiography is the initial imaging examination requested in the immediate postoperative period, whereas gastrointestinal contrast studies are used to look for specific complications. In some countries, especially in Europe, sonography is widely employed to evaluate any acute affection of the abdomen. CT is commonly used to assess postoperative abdominal complications; in our institution also CT enteroclysis is often performed, to provide additional important informations. Radiologist should be able to diagnose less common types of obstruction, such as afferent loop, closed loop, strangulating obstruction as well as internal hernia. This knowledge may assume a critical importance for surgeons to decide on therapy. In this article, we focus our attention on the imaging (particularly CT) in small bowel complications following abdominal surgery.

Sandrasegaran, Kumaresan [Department of Radiology, Indiana University Medical Center, UH 0279, 550 N. University Boulevard, Indianapolis, IN 46202 (United States); Maglinte, Dean D.T. [Department of Radiology, Indiana University Medical Center, UH 0279, 550 N. University Boulevard, Indianapolis, IN 46202 (United States)]. E-mail: dmaglint@iupui.edu

2005-03-01

275

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

Science.gov (United States)

(Full text is available at http://www.manu.edu.mk/prilozi). 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 episodeof 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. Key words: Small bowel, diverticulosis, ileus, management. PMID:23917752

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

2013-01-01

276

The localization of bleeding small bowel lesions for conservative resection: a simple radiographic technique  

International Nuclear Information System (INIS)

Haemorrhage from the small bowel is a serious diagnostic and therapeutic problem. The value of selective superior mesenteric angiography to localize the source accurately does not require emphasizing. However, many of the lesions demonstrated are notoriously difficult to find at operation unless they are actively bleeding at the time. A simple method of intra-operative angiography is described which, because demonstration of the bleeding lesion on the operative films is not an essential requirement, does not involve the use of specialized angiographic equipment. Although only one case is offered to illustrate the method, it seems to possess sufficient versatility to be useful in most situations where intra-operative assistance in isolating a specific loop of small bowel for resection is anticipated. (author)

277

A case of radiation enteritis with small bowel ulcer causing massive bleeding  

International Nuclear Information System (INIS)

A 62-year-old female was admitted to our hospital for massive melena. She had been treated with radiation therapy for cervical cancer 4 months earlier. A retrograde double-balloon enteroscopy revealed a small ulcer in the small intestine, and small-bowel series demonstrated a slight stricture in the ulcerative lesion. Although melena was stopped after conservative therapy with blood transfusion, massive melena occurred again one month later. A normograde double-balloon enteroscopy revealed a small ulcer in the small intestine with a medium hemorrhage. Under laparotomy, a small induration was palpated in the small intestine 220 cm proximal to the ileocecal valve, and partial resection was performed. A small ulcer was included in the resected specimen, and histopathological examination demonstrated radiation enteritis with ulcer. The patient was discharged from the hospital 6 days after the operation, and no obvious symptom such as melena was seen at a 6-month follow-up. (author)

278

Small bowel intussussception due to metastatic melanoma of unknown primary site. Case report.  

Science.gov (United States)

Malignant melanoma is characterized by metastases also to the gastrointestinal tract, especially in the small bowel. The diagnosis is often delayed because unspecific clinical presentation (frequently as chronic iron deficiency anemia, rectal bleeding or intestinal obstruction). We present a case of melanoma of unknown primary site, with clinical presentation of intestinal obstruction. A segmental resection of the ileum was performed including mesentery with lymph nodes. Histology revealed metastatic melanoma from unknown primary. PET and MRI confirmed disseminated disease without brain metastasis. PMID:25419593

Stagnitti, F; Orsini, S; Martellucci, A; Tudisco, A; Avallone, M; Aiuti, F; Di Girolamo, V; Stefanelli, F; De Angelis, Francesco; Di Grazia, C; Napoleoni, A; Nicodemi, S; Cipriani, B; Ceci, F; Mosillo, R; Corelli, S; Casciaro, G; Spaziani, E

2014-01-01

279

Lymphangioma of the small bowel mesentery: A case report and review of the literature  

OpenAIRE

Lymphangioma is a rare benign condition characterized by proliferation of lymphatic spaces. It is usually found in the head and neck of affected children. Lymphangioma of the small-bowel mesentery is rare, having been reported for less than 1% of all lymphangiomas. Importantly, it can cause fatal complications such as volvulus or involvement of the main branch of the mesenteric arteries, requiring emergency surgery. Moreover, the gross and histopathologic findings may resemble benign multicys...

Worapop Suthiwartnarueput; Siriphut Kiatipunsodsai; Amolchaya Kwankua; Utairat Chaumrattanakul

2012-01-01

280

Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia.  

OpenAIRE

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old w...

Suh, I. W.; Park, C. S.; Lee, M. S.; Lee, J. H.; Chang, M. S.; Woo, J. H.; Lee, I. C.; Ryu, J. S.

2000-01-01

281

Small bowel obstruction: a review of 456 cases in a west of Ireland region.  

OpenAIRE

A retrospective study was carried out of 456 patients with small bowel obstruction (SBO). The operative findings of all patients who presented with SBO between 1977 and 1982 were compared and contrasted with those who presented during equivalent periods in the previous three decades. Obstructed hernias still account for the highest percentage of cases. Surprisingly, adhesions as a causative factor are not significantly more common than they were three decades ago, despite the enormous increas...

Cross, K. S.; Johnston, J. G.

1987-01-01

282

Brief Communication: oncofetal protein accompanying irradiation-induced small-bowel adenocarcinoma in the rat  

International Nuclear Information System (INIS)

A tumor-associated protein was found in tissue derived from an X-irradiation-induced adenocarcinoma in the small bowel of the rat. The protein was associated with the cell membranes of the tumor tissue. It shared common antigenic determinants both with a rat fetal protein and a perchloric acid-soluble protein isolated from the serum of the tumor-bearing rat. (auth)

283

Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions.  

OpenAIRE

The workload and costs of the emergency admissions and treatment of adhesive small bowel obstruction (ASBO) are unclear. This review details and costs the admission workload of ASBO. All admissions over a 2-year period for ASBO at two district general hospitals were identified through ICD10 diagnostic codes. Diagnostic investigations, treatment patterns, ward stay and outcome information for admissions were detailed from clinical records to develop mean cost estimates and assess the associate...

Menzies, D.; Parker, M.; Hoare, R.; Knight, A.

2001-01-01

284

Osteomalacic myopathy in a case of diffuse nodular lipomatosis of the small bowel.  

OpenAIRE

The case of a 57-year-old woman is described with a two months history of proximal muscle weakness and pain, marked hypotrophy and brisk reflexes. Clinical investigation demonstrated normal serum CK, myopathic EMG and osteomalacia. Muscle biopsy showed type II fibre atrophy and mitochondrial alterations without inclusions. Further examinations including a jejunal biopsy revealed malabsorption accounting for osteomalacia. At autopsy diffuse nodular lipomatosis of the small bowel was detected (...

Palmucci, Laura; Coda, Renato; Mongini, Tiziana Enrica

1982-01-01

285

Ret heterozygous mice have enhanced intestinal adaptation after massive small bowel resection  

OpenAIRE

Intestinal adaptation is an important compensatory response to massive small bowel resection (SBR) and occurs because of a proliferative stimulus to crypt enterocytes by poorly understood mechanisms. Recent studies suggest the enteric nervous system (ENS) influences enterocyte proliferation. We, therefore, sought to determine whether ENS dysfunction alters resection-induced adaptation responses. Ret+/? mice with abnormal ENS function and wild-type (WT) littermates underwent sham surgery or ...

Hitch, Meredith C.; Leinicke, Jennifer A.; Wakeman, Derek; Guo, Jun; Erwin, Chris R.; Rowland, Kathryn J.; Merrick, Ellen C.; Heuckeroth, Robert O.; Warner, Brad W.

2012-01-01

286

Spontaneous transmesenteric hernia: a rare cause of small bowel obstruction in an adult  

Directory of Open Access Journals (Sweden)

Full Text Available The authors report a case of spontaneous transmesenteric hernia with strangulation in an adult. Transmesenteric hernia (TMH is a rare cause of small bowel obstruction and is seldom diagnosed preoperatively, and most TMHs in adults are related to predisposing factors, such as previous surgery, abdominal trauma, and peritonitis. TMH are more likely to develop volvulus and strangulation or ischemia. A brief review of etiology, clinical features, diagnosis, and treatment is discussed.

Poras Chaudhary

2013-01-01

287

Congenital Internal Hernia Presented with Life Threatening Extensive Small Bowel Strangulation  

OpenAIRE

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 congenit...

Lee, Narae; Kim, Su-gon; Lee, Yeoun Joo; Park, Jae-hong; Son, Seung-kook; Kim, Soo-hong; Hwang, Jae-yeon

2013-01-01

288

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

International Nuclear Information System (INIS)

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 allo 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

289

Small-bowel Diverticulosis: Imaging Findings and Review of Three Cases  

OpenAIRE

Complicated small-bowel diverticulosis is a rather uncommon cause of upper abdominal pain. It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. As the presentation is often similar to other pathologies (acute appendicitis, pancreatitis, or acute cholecystis) and in many cases diagnosis is made on basis of surgical findings, careful analysis of the imaging landmarks may be warranted to aid in the early stages of detection. In this report, we present ...

Peuter, B.; Box, I.; Vanheste, R.; Dymarkowski, S.

2009-01-01

290

Small-bowel Diverticulosis:Imaging Findings and Review of Three Cases  

OpenAIRE

Complicated small-bowel diverticulosis is a rather uncommon cause of upper abdominal pain. It may lead to symptoms presenting with an acute onset or to chronic and nonspecific complaints. As the presentation is often similar to other pathologies (acute appendicitis, pancreatitis, or acute cholecystis) and in many cases diagnosis is made on basis of surgical findings, careful analysis of the imaging landmarks may be warranted to aid in the early stages of detection. In this report, we pres...

Peuter, B.; Box, I.; Vanheste, R.; Dymarkowski, S.

2009-01-01

291

Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. [...] We discuss the presentation of omphalomesenteric duct and its management.

Ghislain, Pauleau; Diane, Commandeur; Christophe, Andro; Xavier, Chapellier.

2012-08-01

292

Delayed Presentation of Small Bowel Injury During Suprapubic Catheterisation  

Directory of Open Access Journals (Sweden)

Full Text Available We present a case of small intestine injury resulting from suprapubic catheter insertion. This case is of particular interest for three reasons. Firstly, the presentation of the injury was delayed by three months, until the time of the first catheter exchange. Secondly, the injury was managed conservatively, without surgical exploration. Finally, the injury occurred using a newer, Seldinger-type suprapubic catheter insertion kit.

Jackson BL

2010-04-01

293

Histological assessment of small bowel hypoperfusion lesions in the pig  

OpenAIRE

Background Authors propose the use of a quantitative morphological assessment for helping in studies concerning intestinal hypoperfusion. The method was applied to the small intestine mucosa stained with the standard hematoxylin and eosin, from pigs that underwent severe hypotension due to acute hemorrhage.,. Methods Six Large White pigs underwent total intravenous anesthesia with propofol and remifentanil. 25 ml/kg of arterial blood were passively removed from the femoral artery...

Oliveira, A. L.; Ferreira, D.; Vala, Helena

2010-01-01

294

Small bowel obstruction caused by a carcinoid tumour  

Directory of Open Access Journals (Sweden)

Full Text Available Carcinoid tumours are rare neuroendocrine tumours causing a spectrum of symptoms ranging from chronic intestinal obstruction to systemic symptoms like sweating, diarrhoea and right side heart failure. We present here the case history of a male patient aged forty with a carcinoid tumour in the distal small intestine presenting with chronic intermittent intestinal obstruction and no systemic symptoms and metastasis. This case is presented for its rarity.

Ganesan M, Nirankumar Samuel, Karthikeyan.D, Ajay Raja

2014-04-01

295

Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention.  

LENUS (Irish Health Repository)

BACKGROUND: Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. METHODS: We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002-2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. RESULTS: Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan (n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15-7.84). CONCLUSION: The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery.

O'Daly, Brendan J

2009-06-01

296

Graft-versus-host reaction in small bowel transplantation and possibilities for its circumvention  

Energy Technology Data Exchange (ETDEWEB)

To describe GVHR in small bowel transplantation and its underlying mechanisms and to find methods for circumventing that response, accessory small bowel transplantation was carried out in the rat model. Animals not treated with cyclosporine, irradiation, or removal of the mesenteric lymph nodes of the graft died within 22 days postoperatively due to graft versus host disease. Mesenteric lymph nodes of the graft and recipient spleen and peripheral lymph nodes showed strong immunologic stimulation histologically and high antihost T-cell-mediated cytotoxic antihost reactivity. Seventy-one percent of the animals that had received 15 mg of cyclosporine per kilogram body weight orally survived 150 days after transplantation. After donor irradiation with 50 rads, 77 percent of the recipients survived 120 days. After microsurgical removal of the mesenteric lymph nodes of the graft, 89 percent survived 120 days. We conclude that GVHR plays an important role in small bowel transplantation and that the experimental regimens of donor, graft, and recipient treatment described herein have proved their efficacy for circumventing GVHR.

Deltz, E.; Ulrichs, K.; Schack, T.; Friedrichs, B.; Mueller-Ruchholtz, W.M.; Mueller-Hermelink, H.K.T.; Thiede, A.

1986-03-01

297

Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation  

Directory of Open Access Journals (Sweden)

Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

Sean Johnston

2012-07-01

298

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study  

International Nuclear Information System (INIS)

The aim of this study was to evaluate the accuracy of enteroclysis in the diagnosis of Crohn's disease of the small bowel in a group of consecutive patients. From January 1992 to December 1995, 165 patients with suspected Crohn's disease of the small bowel presented to our institution for enteroclysis. In 14 patients up to three enteroclysis exams were performed. Most patients (78 %) underwent colonoscopy and retrograde ileoscopy. In the remaining patients clinical follow-up was used as gold standard. In 79 patients no radiographic abnormalities were found. Sixty-one patients (40 men and 21 women; mean age 34.2 years) had a radiological diagnosis of Crohn's disease. This involved the terminal ileum in 39 patients (64 %) either alone (n = 25) or in association with the pelvic ileum (n = 14). In 12 of these patients retrograde ileoscopy was not feasible. Twenty-one patients underwent surgery. In 4 patients pathology revealed diseases other than Crohn's. These patients had all ileocecal diseases (tuberculosis = 2; non-Hodgkin's lymphoma = 1; adenocarcinoma = 1). One false-negative result was observed. Overall, enteroclysis showed a sensitivity of 98.2 % and a positive predictive value of 93.4 %. Enteroclysis is a sensitive technique in evaluating both the extent and the severity of small bowel involvement in Crohn's disease, although the overlap of radiographic findings may hamper its accuracy when the disease is confined to the ileocecal area. (orig.)ileocecal area. (orig.)

299

Graft-versus-host reaction in small bowel transplantation and possibilities for its circumvention  

International Nuclear Information System (INIS)

To describe GVHR in small bowel transplantation and its underlying mechanisms and to find methods for circumventing that response, accessory small bowel transplantation was carried out in the rat model. Animals not treated with cyclosporine, irradiation, or removal of the mesenteric lymph nodes of the graft died within 22 days postoperatively due to graft versus host disease. Mesenteric lymph nodes of the graft and recipient spleen and peripheral lymph nodes showed strong immunologic stimulation histologically and high antihost T-cell-mediated cytotoxic antihost reactivity. Seventy-one percent of the animals that had received 15 mg of cyclosporine per kilogram body weight orally survived 150 days after transplantation. After donor irradiation with 50 rads, 77 percent of the recipients survived 120 days. After microsurgical removal of the mesenteric lymph nodes of the graft, 89 percent survived 120 days. We conclude that GVHR plays an important role in small bowel transplantation and that the experimental regimens of donor, graft, and recipient treatment described herein have proved their efficacy for circumventing GVHR

300

Crohns disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis  

Directory of Open Access Journals (Sweden)

Full Text Available We report a 31-year-old woman with Crohn’s disease complicated by multiple stenoses and internal fistulas clinically misdiagnosed as small bowell endometriosis, due to the patient’s perimenstrual symptoms of mechanical subileus for 3 years; at first monthly, but later continuous, and gradually increasing in severity. We performed an exploratory laparotomy for small bowel obstruction, and found multiple ileal strictures and internal enteric fistulas. Because intraoperative findings were thought to indicate Crohn’s disease, a right hemicolectomy and partial distal ileum resection were performed for obstructive Crohn’s ileitis. Histopathology of the resected specimen revealed Crohn’s disease without endometrial tissue. The patient made an uneventful recovery from this procedure and was discharged home 10 d post-operatively. The differential diagnosis of Crohn’s diease with intestinal endometriosis may be difficult pre-operatively. The two entities share many overlapping clinical, radiological and pathological features. Nevertheless, when it is difficult to identify the cause of intestinal obstruction in a woman of child-bearing age with cyclical symptoms suggestive of small bowel endometriosis, Crohn’s disease should be included in the differential diagnosis.

Zafer Teke, Faruk Onder Aytekin, Ali Ozgur Atalay, Nese Calli Demirkan

2008-01-01

301

Detection of unsuspected colonic abnormalities using the pneumocolon technique during small bowel meal examination  

Energy Technology Data Exchange (ETDEWEB)

AIMS: The pneumocolon technique in small bowel meal examination is used to obtain double-contrast views of the distal ileum. The purpose of this study was to determine the proportion of cases in which an overhead pneumocolon radiograph demonstrated clinically relevant findings in the colon. METHODS: The overhead pneumocolon radiographs in 151 patients who underwent small bowel meals were evaluated retrospectively. A chart review was performed on those patients with positive colonic findings to determine if the suspected abnormalities affected patient management. RESULTS: Colonic abnormalities were identified in 34 of the 151 patients. One patient had a previously undiagnosed ascending colonic cancer; 17 had evidence of acute or chronic colitis; 13 had diverticulosis; one had a caecal polyp; one had an ileosigmoid fistula; one had a filling defect in the ascending colon. In 25 cases the colonic abnormality was visible only on the pneumocolon radiograph and not on the preceding single-contrast images. Management was altered by the colonic findings in seven cases. False-positive findings occurred in two cases. CONCLUSIONS: A routine overhead radiograph following use of the pneumocolon technique is a useful adjunct to small bowel meal examination as it can yield unsuspected and clinically significant colonic findings. Chou, S. (2000)

Chou, S.; Skehan, S.J.; Brown, A.L.; Rawlinson, J.; Somers, S

2000-06-01

302

Detection of unsuspected colonic abnormalities using the pneumocolon technique during small bowel meal examination  

International Nuclear Information System (INIS)

AIMS: The pneumocolon technique in small bowel meal examination is used to obtain double-contrast views of the distal ileum. The purpose of this study was to determine the proportion of cases in which an overhead pneumocolon radiograph demonstrated clinically relevant findings in the colon. METHODS: The overhead pneumocolon radiographs in 151 patients who underwent small bowel meals were evaluated retrospectively. A chart review was performed on those patients with positive colonic findings to determine if the suspected abnormalities affected patient management. RESULTS: Colonic abnormalities were identified in 34 of the 151 patients. One patient had a previously undiagnosed ascending colonic cancer; 17 had evidence of acute or chronic colitis; 13 had diverticulosis; one had a caecal polyp; one had an ileosigmoid fistula; one had a filling defect in the ascending colon. In 25 cases the colonic abnormality was visible only on the pneumocolon radiograph and not on the preceding single-contrast images. Management was altered by the colonic findings in seven cases. False-positive findings occurred in two cases. CONCLUSIONS: A routine overhead radiograph following use of the pneumocolon technique is a useful adjunct to small bowel meal examination as it can yield unsuspected and clinically significant colonic findings. Chou, S. (2000)

303

Retained capsule endoscope leading to the identification of small bowel adenocarcinoma in a patient with undiagnosed Crohn disease.  

Science.gov (United States)

Small intestinal neoplasia is a rare condition that frequently presents a diagnostic challenge. We describe the case of a 70-year-old patient who presented with several years of chronic, intermittent abdominal pain, previously diagnosed as irritable bowel syndrome. Radiographic evaluation, including upper gastrointestinal series with small bowel follow-through and computed tomography, demonstrated dilated small bowel with possible strictures. Colonoscopy and upper endoscopy were unrevealing. Attempted capsule endoscopy resulted in capsule retention. Subsequent laparoscopy led to the identification of severe, active Crohn disease with strictures, ulcers, crypt abscesses, pyloric metaplasia, and transmural inflammation. Extensive flat and polypoid high- and low-grade dysplasia were present, as well as an area of well-differentiated adenocarcinoma invading into the muscularis propria. We discuss the epidemiology, pathogenesis, and diagnosis of small bowel malignancy. PMID:19917475

McGowan, Christopher E; Lagares-Garcia, Jorge A; Bhattacharya, Baishali

2009-12-01

304

Mucosal healing effect of mesalazine granules in naproxen-induced small bowel enteropathy  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To investigate the effect of mesalazine granules on small intestinal injury induced by naproxen using capsule endoscopy (CE. METHODS: This was a single center, non-randomized, open-label, uncontrolled pilot study, using the PillCam SB CE system with RAPID 5 software. The Lewis Index Score (LIS for small bowel injury was investigated to evaluate the severity of mucosal injury. Arthropathy patients with at least one month history of daily naproxen use of 1000 mg and proton pump inhibitor co-therapy were screened. Patients with a minimum LIS of 135 were eligible to enter the 4-wk treatment phase of the study. During this treatment period, 3 × 1000 mg/d mesalazine granules were added to ongoing therapies of 1000 mg/d naproxen and 20 mg/d omeprazole. At the end of the 4-wk combined treatment period, a second small bowel CE was performed to re-evaluate the enteropathy according to the LIS results. The primary objective of this study was to assess the mucosal changes after 4 wk of mesalazine treatment. RESULTS: A total of 18 patients (16 females, ranging in age from 46 to 78 years (mean age 60.3 years were screened, all had been taking 1000 mg/d naproxen for at least one month. Eight patients were excluded from the mesalazine therapeutic phase of the study for the following reasons: the screening CE showed normal small bowel mucosa or only insignificant damages (LIS < 135 in five patients, the screening esophagogastroduodenoscopy revealed gastric ulcer in one patient, capsule technical failure and incomplete CE due to poor small bowel cleanliness in two patients. Ten patients (9 female, mean age 56.2 years whose initial LIS reached mild and moderate-to-severe enteropathy grades (between 135 and 790 and ? 790 entered the 4-wk therapeutic phase and a repeat CE was performed. When comparing the change in LIS from baseline to end of treatment in all patients, a marked decrease was seen (mean LIS: 1236.4 ± 821.9 vs 925.2 ± 543.4, P = 0.271. Moreover, a significant difference between pre- and post-treatment mean total LIS was detected in 7 patients who had moderate-to-severe enteropathy gradings at the inclusion CE (mean LIS: 1615 ± 672 vs 1064 ± 424, P = 0.033. CONCLUSION: According to the small bowel CE evaluation mesalazine granules significantly attenuated mucosal injuries in patients with moderate-to-severe enteropathies induced by naproxen.

István Rácz

2013-01-01

305

Tuberculosis versus non-Hodgkin’s lymphomas involving small bowel mesentery: Evaluation with contrast-enhanced computed tomography  

OpenAIRE

AIM: To evaluate the specific computed tomography (CT) imaging criteria for differentiating tuberculosis involving the small bowel mesenteric lymph nodes from lymphomas.METHODS: We retrospectively reviewed the anatomic distribution, CT enhancement patterns of lymphoma in 18 patients with mesenteric tuberculosis and 22 with untreated non-Hodgkin’s lymphomas (NHL) involving small bowel mesentery (SBM). Of the 18 patients with tuberculosis, 9 had purely mesenteric tuberculous lymphadenopathy (...

Peng Dong, Bin Wang

2008-01-01

306

Adenosine 3',5'-cyclic monophosphate levels in x-ray-induced small-bowel adenocarcinoma in the rat  

International Nuclear Information System (INIS)

X-ray-induced adenocarcinomas in the small bowels of outbred Lewis Brown Norway and Holtzman rats contained significantly lower concentrations of adenosine 3',5'-cyclic monophosphate than did normal rat intestinal tissue. No significant differences were observed between the intracellular concentrations of the nucleotide in the normal rat small bowel and those occurring in normal-appearing intestinal tissue exposed to tumor induction conditions

307

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction. METHODS: A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study. The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube (NGT was used in 90 patients. The therapeutic efficacy was compared between the two groups. RESULTS: Compared with the NGT group, the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph (4.1 ± 2.3 d vs 8.5 ± 5.0 d and laboratory tests (P < 0.01. The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group (P < 0.01. And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery. For recurrent adhesive bowel obstruction, ileus tube was also significantly more effective than NGT (95.8% vs 31.6%. In the ileus tube group, the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure (P < 0.05. The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery. CONCLUSION: Ileus tube can be used for adhesive small bowel obstruction. Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.

Xiao-Li Chen

2012-01-01

308

An experimental study on radiological examination of obstructed small bowel with various contrast media  

Energy Technology Data Exchange (ETDEWEB)

For the evaluation of the level and cause of small bowel obstruction, an oral barium study is usually chosen. When perforation is whether barium or a water-soluble contrast agent should be used, because barium causes from foreign body reactions as well as adhesions in the extraluminal tissues. Water-soluble contrast agent, on the other hand, are less satisfactory but in general have no untoward effects in the extraluminal tissues. Because of hyperosomolarity, water-soluble contrast agents attract large amounts of fluid with subsequent dilution and loss of contrast and pose a risk of pulmonary edema if aspirated. The use of the newer non-ionic and low-osmolarity water-soluble contrast will likely avoid pulmonary complications due to aspiration. The author performed this experimental study to compare the radiological efficacy of different contrast media in enteric follow-through examinations of obstructed small bowel. Rate had a ligature applied to the distal ileum via laparotomy. Four contrast media were subjected to testing by instillation via oro-gastric tube immediately after laparotomy. Radiographs were exposed at 1, 4 and 8 hours and evaluated later. After 24 hours the animals were sacrificed and the stomach and small bowels, free from mesentery and omental tissue, were weighted with contrasts. The progression in the bowel was proportionate to the osmolarity of the contrast media. After 1 hour, the observations indicated sodium diatrizoate (Gastrografin, Schering) to be the least favorable medium with respect to sharpness of the mucosal border. After 8 hours, barium gave a poorer delineation compared to Ioxaglate (Hexabric, Guerbet) and Iopromide (Ultravist, Schering). Early deaths were noted in the sodium diatrizoate and ioxaglate groups. So we conclude that when using a rather high-volume bolus, low-osmolar non-ionic contrast media seem to have significant prospects for general diagnostic use in patients with suspected intestinal obstruction.

Lee, Yong; Kim, Sung Jin; Han, Moon Hee; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1991-03-15

309

An experimental study on radiological examination of obstructed small bowel with various contrast media  

International Nuclear Information System (INIS)

For the evaluation of the level and cause of small bowel obstruction, an oral barium study is usually chosen. When perforation is whether barium or a water-soluble contrast agent should be used, because barium causes from foreign body reactions as well as adhesions in the extraluminal tissues. Water-soluble contrast agent, on the other hand, are less satisfactory but in general have no untoward effects in the extraluminal tissues. Because of hyperosomolarity, water-soluble contrast agents attract large amounts of fluid with subsequent dilution and loss of contrast and pose a risk of pulmonary edema if aspirated. The use of the newer non-ionic and low-osmolarity water-soluble contrast will likely avoid pulmonary complications due to aspiration. The author performed this experimental study to compare the radiological efficacy of different contrast media in enteric follow-through examinations of obstructed small bowel. Rate had a ligature applied to the distal ileum via laparotomy. Four contrast media were subjected to testing by instillation via oro-gastric tube immediately after laparotomy. Radiographs were exposed at 1, 4 and 8 hours and evaluated later. After 24 hours the animals were sacrificed and the stomach and small bowels, free from mesentery and omental tissue, were weighted with contrasts. The progression in the bowel was proportionate to the osmolarity of the contrast media. After 1 hour, the observations indicated sodium diatrizoate (Gastrografin, Schering)odium diatrizoate (Gastrografin, Schering) to be the least favorable medium with respect to sharpness of the mucosal border. After 8 hours, barium gave a poorer delineation compared to Ioxaglate (Hexabric, Guerbet) and Iopromide (Ultravist, Schering). Early deaths were noted in the sodium diatrizoate and ioxaglate groups. So we conclude that when using a rather high-volume bolus, low-osmolar non-ionic contrast media seem to have significant prospects for general diagnostic use in patients with suspected intestinal obstruction

310

Computed tomography features associated with operative management for nonstrangulating small bowel obstruction  

Science.gov (United States)

Background The management of nonstrangulating small bowel obstruction (SBO) may require surgery, but the need for and timing of surgical intervention isn’t always apparent. We sought to determine whether specific features on computed tomography (CT) can predict the necessity for operative management. Methods Two radiologists independently reviewed CT scans from all patients admitted to hospital with SBO between 2004 and 2006. We examined the association between radiographic features and operative management by univariate analysis using the ?2 or Fisher exact test. Significant factors with high concordance between radiologists were entered into a multivariable stepwise logistic regression model. Results There were 228 patients with SBO, 63 of whom met our inclusion criteria and had CT scans available for review. Three CT features were frequently associated with operative management and had good concordance between radiologists: complete bowel obstruction, small bowel dilation greater than 4 cm and transition point. Transition point was the only significant factor predictive of operative management for SBO on multivariable logistic regression analysis (OR 19, 95% confidence interval 1.8–201, p = 0.014). Conclusion In patients with nonstrangulating SBO, the presence of a transition point on CT scan should alert the surgeon to the increased likelihood that operative management may be required. PMID:25078930

Suri, Rakesh R.; Vora, Parag; Kirby, John M.; Ruo, Leyo

2014-01-01

311

Metastatic Deposits of Breast Lobular Carcinoma to Small Bowel and Rectum  

International Nuclear Information System (INIS)

Breast cancer is the most frequent malignancy in women accounting for approximately 32% of all cancers, with a lifetime risk of 1 in 10. It causes considerable morbidity and mortality. Recently, the survival rate has dramatically increased due to early detection of the disease and improvement in the treatment measures. However, more than 30% of the patients develop metastatic diseases following surgical treatment, radiotherapy, hormonal therapy, or chemotherapy. Distant spread is usually found in bones, lungs, liver, brain and skin. Rarely, it spreads to bowel, spleen, gallbladder, pancreas, urinary bladder, and eyes. Breast cancer is the second commonest primary tumour responsible for gastrointestinal metastases after malignant melanoma. We report a case of a Caucasian female who developed an intestinal obstruction secondary to metastatic deposits to the small bowel and later to the rectum from breast lobular carcinoma 2 years after mastectomy, axillary clearance, radiotherapy, hormonal therapy, and transverse rectums abdomens myocutaneous (TRAM) flap for reconstruction.

312

Misoprostol in the intestinal lumen protects against radiation injury of the mucosa of the small bowel  

International Nuclear Information System (INIS)

Systemically administered misoprostol, a PGE analog, has been shown to be an intestinal radioprotector. The purpose of this study was to determine if administration of misoprostol into the intestinal lumen can also reduce the severity of acute radiation enteritis. The rat small bowel was operatively exteriorized and segmented by means of suture ties. The remainder of the intestine and the rat were shielded in a lead box. Misoprostol was introduced into the lumen in various doses. After 30 min exposure to misoprostol, the isolated, exteriorized, segmented bowel was subjected to 11 Gy X irradiation. Five days later the animals were sacrificed and the intestines harvested for evaluation. Surviving crypt numbers per circumference and mucosal height were the criteria used for quantification of damage. Mucosa exposed to misoprostol at the time of radiation delivery showed significantly increased crypt numbers and mucosal height compared to adjacent saline-filled intestine. 24 refs., 2 figs., 2 tabs

313

Differentiation between active and chronic Crohn's disease using MRI small-bowel motility examinations — Initial experience  

International Nuclear Information System (INIS)

Aim: To evaluate the influence of locally active Crohn's disease on systemic small-bowel motility in patients with chronic Crohn's disease compared to healthy individuals. Material and methods: Fifteen healthy individuals (11 men, four women; mean age 37 years) and 20 patients with histopathologically proven active (n = 15; 10 women, 5 men; mean age 45 years) or chronic (n = 5; four women, one man; mean age 48 years) Crohn's disease were included in this institutional review board-approved, retrospective study. Magnetic resonance imaging (MRI; 1.5 T) was performed after standardized preparation. Two-dimensional (2D) cine sequences for motility acquisition were performed in apnoea (27 s). Motility assessment was performed using dedicated software in three randomly chosen areas of the small-bowel outside known Crohn's disease-affected hotspots. The main quantitative characteristics (frequency, amplitude, occlusion rate) were compared using Student's t-test and one-way analysis of variance (ANOVA). Results: Three randomly chosen segments were analysed in each participant. Patients with active Crohn's disease had significantly (p < 0.05) reduced contraction frequencies (active Crohn's disease: 2.86/min; chronic: 4.14/min; healthy: 4.53/min) and luminal occlusion rates (active: 0.43; chronic: 0.70; healthy: 0.73) compared to healthy individuals and patients with chronic Crohn's disease. Contraction amplitudes were significantly reduced during active Crohn's disease (6.71 mm) compared to healthy participants (10.14 mm), but this only reached borderline significance in comparison to chronic Crohn's disease (8.87 mm). Mean bowel lumen diameter was significantly (p = 0.04) higher in patients with active Crohn's disease (16.91 mm) compared to healthy participants (14.79 mm) but not in comparison to patients with chronic Crohn's disease (13.68). Conclusion: The findings of the present study suggest that local inflammatory activity of small-bowel segments in patients with active Crohn's disease alters small-bowel motility in distant, non-affected segments. The motility patterns revealed reduced contraction-wave frequencies, amplitudes, and decreased luminal occlusion rates. Thus evaluation of these characteristics potentially helps to differentiate between chronic and active Crohn's disease

314

Duodenojejunal atresia with "apple-peel" small bowel. A distinct form of intestinal atresia.  

Science.gov (United States)

Prenatal occlusion of the superior mesenteric artery results in a distinct type of distal duodenal or proximal jejunal atresia in which the dorsal mesentery is absent and the distal small bowel assumes a spiral configuration around its vascular stalk, strongly resembling an apple peel. In some instances the condition is transmitted genetically as an autosomal recessive disorder. The mortality rate is much higher than in either simple duodenal or jejunal atresia because of deficient collateral circulation to the small intestine. The authors tell of 2 patients who died of necrotizing enterocolitis, a disease related to vascular insufficiency. PMID:1251017

Leonidas, J C; Amoury, R A; Ashcraft, K W; Fellows, R A

1976-03-01

315

Colectomía parcial laparoscópica electiva por enfermedad diverticular / Elective laparoscopic colectomy for diverticular disease  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish La cirugía laparoscópica colorrectal, aunque de desarrollo lento, ha presentado en los últimos años ventajas con respecto a la cirugía abierta. Hay escasas publicaciones nacionales sobre esta técnica en enfermedad diverticular. Objetivo: Presentar nuestra experiencia en enfermedad diverticular en un [...] a serie consecutiva de pacientes con indicación quirúrgica electiva resueltos por vía laparoscópica. Material y Método: Se analizan los protocolos prospectivos de cirugía laparoscópica de colon con diagnóstico de enfermedad diverticular para resolución electiva, desde junio de 1997, hasta diciembre de 2009. Todo paciente con indicación quirúrgica electiva por esta patología fue resuelto por vía laparoscópica. Se estudian edad, sexo, tipo de resección, evolución postoperatoria inmediata y tardía. Resultados: Se operaron 60 pacientes, con edad promedio de 53,8 años. De éstos 46 fueron sigmoidectomías y 14 hemicolectomías izquierdas. El tiempo operatorio promedio fue de 173 minutos y la hospitalización de 4,16 días. Se convirtieron 3 pacientes (5%) y hubo 3 complicaciones (5%), que fueron manejadas médicamente. Hubo 1 estenosis de anastomosis tratada endoscópicamente como complicación tardía. Seguimiento promedio de 37,9 meses. Hubo 2 recidivas (3,3%), tratadas médicamente y no hubo mortalidad en esta serie. Conclusión: La cirugía laparoscópica para la enfermedad diverticular electiva es factible de realizar en la gran mayoría de los pacientes, con baja morbilidad y rápida recuperación. Abstract in english Background: Colorectal colectomy is a less invasive technique that can be used for the treatment of diverticular disease, recently in younger patients. Aim: To report the experience with laparoscopic colectomy for diverticular disease. Material and Methods: All patients with indication for elective [...] surgical resolution for diverticular disease were subjected to laparoscopic surgery from 1997 to 2009. The surgical protocols of these patients were analyzed. Results: Sixty patients with average age 53,8 (31 males) were operated in the period. Forty six were subjected to a sigmoidectomy and 14 to left hemicolectomy. Operative average time was 173 minutes and hospital stay 4,16 days. Three patients had to be converted to open surgery and three had complications that were managed without need of reoperation. During a median follow up of 38 months, the disease relapsed in two patients, which did not require a new intervention. Conclusions: Elective laparoscopic colectomy for diverticular disease is feasible and safe.

ERNESTO, MELKONIAN T; MARCELO, RODRÍGUEZ G; DAVID, CONTRERAS F; PATRICIO, OPAZO S; IGNACIO, ROBLES G; MAGDALENA, BRAVO H.

2011-02-01

316

A roentgenological study of duodenal diverticular in Korean  

International Nuclear Information System (INIS)

Duodenal diverticulum is a pouch like protrusion of the mucous menibrane through a weak area or defect of the muscle layer of the duodenal wall. 206 cases of the duodenal diverticular out of the consecutive 4030 cases on upper G-I series during the period from Feb. 1977 to Aug. 1978 Department of Radiology, College of Medicine, Hanyang University were studied. The results were as follows; 1. Overall incidence of duodenal diverticular was 5.1 percent (5.0 percent in male, and 5.3 percent in female). 2. The incidence of duodenal diverticular were 1.4 percent in the age group below 19, 1.4 percent in the second decade, 0.8 percent in the third decade, 2.4 percent in the fourth decade, 5.3 percent in the fifth decade, 10.2 percent in the sixth decade, 9.2 percent in the seventh decade, and 17.0 percent in the age group over 70. Incidence of duodenal diverticular is higher in the older individuals. 3. Male was more frequently affected in the age group below 40, but more in females in the age group over 40. 4. 76.3 percent of duodenal diverticular were found in the concave side of the second portion of the duodenum. 5. Multiplicity of duodenal diverticular was 5.8 percent of cases. Triple duodenal diverticular were found in 1 case. 6. The size of duodenal diverticular was variable from 3 to 70 mm in diameter. More than half of duodenal diverticular were smaller than 9 mm in diameter. Large diverticular of more than 30 mm in diameter were 13.6 percent of cases. The size of t were 13.6 percent of cases. The size of the duodenal diverticular were relatively large in older age group.

317

A roentgenological study of duodenal diverticular in Korean  

Energy Technology Data Exchange (ETDEWEB)

Duodenal diverticulum is a pouch like protrusion of the mucous menibrane through a weak area or defect of the muscle layer of the duodenal wall. 206 cases of the duodenal diverticular out of the consecutive 4030 cases on upper G-I series during the period from Feb. 1977 to Aug. 1978 Department of Radiology, College of Medicine, Hanyang University were studied. The results were as follows; 1. Overall incidence of duodenal diverticular was 5.1 percent (5.0 percent in male, and 5.3 percent in female). 2. The incidence of duodenal diverticular were 1.4 percent in the age group below 19, 1.4 percent in the second decade, 0.8 percent in the third decade, 2.4 percent in the fourth decade, 5.3 percent in the fifth decade, 10.2 percent in the sixth decade, 9.2 percent in the seventh decade, and 17.0 percent in the age group over 70. Incidence of duodenal diverticular is higher in the older individuals. 3. Male was more frequently affected in the age group below 40, but more in females in the age group over 40. 4. 76.3 percent of duodenal diverticular were found in the concave side of the second portion of the duodenum. 5. Multiplicity of duodenal diverticular was 5.8 percent of cases. Triple duodenal diverticular were found in 1 case. 6. The size of duodenal diverticular was variable from 3 to 70 mm in diameter. More than half of duodenal diverticular were smaller than 9 mm in diameter. Large diverticular of more than 30 mm in diameter were 13.6 percent of cases. The size of the duodenal diverticular were relatively large in older age group.

Park, Choong Ki [Hanyang University College of Medicine, Seoul (Korea, Republic of)

1979-06-15

318

Morphometric and biomechanical remodelling in the intestine after small bowel resection in the rat  

DEFF Research Database (Denmark)

The short-bowel syndrome is a clinical condition caused by intestinal resection. As intestinal adaptation occurs after resection, it can be used as a model for studying morphometric and biomechanical remodelling in the small intestine and to get a better understanding of the pathophysiology of the short-bowel syndrome. The resected rats had a 67% resection of jejunum and ileum. Control animals underwent no operation (nonoperated controls) or an ileal transection with subsequent end-to-end anastomosis (sham-resected controls). The animals were followed for up to 4 weeks after the operation. Changes in biomechanical properties were studied in terms of residual strain (the internal strain remaining when all external loads are removed), opening angle and stress--strain relations referenced to the zero-stress state (the cut-open state where external and internal stresses are released). The resected animals gained less weight than the controls. The intestinal length and diameter increased more in the resected groups than the control groups (P < 0.05), resulting in a larger absorptive surface. Resection induced profound gross morphometric changes and histological alterations characterized by proliferative increases in the tissue layers. The opening angle, along with residual strain at the mucosal and serosal surface, increased in the remnant small intestine (P < 0.05). All changes increased as function of postoperative time and were most prominent in the remnant ileum. However, the stress-strain relationship remained unchanged. In conclusion, this study demonstrated that resection of the majority of the small bowel results in significant remodelling in structural and residual strain properties in the remnant small intestine. The remodelling seems to be guided by the need for a greater absorptive surface area rather than for a change in the stress-strain properties.

Dou, Y; Lu, X

2002-01-01

319

Surgically treated primary malignant tumor of small bowel: A clinical analysis  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate the clinical presentation, treatment and survival of patients with primary malignant tumor of small bowel (PMTSB.METHODS: Clinicopathologic data about 141 surgically treated PMTSB patients (91 males and 50 females at the median age of 53.5 years (range 23-79 years were retrospectively analyzed.RESULTS: The most common initial clinical features of the patients were intermittent abdominal discomfort or vague abdominal pain (67.4%, abdominal mass (31.2%, bowel obstruction (24.1%, hemotochezia (21.3%, jaundice (16.3%, fever (14.2%, coexistence of bowel perforation and peritonitis (5.7%, coexistence of gastrointestinal bleeding and shock (5.0%, and intraabdominal bleeding (1.4%. Ileum was the most common site of tumor (44.7%, followed by jejunum (30.5% and duodenum (24.8%. PMTSB had a nonspecific clinical presentation. Segmental bowel resection (n = 81 was the most common surgical procedure, followed by right hemi-colectomy (n = 15, pancreaticoduodenectomy (n = 10, and others (n = 19. Twenty-seven adenocarcinoma patients and 13 malignant lymphoma patients received adjuvant chemotherapy with 5-fluorouracil and cyclophosphamide, adriamycin, vincristine and prednisone, respectively. Information about 120 patients was obtained during the follow-up. The median survival time of PMTSB patients was 20.3 mo. The 1-, 3- and 5-year survival rate was 75.0% (90/120, 40.0% (48/120 and 20.8% (25/120, respectively. Adenocarcinoma was found in 73.7% (42/57, 21.1% (12/57 and 15.8% (9/57 of the patients, respectively. Gastrointestinal stromal tumor was observed in 80.0% (20/25, 72.0% (18/25 and 36.0% (9/25 of the patients, respectively. Carcinoid was detected in 100.0% (15/15, 80.0% (12/15 and 46.7% (7/15 of the patients, respectively. Malignant lymphoma was demonstrated in 69.2% (9/13, 30.8% (4/13 and 0% (0/13 of the patients, respectively.CONCLUSION: En bloc resection is the principal therapy for most PMTSB and chemotherapy is the important treatment modality for malignant lymphoma and other malignant tumors of small bowel which cannot be radically removed.

Shao-Liang Han, Jun Cheng, Hong-Zhong Zhou, Sheng-Cong Guo, Zeng-Rong Jia, Peng-Fei Wang

2010-03-01

320

Differentiation between small bowel intussusception in children and adults and the radiological findings which require an operation  

Energy Technology Data Exchange (ETDEWEB)

To assess the differences in small bowel intussusceptions between children and adults, and to interpret the radiological findings requiring a surgical procedure. A total of 62 study subjects (35 children, 27 adults) with small bowel intussusception diagnosed by US or CT and seen between January 2005 and December 2007 were included in this study. Two radiologists retrospectively reviewed both the medical records and radiological findings of each study subject. We contrasted the range of features found to be typical of small bowel intussusception for both children and adults based on cause, abdominal symptoms, diagnostic tools, and treatments. Also, we evaluated the radiological findings requiring a surgical procedure. The causes of small bowel intussusception were not identified in children; however, 4 adults were found to have tumors (a lipoma, a hemangioma, 2 metastases) ({rho} = 0.031). All of the children (100%) and 8 adults (29.6%) had abdominal symptoms ({rho} < 0.001). The primary diagnostic tool in children was the US (31 cases, 88.6%), as opposed to the CT in adults (27 cases, 100%) ({rho} < 0.001). A spontaneous reduction was confirmed in all children (100%) and supposed in 23 adults (85.2%) ({rho} = 0.031). The noteworthy radiological findings of 4 study subjects having undergone a surgical procedure are masses at the lead point and small bowel obstruction ({rho} < 0.0001). Cases of small bowel intussusception in children are different from cases observed in adults, based on cause, symptoms, and diagnostic tools. However, most cases are spontaneously reduced. Important radiological findings requiring a surgical procedure were found to be caused by masses at the lead point and at the small bowel obstruction.

Jeong, Myeong Ja; Lee, Ji Won; Han, Heon; Jeon, Yong Hwan; Kim, Soung Hee; Kim, Soo Hyun; Kim, Ji Young; Kim, Jae Hyung; Jun, Woo Sun [Sanggye Paik Hospital, Inje University, Seoul (Korea, Republic of)

2008-07-15

321

Intussusception of the small bowel secondary to malignant metastases in two 80-year-old people: a case series  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Small bowel intussusception is rare in adults and accounts for one percent of all bowel obstructions. Malignancy is the etiologic agent in approximately 50 percent of all cases. Case presentation Our first patient was an 80-year-old Caucasian woman with signs and symptoms of intermittent bowel obstruction for the last 12 months. Pre-operative investigation by abdominal computed tomography scanning revealed an obstruction at the ileocecal valve. Exploratory laparotomy revealed an ileocecal intussusception. She underwent an enterectomy. Histological examination showed metastatic breast cancer (lobular carcinoma. Our patient had previously undergone a mastectomy due to carcinoma three years earlier. Our second patient was an 80-year-old Caucasian man with signs and symptoms of acute bowel obstruction. Pre-operative investigation by abdominal computed tomography scanning showed an intussusception in the proximal part of the small bowel. Exploratory laparotomy revealed a jejunojejunal intussusception. He underwent an enterectomy. Histological examination showed metastatic melanoma. Our patient had a prior history of a primary cutaneous melanoma which was excised two years ago. Conclusion Pre-operative determination of the etiologic agent of intussusception in the small bowel in adults is difficult. Although a computed tomography scan is very helpful, the diagnosis of intussusception is made by exploratory laparotomy and histological examination defines the etiologic agent. A prior malignancy in the patient's history must be taken under consideration as a possible cause of intussusception.

Papanicolaou Athanasios

2011-05-01

322

Studies of the small bowel surface by scanning electron microscopy in infants with persistent diarrhea  

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Full Text Available We describe the ultrastructural abnormalities of the small bowel surface in 16 infants with persistent diarrhea. The age range of the patients was 2 to 10 months, mean 4.8 months. All patients had diarrhea lasting 14 or more days. Bacterial overgrowth of the colonic microflora in the jejunal secretion, at concentrations above 10(4 colonies/ml, was present in 11 (68.7% patients. The stool culture was positive for an enteropathogenic agent in 8 (50.0% patients: for EPEC O111 in 2, EPEC O119 in 1, EAEC in 1, and Shigella flexneri in 1; mixed infections due to EPEC O111 and EAEC in 1 patient, EPEC O119 and EAEC in 1 and EPEC O55, EPEC O111, EAEC and Shigella sonnei in 1. Morphological abnormalities in the small bowel mucosa were observed in all 16 patients, varying in intensity from moderate 9 (56.3% to severe 7 (43.7%. The scanning electron microscopic study of small bowel biopsies from these subjects showed several surface abnormalities. At low magnification (100X most of the villi showed mild to moderate stunting, but on several occasions there was subtotal villus atrophy. At higher magnification (7,500X photomicrographs showed derangement of the enterocytes; on several occasions the cell borders were not clearly defined and very often microvilli were decreased in number and height; in some areas there was a total disappearance of the microvilli. In half of the patients a mucus-fibrinoid pseudomembrane was seen partially coating the enterocytes, a finding that provides additional information on the pathophysiology of persistent diarrhea.

U. Fagundes-Neto

2000-12-01

323

Double-balloon enteroscopy for mesenchymal tumors of small bowel: Nine years’ experience  

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Full Text Available AIM: To assess the value of double-balloon enteroscopy (DBE for the diagnosis of gastrointestinal mesenchymal tumors (GIMTs in the small bowel and clarify their clinical and endoscopic characteristics. METHODS: A retrospective review in a total of 783 patients who underwent a DBE procedure from January 2003 to December 2011 was conducted. Data from patients with pathologically confirmed GIMTs were analyzed at a single tertiary center with nine years’ experience. The primary outcomes assessed included characteristics of patients with GIMTs, indications for DBE, overall diagnostic yield of GIMTs, endoscopic morphology, positive biopsy, comparison of diagnosis with capsule endoscopy, and subsequent interventional management. RESULTS: GIMTs were identified and analyzed in 77 patients. The mean age was 47.74 ± 14.14 years (range: 20-77 years, with 63.6% being males. The majority of individuals presented with gastrointestinal bleeding, accounting for 81.8%, followed by abdominal pain, accounting for 10.4%. Small bowel pathologies were found in 71 patients, the detection rate was 92.2%. The diagnostic yield of DBE for GIMTs was 88.3%. DBE was superior to capsule endoscopy in the diagnosis of GIMTs (P = 0.006; McNemar’s ?2 test. Gastrointestinal stromal tumor was the most frequent and leiomyoma was the second frequent GIMT. Single and focal lesions were typical of GIMTs, and masses with smooth or unsmooth surface were the most common in the small bowel. GIMTs were removed from all the patients surgically except one patient treated with endoscopic resection. CONCLUSION: DBE is a safe and valuable procedure for patients with suspected GIMTs, and it provides an accurate position for subsequent surgical intervention.

Qiong He

2013-01-01

324

Imaging findings of midgut volvuIus associated with a large small-bowel diverticulum in an aduIt patient: case report  

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Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 .deg.. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament.

Kim, Jee Young; Rha, Sung Eun; Oh, Soon Nam; Bo, Seal Hwang; Byun, Jae Young [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)

2004-05-01

325

Imaging findings of midgut volvuIus associated with a large small-bowel diverticulum in an aduIt patient: case report  

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Although most patients with jejunoileal diverticulum are asymptomatic, a large, small-bowel diverticulum can be associated with midgut volvulus in an adult. We present a rare case of midgut volvulus that was associated with a large, small-bowel diverticulum in a 77-year-old woman presenting with chronic recurrent abdominal pain. The CT showed the characteristic whirl sign of twisted mesentery, the small bowel loops along the superior mesenteric artery and a large sac-like small-bowel diverticulum. A small bowel series also demonstrated a corkscrew appearance of proximal jejunum, a finding suggestive of midgut volvulus, and a large jejunal diverticulum. During the laparotomy, the small bowel was seen twisted counterclockwise 270 .deg.. The mesenteric root was very shortened. A 4 cm sized diverticulum was seen on the mesenteric border of jejunum, on the portion about 40 cm distal from the Treitz ligament

326

Disruption of interstitial cells of Cajal networks after massive small bowel resection  

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Full Text Available AIM: To investigate the disruptions of interstitial cells of Cajal (ICC in the remaining bowel in rats after massive small bowel resection (mSBR. METHODS: Thirty male Sprague-Dawley rats fitting entry criteria were divided randomly into three experimental groups (n = 10 each: Group A rats underwent bowel transection and re-anastomosis (sham and tissue samples were harvested at day 7 post-surgery. Group B and C rats underwent 80% small bowel resection with tissue harvested from Group B rats at day 7 post-surgery, and from Group C rats at day 14 post-surgery. The distribution of ICC at the site of the residual small bowel was evaluated by immunohistochemical analysis of small intestine samples. The ultrastructural changes of ICC in the remnant ileum of model rats 7 and 14 d after mSBR were analyzed by transmission electron microscopy. Intracellular recordings of slow wave oscillations were used to evaluate electrical pacemaking. The protein expression of c-kit, ICC phenotypic markers, and membrane-bound stem cell factor (mSCF in intestinal smooth muscle of each group were detected by Western blotting. RESULTS: After mSBR, immunohistochemical analysis indicated that the number of c-kit-positive cells was dramatically decreased in Group B rats compared with sham tissues. Significant ultrastructural changes in ICC with associated smooth muscle hypertrophy were also observed. Disordered spontaneous rhythmic contractions with reduced amplitude (8.5 ± 1.4 mV vs 24.8 ± 1.3 mV, P = 0.037 and increased slow wave frequency (39.5 ± 2.1 cycles/min vs 33.0 ± 1.3 cycles/min, P = 0.044 were found in the residual intestinal smooth muscle 7 d post mSBR. The contractile function and electrical activity of intestinal circular smooth muscle returned to normal levels at 14 d post mSBR (amplitude, 14.9 ± 1.6 mV vs 24.8 ± 1.3 mV; frequency, 30.7 ± 1.7 cycles/min vs 33.0 ± 1.3 cycles/min. The expression of Mscf and c-kit protein was decreased at 7 d (P = 0.026, but gradually returned to normal levels at 14 d. The ICC and associated neural networks were disrupted, which was associated with the phenotype alterations of ICC. CONCLUSION: Massive small bowel resection in rats triggered damage to ICC networks and decreased the number of ICC leading to disordered intestinal rhythmicity. The mSCF/c-kit signaling pathway plays a role in the regulation and maintenance of ICC phenotypes.

Jie Chen

2013-01-01

327

Ectopic intestinal glands after segmental small bowel irradiation in the cat  

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Following segmental irradiation of the small bowel, 5 of 64 cats demonstrated ectopic intestinal glands in the submucosal tissue. In addition, one of these 5 cats had foci of abnormal glands in the muscularis mucosae. In 2 of the 5 animals, cellular polymorphism, nucleolar irregularity and loss of cellular polarity were present in irradiation-induced ectopic intestinal glands. The review of the literature indicates that intestinal irradiation may induce intestinal adenocarcinomas with metastatic growth. The possibility that ectopic intestinal glands are precancerous lesions in the irradiated cat is discussed. (Auth.)

328

Surgical intervention for complications caused by late radiation damage of the small bowel; a retrospective analysis  

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The authors studied the records of 46 patients who had been operated on between 1974 and 1990 in the Netherlands Cancer Institute because of complications due to late radiation damage of the small bowel. The following factors led to an increase in complication-risk: hypalbuminemia. more than one laparotomy prior to irradiation and a short interval (< 12 months) between irradiation and surgical intervention. The following factors related to a poorer survival: incomplete resection of the primary tumor and a short interval (< 12 months) between irradiation and surgical intervention. The type f surgical intervention did not have cumulative prognostic value in relation to complication-risk or survival. (author)

329

Clinico-Pathological Profile and Management of Acute Mechanical Small Bowel Obstruction: A Prospective Study  

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Conclusion: Abdominal pain and distention of the abdomen are the most common symptoms and physical findings in patients presenting with acute mechanical small bowel obstruction (SBO. Worm (ascaridial obstruction is the most common cause of obstruction followed by postoperative adhesions. Although all patients were managed conservatively to start with, the operative rate in our series remained very high because it is very difficult to distinguish simple from strangulation obstruction on clinical, biochemical and/or radiological grounds with certainty. [Arch Clin Exp Surg 2013; 2(3.000: 154-160

Tahir Saleem Khan

2013-06-01

330

Small bowel parasitosis as cause of obscure gastrointestinal bleeding diagnosed by capsule endoscopy  

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Full Text Available Hookworm infection is a relatively common cause of anemia in endemic areas. However, it is rarely encountered in Europe. In this report we describe the case of a 24-year old patient originating from an endemic area who was admitted due to severe anemia, with an Hct of 15.6% and eosinophilia (Eosinophils: 22.4%. While both esophagogastroduodenoscopy and colonoscopy were non-diagnostic, capsule endoscopy revealed a large number of hookworms infesting his small bowel and withdrawing blood. The patient was successfully treated with Albendazole. Capsule endoscopy was proven an important tool in diagnosing intestinal parasitosis.

Dimitrios K Christodoulou

2010-11-01

331

[Nonimmune hydrops fetalis associated with congenital small bowel atresia--a case study].  

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Nonimmune hydrops fetalis is observed with the frequency of 1:3000 cases diagnosed pre- and postnatally. In the following paper the authors analyzed the course of pregnancy complicated by fetal ascites and polyhydramnios with the appearance of colonic ileus and they presented the postnatal condition of the baby The preliminary diagnosis was confirmed after birth and the newborn was operated in the second day of his life. The congenital small bowel atresia was qualified as a III B type (Grossfeld qualification), which is called the "pagoda" syndrome [3]. The colonic atresia is located then around the superior mesenteric vessels, which leads to colonic necrosis (Figure 1). PMID:22379934

Pietryga, Marek; Murlewska, Julia; Pietrzycka, Dorota; Becela, Piotr; Brazert, Jacek; Gadzinowski, Janusz; Jankowski, Andrzej

2011-09-01

332

Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma  

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Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition o...

Heizmann, O.; Oertli, D.; Hoffmann, H.

2010-01-01

333

Characteristic imaging features of carcinoid tumors of the small bowel in MR enteroclysis  

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To determine the value of MR enteroclysis (MRE) in the localization and characterization of primary carcinoid tumors of the small bowel and to describe typical imaging features. Twenty patients with suspicion of primary small bowel carcinoid tumors (pCT) were recruited to undergo MRE following nasojejunal intubation and small bowel filling with 2.5 l of 0.5% methylcellulose solution under MR fluoroscopic guidance. MRE was performed on a 1.5 T MR scanner including T2w SSFSE, SSFP and contrast enhanced T1w GRE sequences with fat saturation. Fifteen patients, who subsequently had surgery for resection of their pCT, were retrospectively included in the study. All MRE were analyzed as for the presence, location, number, size, multiplicity and morphologic appearance of the pCT by two board certified radiologists in consensus. The conspicuity of the tumors was rated for each sequence type separately, according to a 4-point rating scale. Signal intensity measurements were performed in tumor and muscle. The presence of desmoplastic reaction, vascular involvement and lymph node metastases was also analyzed. pCT were correctly identified and localized in 14/15 patients. Due to their hyperenhancement tumors was best detected on contrast-enhanced T1w fat saturated GRE sequences. SSFSE was clearly inferior with the tumors being either hyperintense or isointense to muscle. pCT appeared as nodular intraluminal masses in 40% of the cases, as focal wall thickening in 33.3% and in 20% wocal wall thickening in 33.3% and in 20% with both. Mean size was 25 (7-46 mm) with a tendency to smaller size for ileal tumors. MRE failed to depict superficial micronodular peritoneal spread in one patient. Desmoplastic reaction was observed in 73.3% of the cases with mesenteric masses exhibiting lower signal than the pCT due to fibrotic changes. MRE is a valuable method for the detection and localization of primary carcinoid tumors, provided that appropriate bowel distension is achieved. Various characteristic morphologic features could be identified which may contribute to characterize pCT and their loco-regional metastases. (orig.)

334

Closed loop obstructions of the small bowel: role of Computed Tomography  

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Small bowel obstructions can be distinguished into more simple and closed loop obstructions. The latter is a more severe condition which is often complicated by strangulation with vascular impairment, edema and intramural and mesenteric hemorrhage. Consequent arterial insufficiency rapidly leads to ischemia, infarction and necrosis. The radiologist plays a role in the early recognition of the closed loop obstruction and of any sign of strangulation. The role of CT in the diagnosis and workup of patients with suspected intestinal occlusion has been analyzed in the literature with reported 63% sensitivity, 78% specificity and 66% accuracy. CT is also capable of revealing the causes of occlusion in 73-95% of cases. The above CT signs allow to identify closed loop obstruction and also small bowel strangulation, thus supplying a valuable contribution to diagnosis and accurate preoperative evaluation. The conclusion is that CT can accurately demonstrate the presence of closed loop obstruction and can be the technique of choice in patients in whom obstruction is associated with clinical signs suggestive of strangulation

335

CT enterography: a preliminary experience in the evaluation of small bowel diseases  

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Objective: the present study was aimed at demonstrating the value of computed tomography enterography (CT enterography) and how this imaging method can be useful in the diagnostic elucidation and assessment of patients with small bowel diseases. Materials and methods: retrospective evaluation of 35 patients submitted to CT enterography in a 16-row multidetector CT equipment from May/2008 to March/2009. All the patients received intravenous and neutral oral iodinated contrast agents (polyethylene glycol). Main indications were: Crohn's disease, diarrhea of undetermined origin and suspicion of neoplasia. Results: a good correlation was observed between CT enterography findings and clinical, laboratory and endoscopic data related to the disease activity in patients with Crohn's disease. In 15 cases alterations compatible with Crohn's disease were identified, nine of them suggesting disease activity. A diagnosis was achieved in the majority of the patients with diarrhea. Carcinoid tumors were identified in two patients. Conclusion: CT enterography is a simple and effective method in the evaluation of inflammatory/neoplastic small bowel diseases, particularly in cases of Crohn's disease, indicating disease activity. One of the main advantages of this method is the possibility of evaluating associated mesenteric and extraintestinal alterations (author)

Costa-Silva, Luciana [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Medical School. Dept. of Supplementary Propedeutics; Martins, Tatiana [Ecoar Medicina Diagnostica, Belo Horizonte, MG (Brazil); Passos, Maria do Carmo Friche [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Medical School. Dept. of Medical Practice

2010-09-15

336

Interdigestive small bowel motility and duodenal bacterial overgrowth in experimental acute pancreatitis.  

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The objective of this study is to investigate the effects of an acute necrotizing pancreatitis (ANP), without biliary obstruction, on the migrating motor complex (MMC), small bowel bacterial overgrowth (SBBO), bacterial translocation (BT) and infection of the pancreas simultaneously. Rats were divided into four groups: mild pancreatitis, control, ANP and sham operated control. Jejunal myoelectrodes were used to measure MMCs. Blood, peritoneal fluid, bile, and abdominal organs were harvested for microbial culturing 72 h after induction of pancreatitis. The splenic portion of the pancreas was taken for histology. During ANP the MMC cycle length was significantly increased from 14.1 +/- 0.2 to 22.4 +/- 1.9 min (P Enterobacteriacae (> 3 log 10 CFU g-1 in seven of 12 rats, P < 0.05). A positive correlation (r = 0.78, P < 0.01) existed between duodenal Gram-negative and anaerobic flora and the MMC cycle. Correlation between MMC cycle length and BT to the pancreas was positive as well (r = 0.70, P < 0.01). A positive correlation (r = 0.85, P < 0.01) was found between the severity of pancreatitis and duodenal bacterial overgrowth. During ANP without biliary obstruction, the jejunal MMC is disturbed and consequently SBBO occurs. The correlation between the severity of pancreatitis, the disturbance of the MMC and SBBO suggests an important pathophysiological role of the proximal small bowel in the infection of pancreatic necrosis. PMID:12787336

Van Felius, I D; Akkermans, L M A; Bosscha, K; Verheem, A; Harmsen, W; Visser, M R; Gooszen, H G

2003-06-01

337

Profile of epidermal metabolic activity in autosomal dominant ichthyosis and small bowel disorders  

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The in vitro incorporation of 14C acetate by the epidermis has been studied in patients with autosomal dominant ichthyosis and in patients with a dry, itchy, slightly scaly skin associated with a disorder of the small bowel. Analysis of 14C acetate containing lipid moieties by thin layer chromatography has indicated that there are both quantitative and qualitative differences in the uptake of 14C acetate between autosomal dominant ichthyosis and normal. In particular an increased incorporation into the triglyceride and phosphatidyl choline fractions was noted. No such differences were apparent in those patients with disorders of the small bowel. In addition the in vitro incorporation of radioactively labelled thymidine, proline and histidine has been studied in these patients. In both groups of patients the rate of incorporation of tritiated thymidine and histidine into epidermal macromolecules was found not to differ significantly from normal. On the other hand the rate of incorporation of tritiated proline was increased in both groups of patients. (author)

338

Perforation of small bowel caused by Schistosoma japonicum: A case report.  

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A 67-year-old man from Jingzhou was admitted to the First Hospital Affiliated to Yangtze University in July 2013 with sudden onset of abdominal pain with dizziness for 12 h. The patient had sign of peritoneal irritation. Ultrasonography of the abdomen and pelvis showed hepatic fibrosis due to schistosomiasis. Computed tomography showed free gas in the peritoneal cavity. Plain abdominal radiography showed bilateral subdiaphragmatic accumulation of gas, perforation of the viscus, and radio-opacity in the left renal area. The patient underwent emergency exploratory laparotomy. At laparotomy, a moderate amount of muddy yellow pus was found in the intra-abdominal cavity. At the junction of the jejunum and ileum, about 250 cm from Treitz's ligament, there was an about 10-cm length of inflamed small bowel with perforation (3 mm in diameter) along the mesenteric border at the middle of the lesion. The patient underwent resection of the affected intestinal segment, along with end-to-end intestinal anastomosis. Histopathological examination revealed mucosal necrosis and hemorrhage with a large number of infiltrating eosinophils and neutrophils, and acute submucosal inflammation with a large number of infiltrating eosinophils and neutrophils associated with Schistosoma japonicum (S. japonicum) eggs. No intravascular adult parasite was found. Postoperatively, the patient was treated with praziquantel (30 mg/kg daily) for 4 d. The patient progressed well. To the best of our knowledge, this is the first case of small bowel perforation associated with eggs of S. japonicum. PMID:25759563

Xiang, Jin-Jian; Cheng, Ben-Jing; Tian, Fu; Li, Mi; Jiang, Xue-Feng; Zhao, Hui-Chuan; Hu, Xiao-Miao; Xiao, Bao-Lai; Xie, Jian-Ping; Shrestha, Arpana

2015-03-01

339

Effect of acetylcysteine on adaptation of intestinal smooth muscle after small bowel bypass  

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The authors have postulated that the adaptive changes in function and structure of bypassed segments of small bowel are due in part to the change in intestinal contents following operation. The purpose of these experiments was to determine if a mucolytic agent could alter the adaptation. Rats were anesthetized and a 70% jejunoileal bypass was performed. The bypassed segments then were perfused with either saline or acetylcysteine for 3-12 days. Then, either intestinal transit was determined using Cr-51, or segments were taken for morphometric analysis. Transit, as assessed by the geometric center, was increased 32% by acetylcysteine treatment. Treatment also caused a decrease in hypertrophy of the muscularis. Muscle wet weight, muscle cross-sectional area, and muscle layer thickness all were significantly less in those animals infused with acetyl-cysteine. No decreases in hypertrophy were seen in the in-continuity segments. These data indicate that alterations in intestinal content can affect the course of adaptation of intestinal muscle in response to small bowel bypass

340

The stepchild of intestinal diagnostics. Evaluation of radiological methods to diagnose leiomyomas of the small bowel  

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Purpose: Various radiological methods to diagnose small bowel neoplasmas and problems of differential diagnosis specially considerating leiomyomas are discussed. Patients and methods: Two patients with leiomyoma of the ileum underwent enteroclysis, computed tomography of the abdomen, intra-arterial DSA and colour Doppler sonography. Another patient with leiomyosarcoma just underwent CT of the abdomen with CT-guided biopsy. Results: Due to the homogenous density and the smooth surface of the tumors in computed tomography and respectively enteroclysis and the presentation of the tumor vascularisation in the angiography and Colour Doppler sonography in both patients a leiomyoma of the small bowel was diagnosed. Postoperatively this diagnosis was histologically confirmed. The CT-findings of the patient with leiomyosarcoma were not suspicious of a malignant tumor. Conclusion: Radiologically it is not possible to determine the dignity of smooth muscle cell tumors safely. That is the reason why the diagnosis has to be achieved operatively. But the histopathological diagnosis based on the mitotic rate may be difficult. Therefore the after care has to be carried out thoroughly. (orig.)

341

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension  

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Full Text Available AIM: To study the small bowel (SB mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria.METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence.RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension.CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.

Jamilé Wakim-Fleming, Nizar N Zein, Ana Bennett, Rocio Lopez, Janice Santisi, William D Carey

2008-11-01

342

Evaluation of small bowel blood flow in healthy subjects receiving low-dose aspirin  

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Full Text Available AIM: To investigate the relationship between low-dose aspirin-induced small bowel mucosal damage and blood flow, and the effect of rebamipide.METHODS: Ten healthy volunteers were enrolled in this study. The subjects were divided into two groups: a placebo group given low-dose aspirin plus placebo and a rebamipide group given low-dose aspirin plus rebamipide for a period of 14 d. Capsule endoscopy and contrast-enhanced ultrasonography were performed before and after administration of drugs. Areas under the curves and peak value of time-intensity curve were calculated.RESULTS: Absolute differences in areas under the curves were -1102.5 (95% CI: -1980.3 to -224.7, P = 0.0194 in the placebo group and -152.7 (95% CI: -1604.2 to 641.6, P = 0.8172 in the rebamipide group. Peak values of time intensity curves were -148.0 (95% CI: -269.4 to -26.2, P = 0.0225 in the placebo group and 28.3 (95% CI: -269.0 to 325.6, P = 0.8343 in the rebamipide group. Capsule endoscopy showed mucosal breaks only in the placebo group.CONCLUSION: Short-term administration of low-dose aspirin is associated with small bowel injuries and blood flow.

Urara Nishida, Mototsugu Kato, Mutsumi Nishida, Go Kamada, Takeshi Yoshida, Shouko Ono, Yuichi Shimizu, Masahiro Asaka

2011-01-01

343

Gradient-enhanced volume rendering: an image processing strategy to facilitate whole small bowel imaging with MRI  

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MRI of the small bowel with positive contrast from orally administered contrast agent is a promising non-invasive imaging method. The aim of our study was to introduce small bowel MRI in a display format that clinicians are accustomed to and that maximizes the amount of information visualized on a single image. Twelve healthy volunteers, median age 32 years (range 18-49 years) participated in the study. A mixture of 20 ml Gd-DOTA (Dotarem), 0.8 g/kg body weight psyllium fibre (Metamucil) and 1.2 l water were sequentially administered over a period of 4 h. Imaging was performed on a 1.5 T unit (Philips Gyroscan, Intera). Fat-saturated, 3D, gradient echo imaging was performed while the patient was in apnea (30 s). Bowel motion was reduced with 40 mg intravenously administered scopolamine (Buscopan). A 3D, gradient-enhanced, volume rendering technique was applied to the 3D data sets. Standard projections [left anterior oblique (LAO), right anterior oblique (RAO), supine and prone] resembling conventional enteroclysis were successfully generated within fewer than 10 min processing time. Reconstructions were reproducible and provided an entire overview of the small bowel. In addition thin-slab volume rendering allowed an overlap-free display of individual structures. Positive contrast from orally administered contrast agent, combined with a gradient enhanced volume rendering method, allows the reconstruction of the small bowel in a pattern resembling conventional double-contrast enteroclysis. Segmental display without overlay is possible. (orig.)

Wyss, Michael [Cantonal Hospital, Institute of Diagnostic Radiology, Winterthur (Switzerland); ETH and University of Zuerich, Institute of Biomedical Engineering, Zuerich (Switzerland); Froehlich, Johannes M.; Patak, Michael A.; Juli, Christoph F.; Zollikofer, Christoph L. [Cantonal Hospital, Institute of Diagnostic Radiology, Winterthur (Switzerland); Scheidegger, Markus B. [ETH and University of Zuerich, Institute of Biomedical Engineering, Zuerich (Switzerland); Wentz, Klaus U. [Cantonal Hospital, Institute of Diagnostic Radiology, Winterthur (Switzerland); University of Witten Herdecke, Herdecke (Germany)

2007-04-15

344

Small bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities  

International Nuclear Information System (INIS)

Small bowel obstruction is a leading cause of acute surgical admissions for abdominal pain. There is an increasing tendency for initial conservative management rather than immediate operative intervention, as a proportion of cases will resolve spontaneously. This has resulted in a growing reliance on radiological investigations to reassure the surgeon that medical therapy can be safely instituted. The onus therefore rests with radiologists to guide their surgical colleagues by correctly interpreting the plain abdominal radiograph and suggesting appropriate further investigation if warranted. Recently, computed tomography (CT) has been proposed as the test of choice to define the level and cause of acute small bowel obstruction and to identify complications such as ischaemia and perforation which will prompt surgical intervention. This review will discuss the utility of early CT in the diagnosis of acute small bowel obstruction and outline its impact on patient management. (orig.)

345

Adult intussusception caused by myoepithelial hamartoma in the small bowel: A case report  

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Conclusion: Intussusception caused by MEH is a rare but serious cause of mechanical bowel obstruction. We propose that surgeons should consider this diagnosis in atypical cases of bowel obstruction and expedite laparotomy when it is suspected.

Adeyanju Adetunji

2015-01-01

346

Double-illumination photoacoustic microscopy of intestinal hemodynamics following massive small bowel resection  

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Massive small bowel resection (SBR) results in villus angiogenesis and intestinal adaptation. The exact mechanism that causes intestinal villus angiogenesis remains unknown. We hypothesize that hemodynamic changes within the remnant bowel after SBR will trigger intestinal angiogenesis. To validate this, we used photoacoustic microscopy (PAM) to image the microvascular system of the intestine in C57B6 mice and to measure blood flow and oxygen saturation (sO2) of a supplying artery and vein. Baseline measurements were made 6 cm proximal to the ileal-cecal junction (ICJ) prior to resection. A 50% proximal bowel resection was then performed, and measurements were again recorded at the same location immediately, 1, 3 and 7 days following resection. The results show that arterial and venous sO2 were similar prior to SBR. Immediately following SBR, the arterial and venous sO2 decreased by 14.3 +/- 2.7% and 32.7 +/- 6.6%, respectively, while the arterial and venous flow speed decreased by 62.9 +/- 17.3% and 60.0 +/- 20.1%, respectively. Such significant decreases in sO2 and blood flow indicate a hypoxic state after SBR. Within one week after SBR, both sO2 and blood flow speed had gradually recovered. By 7 days after SBR, arterial and venous sO2 had increased to 101.0 +/- 2.9% and 82.7 +/- 7.3% of the baseline values, respectively, while arterial and venous flow speed had increased to 106.0 +/- 21.4% and 150.0 +/- 29.6% of the baseline values, respectively. Such increases in sO2 and blood flow may result from angiogenesis following SBR.

Yao, Junjie; Rowland, Kathryn J.; Wang, Lidai; Maslov, Konstantin I.; Warner, Brad W.; Wang, Lihong V.

2012-02-01

347

Diffuse mesenterial sclerosis: a characteristic feature of chronic small-bowel allograft rejection.  

Science.gov (United States)

Chronic rejection is the major cause of late intestinal allograft dysfunction. The aim of this study was to analyze in detail the histopathological features of chronic rejection in the ACI-to-Lewis rat model of intestinal transplantation. Chronic rejection was achieved in orthotopic small-bowel allografts (ACI-Lewis) by limited immunosuppression with cyclosporin A (CyA). Isogeneic transplants (ACI-ACI) as well as native bowels (ACI) with and without immunosuppression served as controls. Bowels were removed together with the mesenteries 90 days postoperatively and analyzed using sections stained with hematoxylin and eosin as well as Masson's trichrome. The slides were coded, randomized and analyzed by grading of histological abnormalities. The most striking alterations of the allografts were noticed in the mesenteries exhibiting an extensive infiltration by mononuclear cells accompanied by a progressive diffuse fibrosis with shrinking of the mesenteries. These changes were most pronounced in the perivascular areas of the mesenteric arteriae and venae rectae. Three of five allografts showed vasculitis with myointimal proliferation of the arteriae rectae. Focally, there was spill-over of the inflammatory cells onto the intestinal muscularis propria. The mucosa of the allografts showed mild blunting, lymphocytic infiltration of the crypt epithelium and increased crypt cell apoptoses. The submucosa was unaffected, and there were no detectable abnormalities of the enteric ganglion cells. The present data support the view that chronic rejection of intestinal allografts is characterized by a diffuse sclerosing mesenteritis which may significantly contribute to late graft dysfunction. The present model may be useful to study the pathomechanisms of this inflammatory fibrosing process. PMID:12536314

Klaus, Alexander; Margreiter, Raimund; Pernthaler, Heinz; Klima, Günther; Offner, Felix A

2003-01-01

348

Invasive aspergillosis causing small bowel infarction in a patient of carcinoma breast undergoing chemotherapy  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background To report a 45 year old lady presenting with proximal jejunal gangrene due to invasive Aspergillosis. The patient was undergoing adjuvant chemotherapy for advance carcinoma of breast (Stage IV. Methods The patient was referred to our surgical emergency for acute abdominal symptoms for 6 hours. Histopathology revealed bowel wall necrosis and vascular invasion by Aspergillus Fumigatus. Postoperative recovery was uneventful and the patient received Amphotericin-B (1 mg/kg/day for invasive aspergillosis. Invasive pulmonary aspergillosis was confirmed by isolating Aspergillus Fumigatus from bronchoalveolar lavage and by a positive circulating galactomannan test (ELISA Assay. Results Detailed history revealed dry cough and two episodes of haemoptesis for 2 weeks. Haemogram and counts revealed anemia and neutropenia. Plain X – ray of the abdomen showed multiple air fluid levels and ultrasound of the abdomen revealed distended bowel loops. On exploration small bowel was found to be gangrenous. The patient was successfully managed by supportive treatment and conventional intravenous Amphotericin-B for 2 weeks. The lady was discharged one week after completion of antifungal therapy and one month later she underwent toilet mastectomy. The lady came to follow up for 1 year and she is currently under hormone therapy. Conclusion With the emergence of new and powerful immunosuppressive, anticancer drugs and potent antibiotics the survival of transplant and critically ill patients has remarkably increased but it has shown a significant rise in the incidence of invasive opportunistic fungal infections. We conclude hat the diagnosis of invasive gastrointestinal aspergillosis may be considered in a neutropenic patient with acute abdominal symptoms.

Jain Vinod

2006-01-01

349

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

International Nuclear Information System (INIS)

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 paramepatients (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

350

MR enteroclysis for MR diagnosis of inflammatory small bowel disease with contrast enhancement  

International Nuclear Information System (INIS)

Purpose: To evaluate MRI for effectiveness in assessment of intra- und extramural changes in the small intestine. Methods: 40 patients with known or suspected small bowel disease underwent MR imaging immediately after conventional enteroclysis with barium and a mixture of methyl cellulose and gadolinium-DTPA. Results: In 6 of 24 patients with no pathological findings in conventional enteroclysis, intraabdominal pathology such as thickening of the intestinal wall and an abscess were identified. In the remaining patients, MRI showed good correlation with conventionally obtained data and provided important additional information regarding extraluminal involvement such as enlargement of mesenterial lymph nodes and fistulas as well as abscesses. Conclusions: MRI, carried out using this technique, provides important additional information regarding intra- and extraluminal changes with good image quality. (orig.)

351

Effects of oral parenteral nutrition solution on the morphology and mechanical resistance of the small bowel in rats  

OpenAIRE

The objective of this study was to investigate the effect of an elemental diet (ED) on the strength and on the morphology of the small bowel. Male Wistar rats were randomized to two groups to receive during 14 days either standard laboratory rat chow (N=16) or ED (N=16) containing total parenteral nutrition (TPN) solution. After this period they were killed and necropsied. The small bowel was measured and weighted with and without the contents. Bursting pressure (BP) was taken from the jejunu...

de Aguilar-Nascimento José E; Lima Stenio A.; Pereira Alexandre C. C.

1997-01-01

352

TRATAMIENTO LAPAROSCÓPICO DE LA OBSTRUCCIÓN INTESTINAL POR BRIDAS / Laparoscopic treatment of adhesive small bowel obstruction  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Introducción: El tratamiento de la Obstrucción Intestinal por Bridas (OIB) incluye alternativas conservadoras y quirúrgicas, esta última tradicionalmente a través de cirugía abierta. El abordaje laparoscópico ha sido incorporado recientemente, sin embargo, existe información limitada sobre su seguri [...] dad y sus resultados varían considerablemente. Nuestro objetivo es presentar la experiencia de nuestro centro en el tratamiento laparoscópico de la OIB. Material y Métodos: Estudio retrospectivo incluyendo pacientes con el diagnóstico de OIB que fueron sometidos a cirugía laparoscópica en nuestro centro, entre junio de 2003 y abril de 2013. Análisis de variables demográficas, quirúrgicas y resultados obtenidos en términos de tasa de conversión, tiempo operatorio, tiempo de realimentación y estadía hospitalaria. Análisis estadístico con pruebas no paramétricas. Resultados: Serie de 38 pacientes, edad promedio: 51 ± 16 años, 47% sexo masculino. 53% con antecedente de cirugía abdominal previa. Resolución completa por laparoscopía fue posible en 31 pacientes (82%), con 7 conversiones a cirugía abierta. La mediana de tiempo operatorio fue de 60 m (25-180), la mediana de tiempo a la realimentación fue de 24 h (24-192) y la mediana de estadía hospitalaria de 4 (2-52) días. Dos pacientes requirieron reoperaciones durante su hospitalización; uno debido a obstrucción intestinal persistente y otro debido a colitis isquémica. No se presentaron otras complicaciones ni mortalidad en esta serie. Conclusiones: El abordaje laparoscópico en OIB es factible de realizar en pacientes seleccionados, logrando buenos resultados en caso de resolución completa por laparoscopía. Pacientes sin cirugías abdominales previas son buenos candidatos para un abordaje laparoscópico inicial. Abstract in english Background: Treatment options for adhesive small bowel obstruction (ASBO) involve conservative and surgical management, traditionally through open adhesiolysis. Laparoscopic approach has been performed in recent years; however, limited data exist on its safety and results vary considerably. Our aim [...] is to report our experience of laparoscopic treatment for ASBO. Methods: Retrospective study including patients admitted with the diagnosis of adhesive small bowel obstruction and that were submitted to laparoscopic exploration, between June 2003 and April 2013. We analyzed demographic, surgical variables and outcomes in terms of conversion rate, operative time, re-feeding time and length of stay. Non-parametric tests were used for statistical analysis. Results: Series of 38 patients submitted to laparoscopic exploration, mean age: 51 ± 16 years, 47% male. 53% had prior intra-abdominal surgeries. Laparoscopic resolution of bowel obstruction was possible in 31 patients (82%), with 7 conversions to open surgery. Median operative time was 60 (25-180) minutes, median re-feeding time was 24 (24-192) hours and median length of stay was 4 (2-52) days. Two patients required re-intervention during their hospital stay, one due to persistent bowel obstruction and one due to ischemic colitis. There were no other complications or mortality. Conclusions: Laparoscopy in adhesive small bowel obstruction was a feasible approach in this series, with good results when laparoscopic resolution is achieved. Patients with no prior surgeries seem to be good candidates for this approach.

Nicolás, Quezada S; Felipe, León F; Juan de la, Llera K; Ricardo, Funke H; Mauricio, Gabrielli N; Fernando, Crovari E; Jorge, Martínez C; Camilo, Boza W; Nicolás, Jarufe C.

2014-09-01

353

Computed tomography to detect body packing: an unusual cause of small bowel obstruction  

Energy Technology Data Exchange (ETDEWEB)

Concealment of illicit drugs within the alimentary tract is now an established method used by both smugglers and traffickers to evade detection by authorities. Those who ingest wrapped packets of drugs to transport them across international borders are known as 'body packers,' whereas those who ingest packages of drugs upon an unexpected encounter with law enforcement agents are known as 'body stuffers' or 'quick swallowers. Although most of these individuals require no medical care, acute drug toxicity (from inadvertent leaking of contents or rupture of the drug packet) and bowel obstruction are recognized hazards of drug packet ingestion. The detection of these packets is a challenge to custom officials and police interested in preventing the import and trafficking of illegal drugs, as well as to physicians who have to treat individuals who have ingested them. We report a case of a 38-year-old intravenous drug abuser who presented with an acute small bowel obstruction secondary to an impacted intraluminal heroin balloon in the mid jejunum. The value of computed tomography (CT) in the patient's diagnostic evaluation is highlighted. (author)

Brown, J.A. [St. Paul' s Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada); Phang, T. [St. Paul' s Hospital, Dept. of Surgery, Vancouver, British Columbia (Canada); Enns, R. [St. Paul' s Hospital, Div. of Gastroenterology, Dept. of Internal Medicine, Vancouver, British Columbia (Canada); Butchart, M.K. [St. Paul' s Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada); Filipenko, J.D. [St. Paul' s Hospital, Dept. of Pathology, Vancouver, British Columbia (Canada); Mason, A.C.; Cooperberg, P.I. [St. Paul' s Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)

2002-04-01

354

Computed tomography to detect body packing: an unusual cause of small bowel obstruction  

International Nuclear Information System (INIS)

Concealment of illicit drugs within the alimentary tract is now an established method used by both smugglers and traffickers to evade detection by authorities. Those who ingest wrapped packets of drugs to transport them across international borders are known as 'body packers,' whereas those who ingest packages of drugs upon an unexpected encounter with law enforcement agents are known as 'body stuffers' or 'quick swallowers. Although most of these individuals require no medical care, acute drug toxicity (from inadvertent leaking of contents or rupture of the drug packet) and bowel obstruction are recognized hazards of drug packet ingestion. The detection of these packets is a challenge to custom officials and police interested in preventing the import and trafficking of illegal drugs, as well as to physicians who have to treat individuals who have ingested them. We report a case of a 38-year-old intravenous drug abuser who presented with an acute small bowel obstruction secondary to an impacted intraluminal heroin balloon in the mid jejunum. The value of computed tomography (CT) in the patient's diagnostic evaluation is highlighted. (author)

355

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

International Nuclear Information System (INIS)

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

356

Efficacy of belly board device with CT-simulation in reducing small bowel volume within pelvic irradiation fields  

International Nuclear Information System (INIS)

Purpose/Objective: Acute and chronic small bowel toxicity associated with pelvic irradiation limits dose escalation with both chemotherapy and radiotherapy (RT) for rectal cancer. Various surgical and technical maneuvers including compression and belly board devices (BBD) have been used to reduce small bowel volume in treatment fields. However, quantitative dose volume advantages of such methods have not been reported. In this study, the efficacy of BBD with CT-simulation is presented with dose-volume histogram (DVH) analyses for rectal cancer. Materials and Methods: Five consecutive patients referred to our department with rectal cancer (2 preoperative, 3 postoperative RT) were included in this study. Each patient was asked to drink 450 cc of oral contrast 60 minutes prior to scanning and an additional 450 cc 15 minutes before CT-simulation. Patients were advised not to void for at least 2 hours prior to CT-simulation for optimal bladder distention. Patients were initially scanned in the prone position with alpha-cradle immobilization. A second CT study was conducted with a commercially available BBD which is made up of a hard sponge 18 cm thick with an adjustable opening (maximum 40x40 cm2). Patients were positioned prone over the BBD opening which was placed between the diaphragm and fourth lumbar spine of the patient. With the spiral CT-scanner, the entire scanning process was accomplished within 30 minutes. Image fusion between both sets of CT scans (wge fusion between both sets of CT scans (with and without BBD) was performed using three common bony landmarks. The critical structures including small bowel, bladder, and target volumes were delineated on each slice for DVH calculation. The target volumes were maintained in both studies. On each study, a three field optimized plan with conformal blocks in beams-eye-view was generated for volumetric analysis. The DVHs with and without BBD were evaluated for each patient. Results: The average weight of the patients was 80.3±10.1 kg. The central axis anterior-posterior (AP) and lateral separation with and without BBD were measured. The changes in lateral separation were minimal (<0.5 cm), however the changes in AP separation were reduced by 2.5±0.8 cm when BBD was used. With the BBD, the small bowel volume was significantly reduced with a mean reduction of 50.3% (range 34%-71%). The volume reduction was not correlated with body weight or sequence of RT (preop vs. post op). The DVH analysis of small bowel with and without BBD is shown in Table 1 for limited dose levels. The reduction of small bowel volume can be seen at each dose level. A representative DVH of small bowel with and without BBD is shown in Fig. 1. Figure 2 shows the ratio of volumes with and without BBD at various dose levels for each patients. A ratio below 1.0 represents a reduction of small bowel volume. A slight increase in bladder dose volume with BBD was also noted in a few patients. Conclusions: The belly board provides an easy technique to displace small bowel from pelvic RT treatment fields. The small bowel volume reduction is significant and is not related to body weight, separation, and sequence of RT with surgery. The volume reduction is appreciable at each dose level with a maximum of 70%. For some patients, the bladder dose volume may be increased moderately. Further study of the clinical efficacy of the BBD with specific attention to acute and chronic bowel complications and tolerances of full dose chemoradiation will continue

357

Management of Perforated Essure with Migration into Small and Large Bowel Mesentery.  

Science.gov (United States)

The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material. PMID:25460518

Braginsky, Lena; George, Sean T; Locher, Stephen R

2015-01-01

358

Hemorragia digestiva por leiomiosarcoma de intestino delgado / Gastrointestinal bleeding caused by small bowel leiomyosarcoma  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish El leiomiosarcoma de intestino delgado es un tumor infrecuente en la práctica clínica. Presentamos el caso de un hombre de 50 años que ingresó en el hospital en dos ocasiones por hemorragia digestiva. En el segundo ingreso una enteroscopia permitió localizar en yeyuno un tumor. El diagnóstico anatom [...] opatológico fue de un leiomiosarcoma de yeyuno de bajo grado. El paciente precisó cirugía con resección de la porción de yeyuno afectada. Abstract in english The small bowel leiomiosarcoma is a infrequent tumour in the clinical practice.We report the case of a 50 year old male admitted to the hospital on two occasions for gastrointestinal bleeding. On the second ocassion a push enteroscopy located in jejunum a tumour. The pathologic diagnosis was a low g [...] rade jejunal leiomyosarcoma. The patient required a surgical intervention with resection of the affected portion of the jejunum.

R., Baños Madrid; A., Albaladejo Meroño; A., Serrano Jiménez; M., Alajarín Cervera; A., Vargas Acosta; F., Alberca de las Parras; J., Molina Martínez; F., Carballo.

2006-08-01

359

Seatbelt injury causing small bowel devascularisation: case series and review of the literature.  

LENUS (Irish Health Repository)

The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the "lap belt". We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

O'Dowd, Vincent

2012-01-31

360

Acute small bowel obstruction caused by endometriosis: A case report and review of the literature  

Directory of Open Access Journals (Sweden)

Full Text Available Gastrointestinal involvement of endometriosis has been found in 3%-37% of menstruating women and exclusive localization on the ileum is very rare (1%-7%. Endometriosis of the distal ileum is an infrequent cause of intestinal obstruction, ranging from 7% to 23% of all cases with intestinal involvement. We report a case in which endometrial infiltration of the small bowel caused acute obstruction requiring emergency surgery, in a woman whose symptoms were not related to menses. Histology of the resected specimen showed that endometriosis was mainly prevalent in the muscularis propria and submucosa and that the mucosa was not ulcerated but had inflammation and glandular alteration. Endometrial lymph node involvement, with a cystic glandular pattern was also detected.

Antonella De Ceglie, Claudio Bilardi, Sabrina Blanchi, Massimo Picasso, Marcello Di Muzio, Alberto Trimarchi, Massimo Conio

2008-06-01

361

Vomiting gallstones as a presenting feature of small bowel obstruction secondary to inflammatory stricture.  

Science.gov (United States)

Patients presenting with symptoms caused by gallstones are common on a surgical take. Understanding the different ways in which this common condition can present is important to enable the correct diagnosis and thus management plan. The immediate management of gallstones depends on the presenting features and can range from analgesia to surgical intervention. Obstructive cases require intervention, either by ERCP or surgery; the non-obstructive cases are usually left to settle before an elective operation at a later date. In surgery, the presence of a clinical sign where it 'should not be' can be a sign of another underlying pathology and this is the embodiment of surgery-to assimilate seemingly disparate pieces of information and act in a way to treat the cause. This case study highlights a rare presentation of one disease state, in vomiting of gallstones, that raised the diagnosis of another pathology, a small bowel obstruction. PMID:23608850

McGowan, David Ross; Norris, Joseph M; Zia, Khawaja

2013-01-01

362

A prospective study of differences in duodenum compared to remaining small bowel motion between radiation treatments: Implications for radiation dose escalation in carcinoma of the pancreas  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Purpose As a foundation for a dose escalation trial, we sought to characterize duodenal and non-duodenal small bowel organ motion between fractions of pancreatic radiation therapy. Patients and methods Nine patients (4 women, 5 men undergoing radiation therapy were enrolled in this prospective study. The patients had up to four weekly CT scans performed during their course of radiation therapy. Pancreas, duodenum and non-duodenal small bowel were then contoured for each CT scan. On the initial scan, a four-field plan was generated to fully cover the pancreas. This plan was registered to each subsequent CT scan. Dose-volume histogram (DVH analyses were performed for the duodenum, non-duodenal small bowel, large bowel, and pancreas. Results With significant individual variation, the volume of duodenum receiving at least 80% of the prescribed dose was consistently greater than the remaining small bowel. In the patient with the largest inter-fraction variation, the fractional volume of non-duodenal small bowel irradiated to at least the 80% isodose line ranged from 1% to 20%. In the patient with the largest inter-fraction variation, the fractional volume of duodenum irradiated to at least the 80% isodose line ranged from 30% to 100%. Conclusion The volume of small bowel irradiated during four-field pancreatic radiation therapy changes substantially between fractions. This suggests dose escalation may be possible. However, dose limits to the duodenum should be stricter than for other segments of small bowel.

Wahab Sasha H

2006-09-01

363

Differentiation of obstructive from non-obstructive small bowel dilatation on CT  

International Nuclear Information System (INIS)

Purpose: to find a useful decision procedure for the differentiation of obstructive from non-obstructive small bowel (SB) dilatation on the computed tomography (CT). Materials and methods: four criteria were divided into different degrees and evaluated. These include: (A): continuity (non-continuous, continuous); (B): transition zone (absent, gradual, abrupt); (C): prestenotic SB fluid (minimal, about one-fourth, one-half, and three-fourths, nearly complete); and (D): colonic contents (minimal, moderate, considerable). One hundred fifty-three examinations, 86 obstructive and 67 non-obstructive, were analyzed using ?2-square tests to determine the relationship of each criterion to the presence of small bowel obstruction (SBO), whether the proportions of various degrees of these criteria differed significantly among the obstructive and non-obstructive subgroups, and to classify the criteria with a tree-based model (calculated by the computer) for the development of a useful decision procedure. Results: in each of the four criteria, the trend of probability of obstruction was statistically significant (P=0.0000). The proportions of most, except two, of the various degrees of different criteria in the obstructive and non-obstructive subgroups differed significantly (P<0.01). The obstruction tends to have a continuou dilatation, an abrupt transition, more prestenotic SB fluids, and less colonic contents. The results of classification by a tree-based model were lassification by a tree-based model were 76 true-positive, ten false-negative, six false-positive, and 61 true-negative. The sensitivity was 88%; specificity was 91%; positive predictive value was 93%; negative predictive value was 86%; and the overall accuracy was 90%. Conclusion: by analyzing the above four criteria together, a useful tree-based model can be developed and utilized as a supplemental decision procedure for the differentiation of obstructive from non-obstructive SB dilatation. The accuracy can be further promoted if the factor of a recognized pathologic condition is taken into consideration

364

MALIGNANT MELANOMA WITH MULTIPLE METASTASES ON THE SMALL BOWEL - CASE REPORT  

Directory of Open Access Journals (Sweden)

Full Text Available BACKGROUND: Malignant melanomas often cause intestinal metastasis.Metastases of malignant melanoma are the most common secondary tumors of the gastrointestinal tract.The incidence of intestinal metastasis of malignant melanomas is 1.5-4.4% in clinical studies, reaching upto 35.6-58% in necroptic studies. AIM: We present a clinical case of multiple metastases to the smallbowel with point of departure right retroauricular malignant melanoma. METHODS: Patient T.I., 76years old, is admitted in our clinic with occlusion clinical features installed by approximately 2-3 days.From anamnesis we retain a subocclusion clinical feature installed by approximately 1-2 months, withgradual overheating. On clinical examination a right supraclavicular tumoral formation is found, sizing2.5-3cm, suggestive for malignant melanoma. The abdominal CT shows multiple tumoral formations inthe small bowel, with no other secondary determinations in the other organs. RESULTS: Intraoperatorywe have found six secondary lesions on the jejunum, two on the ileum and two mesenteric metastases. Itwas done partial enterectomy on the jejunal segment with latero-lateral jejuno-jejunal anastomoses andpartial enterectomy on the ileum segment with ileostoma. Postoperatory short-term outcome, at six andtwelve months was favorable. CONCLUSIONS: Small bowel metastases of malignant melanoma is thefirst suspected diagnosis in a patient with oclusive/suboclusive intestinal manifestations and clinicallesions suggestive of malignant melanoma. The patient presentes for acute complications (occlusion,intestinal perforation or chronic complications (chronic digestive bleeding, anemic syndrome. Oftennon-specific symptoms are present, which delay the diagnosis. Surgical treatment is the first therapeuticoption, even in case of multiple secondary determinations.

V.T. Grigorean

2010-08-01

365

Diagnostic accuracy of capsule endoscopy for small bowel Crohn's disease is superior to that of MR enterography or CT enterography  

DEFF Research Database (Denmark)

Capsule endoscopy (CE) detects small bowel Crohn's disease with greater diagnostic yield than radiologic procedures, although there are concerns that CE has low specificity. We compared the sensitivity and specificity of CE, magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) in patients with suspected or newly diagnosed Crohn's disease.

Jensen, Michael Dam; Nathan, Torben

2011-01-01

366

Large bowel obstruction secondary to adhesive bands.  

Science.gov (United States)

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

El-Masry, Nabil S; Geevarghese, Ruben

2015-01-01

367

Gradient-enhanced volume rendering: an image processing strategy to facilitate whole small bowel imaging with MRI  

International Nuclear Information System (INIS)

MRI of the small bowel with positive contrast from orally administered contrast agent is a promising non-invasive imaging method. The aim of our study was to introduce small bowel MRI in a display format that clinicians are accustomed to and that maximizes the amount of information visualized on a single image. Twelve healthy volunteers, median age 32 years (range 18-49 years) participated in the study. A mixture of 20 ml Gd-DOTA (Dotarem), 0.8 g/kg body weight psyllium fibre (Metamucil) and 1.2 l water were sequentially administered over a period of 4 h. Imaging was performed on a 1.5 T unit (Philips Gyroscan, Intera). Fat-saturated, 3D, gradient echo imaging was performed while the patient was in apnea (30 s). Bowel motion was reduced with 40 mg intravenously administered scopolamine (Buscopan). A 3D, gradient-enhanced, volume rendering technique was applied to the 3D data sets. Standard projections [left anterior oblique (LAO), right anterior oblique (RAO), supine and prone] resembling conventional enteroclysis were successfully generated within fewer than 10 min processing time. Reconstructions were reproducible and provided an entire overview of the small bowel. In addition thin-slab volume rendering allowed an overlap-free display of individual structures. Positive contrast from orally administered contrast agent, combined with a gradient enhanced volume rendering method, allows the reconstruction of the small bowel in a pattern resembling conventional double-co pattern resembling conventional double-contrast enteroclysis. Segmental display without overlay is possible. (orig.)

368

Arterial hypertension due to fructose ingestion: model based on intermittent osmotic fluid trapping in the small bowel  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Based on recently reported data that fructose ingestion is linked to arterial hypertension, a model of regulatory loops involving the colon role in maintenance of fluid and sodium homeostasis is proposed. In normal digestion of hyperosmolar fluids, also in cases of postprandial hypotension and in patients having the "dumping" syndrome after gastric surgery, any hyperosmolar intestinal content is diluted by water taken from circulation and being trapped in the bowel until reabsorption. High fructose corn sirup (HFCS soft drinks are among common hyperosmolar drinks. Fructose is slowly absorbed through passive carrier-mediated facilitated diffusion, along the entire small bowel, thus preventing absorption of the trapped water for several hours. Here presented interpretation is that ingestion of hyperosmolar HFCS drinks due to a transient fluid shift into the small bowel increases renin secretion and sympathetic activity, leading to rise in ADH and aldosterone secretions. Their actions spare water and sodium in the large bowel and kidneys. Alteration of colon absorption due to hormone exposure depends on cell renewal and takes days to develop, so the momentary capacity of sodium absorption in the colon depends on the average aldosterone and ADH exposure during few previous days. This inertia in modulation of the colon function can make an individual that often takes HFCS drinks prone to sodium retention, until a new balance is reached with an expanded ECF pool and arterial hypertension. In individuals with impaired fructose absorption, even a higher risk of arterial hypertension can be expected.

Kurbel Sven

2010-06-01

369

The effect of cholecystokinin octapeptide upon the migrating myoelectric complex in the ovine small bowel  

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Full Text Available There is no evident and precise data regarding the effect of cholecystokinin octapeptide (CCK-OP on the migrating myoelectric complex (MMC in sheep. Thus, in five rams seven bipolar platinum electrodes were implanted in the abomasal antrum and entire small intestine. The strain gauge force transducer was also attached near the duodenal electrode in three of these animals. During the experiments the myoelectric and motor activity was continuously recorded in fasted and non-fasted sheep. During the recordings two normal consecutive phases 3 of the MMC were recorded. Then, slow injections of CCK-OP of 0.02; 0.2 and 2.0 _g/kg of body weight were given intravenously during phase 1, 2a or 2b of the MMC, identified in the duodenum, until next two consecutive phases 3 MMC were recorded. The moderate dose of CCK-OP administered during phase 2a in non-fasted animals shortened the MMC cycles significantly while the highest dose of the hormone increased the cycle duration and inhibited phase 3 MMC in the duodenum. No such effect was observed in the jejunum. However, duration of phase 3 in this region was decreased mostly by the highest dose of CCK-OP. It can be concluded that CCK inhibits the MMC in ovine small bowel and its effect in the duodenum is most pronounced.

Romanski Krzysztof W.

2007-01-01

370

Intestinal small bowel lymphomas - diagnosis and treatment; Primaer intestinale Lymphome - Diagnosestellung mittels CT und Therapie  

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Primary intestinal lymphomas are most common in the stomach. The mucosa associated lymphatic tissue (MALT)-lymphoma which is closely associated with helicobacter pylori is very well known. In most cases, these malignancies are from B-cells origin. Another possible point of manifestation, although not well known, is the small bowel. Both tumors have enormous capabilities to enlarge in the abdominal cave. This is responding to their often asymptomatic manifestation. The symptoms, if they occur, are widespread and unspecific. Ileus, diarrhae, abdominal pain or bleeding will be observed, in rare cases also perforation or gastrointestinal or cutaneous fistulas. Diagnostic imaging often demonstrates a tumour of massive size by then, which is echopoor in the abdominal ultrasound. Our report concerns two cases of small intestine lymphomas, which were diagnosed by CT-scanning and treated in our clinic in only a short period of time. The first case was a low malignant jejunal lymphoma which was almost asymptomatic, whereas the second case had an ileus, due to compression of the intestine because of a high malignant lymphoma of the ileocecal region. (orig.)

Goessmann, H.; Reith, H.B. [Klinikum fuer Visceral-, Thorax und Gefaesschirurgie, Klinikum Konstanz (Germany); Goerlitz, T.; Beck, A. [Inst. fuer Roentgendiagnostik und Nuklearmedizin, Klinikum Konstanz (Germany)

2006-07-01

371

Transplante de intestino delgado: "una realidad en Colombia" Small bowel transplant: "a reality in Colombia"  

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Full Text Available Desde el año 2005, con previa capacitación de los integrantes del grupo en Pittsburgh (EU, y gracias al apoyo del hospital, decidimos crear la consulta de Rehabilitación Intestinal y Transplante de Intestino Delgado en el Hospital Pablo Tobón Uribe de Medellín (Colombia, a donde nos remiten, desde diversos lugares del país, pacientes con dificultades para su nutrición, a los cuales, con asesoría, los tenemos controlados con nutrición enteral y en algunos casos con nutrición parenteral ambulatoria con colaboración de sus entidades prestadoras de salud. Algunos de estos pacientes presentan falla intestinal o pérdida de accesos vasculares centrales para su nutrición parenteral y se les ofrece la posibilidad de transplante de intestino delgado. El grupo de Transplante de Intestino Delgado del Hospital Pablo Tobón Uribe está conformado por un equipo multidisciplinario de cirujanos de transplante, gastroenterólogos, anestesiólogos, nutricionistas, patólogos, trabajadora social, psicólogos, intensivistas y enfermeras. Desde febrero del año 2006 hemos realizado cuatro transplantes de intestino delgado aislado, a pacientes provenientes de distintas ciudades de Colombia, y hasta el momento hemos obtenido muy buenos resultados, logrando independencia nutricional, con una calidad de vida excelente que incluye retorno a su vida laboral. Todo esto ha sido posible gracias a la remisión de estos pacientes por médicos colegas de diferentes regiones del país, con el objeto de ofrecerles una opción de vida a estos individuos, que anteriormente fallecían en lamentables condiciones nutricionales y con infecciones sobreagregadas. Esperamos que en el futuro nos sigan enviando pacientes con este tipo de patologías para ofrecer con nuestro grupo multidisciplinario, esta alternativa de manejo.In 2005, with previous training of the medical team in Pittsburgh (USA and thanks to our hospital’s support, we decided to establish an Intestinal Rehabilitation and Small Bowel Transplant program at Pablo Tobón Uribe Hospital in Medellin (Colombia, where people from many places of the country come with nutritional deficiencies. These patients, with the support of nutritional group, receive home enteral and total parenteral nutrition (TPN with collaboration of their health insurance services. Some of these patients have intestinal failure or difficulties with central vascular access for their TPN, and in some cases our program offers the possibility of small bowel transplantation. The Small Bowel Transplant group of Pablo Tobón Uribe Hospital is integrated by multidisciplinary professionals (Transplant surgeons, gastroenterologist, anesthesiologist, pathologist, nutritionists, social work services, psychologist, intensive care physicians and nurses. Since February 2006 we have performed intestinal transplant in four adult patients, with excellent outcome, achieving nutritional independence and great quality of life. These results have been acquired thanks to early consultation and remission from our colleagues from different cities of Colombia. In the past, these patients frequently died secondary to severe malnutrition and infectious diseases. We hope in a near future to have the possibility of new cases in order to continue working with our main objective of offering an alternative to the management of these patients.

Fabián Juliao Baños

372

Lymphocyte cytotoxicity in x-irradiation induced rat small bowel adenocarcinoma. IV. Activation of cellular immunity by x irradiation  

International Nuclear Information System (INIS)

Exposure of only the ileum and jejunum of Holtzman male rats to 100 to 2000 R resulted in almost immediate and dose-dependent activation of anti-tumor cellular immune mechanisms, as measured in vitro by the cytotoxicity of the animals' peripheral blood lymphoid cells to allogeneic cultured cells from an x-irradiation induced Holtzman rat small bowel adenocarcinoma. These cytotoxic responses were somewhat specific; the lymphoid cells did not kill prostatic adenocarcinoma target cells and cytotoxicity could not be induced by x irradiation of some tissues other than the small bowel. Results suggest that exposure of an organ to ionizing radiation results in changes which sensitize the lymphoid cells in the animal to recognize and kill cancer cells of the particular tissue. Immunologic suppression by ionizing radiation presumably did not occur because only a small portion of the body was exposed

373

The volume effect in radiation-related late small bowel complications. Results of a clinical study of the EORTC Radiotherapy Cooperative Group in patients treated for rectal carcinoma  

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The purpose of this study was to quantify the correlation between irradiated small bowel volume and late occurring small bowel complications. Methods: Small bowel volumes in the high-dose region were measured using orthogonal barium films for 203 patients treated for rectal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EORTC multicentric study. Results: The 5-year estimate of lat pelvic small bowel obstruction requiring surgery was 11%. No correlation between the irradiated small bowel volume and obstruction was detected. The actuarial 5-year estimate of chronic diarrhea varied from 31% in patients with irradiated small bowel volumes below 77 cm3 to 42% in patients with volumes over 328 cm3. This correlation was significant in the univariate and multivariate analysis (p=0.025). The type of rectal surgery significantly influenced the incidence of chronic diarrhea and malabsorption, the actuarial 5-year estimate being 49% and 26% after low anterior resection and abdominoperineal resection, respectively (p=0.04). Conclusions: This study demonstrated that there is a volume-effect in radiation-induced diarrhea atr a dose of 50 Gy in 25 fractions. No volume-effect for small bowel obstruction was detected at this dose-level in pelvic postoperative radiotherapy. A review of the literature data on small bowel obstruction indicates that the volume effect at this dose level can only be demonstrated in patients who were treated with extende in patients who were treated with extended field radiotherapy (estimated small bowel volume 800 cm3) after intra-abdominal surgery. (author). 22 refs., 5 tabs

374

Diverticular Disease Is Associated With Increased Risk of Subsequent Arterial and Venous Thromboembolic Events  

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Diverticular disease and cardiovascular disease share several risk factors. Inflammation associated with diverticular disease could predispose to cardiovascular disease. We assessed the association between a diagnosis of diverticular disease and subsequent arterial and venous thromboembolic events, adjusting for related comorbidities to explore a possible causal relationship.

Strate, Lisa L; Erichsen, Rune

2013-01-01

375

Frequency and risk factors for rebleeding events in patients with small bowel angioectasia.  

Science.gov (United States)

BackgroundSmall bowel angioectasia is reported as the most common cause of bleeding in patients with obscure gastrointestinal bleeding. Although the safety and efficacy of endoscopic treatment have been demonstrated, rebleeding rates are relatively high. To establish therapeutic and follow-up guidelines, we investigated the long-term outcomes and clinical predictors of rebleeding in patients with small bowel angioectasia.MethodsA total of 68 patients were retrospectively included in this study. All the patients had undergone CE examination, and subsequent control of bleeding, where needed, was accomplished by endoscopic argon plasma coagulation. Based on the follow-up data, the rebleeding rate was compared between patients who had/had not undergone endoscopic treatment. Multivariate analysis was performed using Cox proportional hazard regression model to identify the predictors of rebleeding. We defined the OGIB as controlled if there was no further overt bleeding within 6 months and the hemoglobin level had not fallen below 10 g/dl by the time of the final examination.ResultsThe overall rebleeding rate over a median follow-up duration of 30.5 months (interquartile range 16.5¿47.0) was 33.8% (23/68 cases). The cumulative risk of rebleeding tended to be lower in the patients who had undergone endoscopic treatment than in those who had not undergone endoscopic treatment, however, the difference did not reach statistical significance (P =0.14). In the majority of patients with rebleeding (18/23, 78.3%), the bleeding was controlled by the end of the follow-up period. Multiple regression analysis identified presence of multiple lesions (¿3) (OR 3.82; 95% CI 1.30¿11.3, P =0.02) as the only significant independent predictor of rebleeding.ConclusionIn most cases, bleeding can be controlled by repeated endoscopic treatment. Careful follow-up is needed for patients with multiple lesions, presence of which is considered as a significant risk factor for rebleeding. PMID:25430814

Sakai, Eiji; Endo, Hiroki; Taguri, Masataka; Kawamura, Harunobu; Taniguchi, Leo; Hata, Yasuo; Ezuka, Akiko; Nagase, Hajime; Kessoku, Takaomi; Ishii, Ken; Arimoto, Jun; Yamada, Eiji; Ohkubo, Hidenori; Higurashi, Takuma; Koide, Tomoko; Nonaka, Takashi; Takahashi, Hirokazu; Nakajima, Atsushi

2014-11-28

376

A roentgenologic study of diverticular throughout the entire gastrointestinal tract  

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Diverticulum is considered as a common lesion involving any gastrointestinal tract from the pharynx to the rectum. We reviewed 5,806 cases of upper G-I series and 801 cases of double contrast barium enema during the period from Jan.1978 to Dec. 1981 in the Department of Radiology, School of Medicine, Jeonbug National University Hospital to analyze diverticula of the entire gastrointestinal tract. The results were as follows: 1. Roentgen examination of 5,806 esophagus, stomachs, duodenums and small bowels, and 801 colons during the past four years: diverticula of the esophagus, 60 cases (1.0%); diverticula of the stomach, 42 cases (0.7%); diverticula of the duodenum, 358 cases (6.2%); diverticula of the small bowel, 20 cases (0.3%); diverticula of the colon, 26 cases (3.2%). The location of diverticula in order of frequency was duodenum, colon, esophagus, stomach and small bowel. 2. The most common site of diverticula of each gastrointestinal tract was as follows: diverticula of the esophagus, middle portion (84.7%); diverticula of the stomach, the cardia (59.5%); diverticula of the duodenum, the second portion (81.3%); diverticula of the small bowel, the jejunum (96.4%)-especially the larger percentage were observed at the upper jejunum near the ligament of Treitz; diverticula of the colon, the right sided colon (80.8%)-the cecum and ascending colon (57.1%). 3. Diverticula may occur at any age. The majority of diverticula of the entire gastrointestinal tract were observed over 40 years of age. Especially in diverticula of the duodenum and colon, their frequency increase with age. 4. Duodenal diverticula were observed more frequently in woman than in man but in diverticula of the esophagus, stomach, small bowel and colon, male was more frequently affected. 5. The size of diverticula of the entire gastrointestinal tract was variable. The majority of diverticula of the esophagus, stomach, duodenum and small bowel were intermediate in size (10-49 mm). Diverticula of the colon were usually smaller than 10 mm. 6. Multiplicity of diverticula of the entire gastrointestinal tract was 16.2% of 506 cases. In diverticula of the esophagus, stomach, duodenum and small bowel, single lesion was more frequently found. On the other hand, the majority of diverticula of the colon were found as multiple lesion(69.2%)

Sohn, Myung Hee; Song, Ho Young; Lim, Kyu Yeob [College of Medicine, Jeonbug National University, Jeonju (Korea, Republic of)

1983-03-15

377

A roentgenologic study of diverticular throughout the entire gastrointestinal tract  

International Nuclear Information System (INIS)

Diverticulum is considered as a common lesion involving any gastrointestinal tract from the pharynx to the rectum. We reviewed 5,806 cases of upper G-I series and 801 cases of double contrast barium enema during the period from Jan.1978 to Dec. 1981 in the Department of Radiology, School of Medicine, Jeonbug National University Hospital to analyze diverticula of the entire gastrointestinal tract. The results were as follows: 1. Roentgen examination of 5,806 esophagus, stomachs, duodenums and small bowels, and 801 colons during the past four years: diverticula of the esophagus, 60 cases (1.0%); diverticula of the stomach, 42 cases (0.7%); diverticula of the duodenum, 358 cases (6.2%); diverticula of the small bowel, 20 cases (0.3%); diverticula of the colon, 26 cases (3.2%). The location of diverticula in order of frequency was duodenum, colon, esophagus, stomach and small bowel. 2. The most common site of diverticula of each gastrointestinal tract was as follows: diverticula of the esophagus, middle portion (84.7%); diverticula of the stomach, the cardia (59.5%); diverticula of the duodenum, the second portion (81.3%); diverticula of the small bowel, the jejunum (96.4%)-especially the larger percentage were observed at the upper jejunum near the ligament of Treitz; diverticula of the colon, the right sided colon (80.8%)-the cecum and ascending colon (57.1%). 3. Diverticula may occur at any age. The majority of diverticula of the entire gastrointestinal tract were obsehe entire gastrointestinal tract were observed over 40 years of age. Especially in diverticula of the duodenum and colon, their frequency increase with age. 4. Duodenal diverticula were observed more frequently in woman than in man but in diverticula of the esophagus, stomach, small bowel and colon, male was more frequently affected. 5. The size of diverticula of the entire gastrointestinal tract was variable. The majority of diverticula of the esophagus, stomach, duodenum and small bowel were intermediate in size (10-49 mm). Diverticula of the colon were usually smaller than 10 mm. 6. Multiplicity of diverticula of the entire gastrointestinal tract was 16.2% of 506 cases. In diverticula of the esophagus, stomach, duodenum and small bowel, single lesion was more frequently found. On the other hand, the majority of diverticula of the colon were found as multiple lesion(69.2%)

378

Radiological aspects of diagnosis and staging of small bowel lymphoma - a case report; Aspectos radiologicos no diagnostico e estadiamento do linfoma de intestino delgado - relato de um caso  

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The authors report a case of a non-Hodgkin lymphoma of the small bowel, presenting with ulcerative lesions on radiological studies. primary intestinal lymphoma is considered a rare entity and its diagnosis criteria are quiet strict. The secondary form of the disease - involvement of the small bowel by systemic lymphoma - constitutes an infrequent clinical presentation of these neoplasms and must be considered when the criteria for primary disease are not fulfilled. Diagnosis is based on small bowel series studies and/or computed tomography findings, but the definitive diagnosis is established by biopsy. (author)

Antunes, Luciano Magrini; Medeiros, Sergio Cainelli; Fraga, Rafael [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Faculdade de Medicina; Friedrich, Mariangela Gheller; Todeschini, Luiz Alberto; Furtado, Alvaro Porto Alegre [Hospital de Clinicas de Porto Alegre, RS (Brazil)

1999-12-01

379

Comparison of upper gastrointestinal radiographic findings to histopathologic observations: a retrospective study of 41 dogs and cats with suspected small bowel infiltrative disease (1985 to 1990)  

International Nuclear Information System (INIS)

It was the intent of this study to define which, if any, radiographic observations corresponded with specific causes of diffuse infiltrative small bowel disease and if radiographic findings could differentiate inflammatory disease from neoplastic disease and either of them from normal. Bowel spasticity, luminal narrowing, and thumb printing tend to indicate the presence of tumor more often than inflammatory disease. Increased bowel gas in cats and barium adhesion in dogs and cats suggest that a component of enteritis is present. Decreased bowel gas in dogs is more often associated with obstructive disease, but is not helpful in differentiating diffuse inflammatory disease from diffuse neoplastic disease. While several observations that can foster differentiation of neoplastic from inflammatory disease were found, this study also indicated that the UGI lacks a high degree of predictive value other than to indicate the presence of infiltrative small bowel disease

380

Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease  

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Full Text Available Abstract Background Due to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient. We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration. Methods Twenty-five celiac disease adults were challenged with low (1-3 g or moderate (3-5g doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs and celiac serology were determined. Results Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients. Conclusions Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis.

Lähdeaho Marja-Leena

2011-11-01

381

The scintigraphic determination of small intestinal transit time in patients with irritable bowel syndrome  

International Nuclear Information System (INIS)

Diffuse disturbance in gastrointestinal motility may be present in patients with irritable bowel syndrome (IBS). To further investigate small intestinal motility in IBS patients small intestinal transit time (SITT) was determined and related to the symptom status. 11 female patients with IBS (mean age 29 years) were divided into those whose predominate symptom was diarrhea (N=6), and those with only constipation (N=5). All subjects ingested an isosmotic solution of lactulose (10 gm in 150cc of water) labeled with 99m-Tc-DTPA (Sn). The patient was studied supine under a 25 inch gamma camera with data collected at 1 frame per minute for 180 minutes or until activity appeared in the ascending colon. Regions of interest were selected over the cecum and ascending colon. The time of first appearance of radioactivity in the region of the cecum was taken as the small intestinal transit time. SITT in the 5 normal females was 98.7 +- 13 min (mean +- SEM). SITT in the IBS patients with diarrhea, 67.3 +- 7 min was significantly faster (p< 0.08). SITT in the constipated IBS patients, 126 +- 12 min, was slower than normals and significantly different from diarrhea patients (p< 0.001). These studies show that IBS patients with diarrhea have significantly faster SITT than normals while constipated IBS patients have significantly slower SITT than the diarrhea subgroup. Further, this study emphasizes the need to study the various symptomatic subgroups of IBs patients independently and indicates a possible role for abnormal SITT in the pathogenesis of IBS

382

The scintigraphic determination of small intestinal transit time in patients with irritable bowel syndrome  

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Diffuse disturbance in gastrointestinal motility may be present in patients with irritable bowel syndrome (IBS). To further investigate small intestinal motility in IBS patients small intestinal transit time (SITT) was determined and related to the symptom status. 11 female patients with IBS (mean age 29 years) were divided into those whose predominate symptom was diarrhea (N=6), and those with only constipation (N=5). All subjects ingested an isosmotic solution of lactulose (10 gm in 150cc of water) labeled with 99m-Tc-DTPA (Sn). The patient was studied supine under a 25 inch gamma camera with data collected at 1 frame per minute for 180 minutes or until activity appeared in the ascending colon. Regions of interest were selected over the cecum and ascending colon. The time of first appearance of radioactivity in the region of the cecum was taken as the small intestinal transit time. SITT in the 5 normal females was 98.7 +- 13 min (mean +- SEM). SITT in the IBS patients with diarrhea, 67.3 +- 7 min was significantly faster (p< 0.08). SITT in the constipated IBS patients, 126 +- 12 min, was slower than normals and significantly different from diarrhea patients (p< 0.001). These studies show that IBS patients with diarrhea have significantly faster SITT than normals while constipated IBS patients have significantly slower SITT than the diarrhea subgroup. Further, this study emphasizes the need to study the various symptomatic subgroups of IBs patients independently and indicates a possible role for abnormal SITT in the pathogenesis of IBS.

Marano, A.R.; Caride, V.J.; Shah, R.V.; Prokop, E.K.; Troncale, F.J.; McCallum, R.W.

1984-01-01

383

Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours  

International Nuclear Information System (INIS)

To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection. Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19-85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies. Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89-100 %], 96 % [90-100 %], 93 % [83-100 %], 98 % [94-100 %] and 96 % [92-100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56-85 %] and 93 % [83-100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P = 0.008). MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection. (orig.)

384

Two cameras detect more lesions in the small-bowel than one  

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Full Text Available AIM: To explore the feasibility of dual camera capsule (DCC small-bowel (SB imaging and to examine if two cameras complement each other to detect more SB lesions.METHODS: Forty-one eligible, consecutive patients underwent DCC SB imaging. Two experienced investigators examined the videos and compared the total number of detected lesions to the number of lesions detected by each camera separately. Examination tolerability was assessed using a questionnaire.RESULTS: One patient was excluded. DCC cameras detected 68 positive findings (POS in 20 (50% cases. Fifty of them were detected by the “yellow” camera, 48 by the “green” and 28 by both cameras; 44% (n = 22 of the “yellow” camera’s POS were not detected by the “green” camera and 42% (n = 20 of the “green” camera’s POS were not detected by the “yellow” camera. In two cases, only one camera detected significant findings. All participants had 216 findings of unknown significance (FUS. The “yellow”, “green” and both cameras detected 171, 161, and 116 FUS, respectively; 32% (n = 55 of the “yellow” camera’s FUS were not detected by the “green” camera and 28% (n = 45 of the “green” camera’s FUS were not detected by the “yellow” camera. There were no complications related to the examination, and 97.6% of the patients would repeat the examination, if necessary.CONCLUSION: DCC SB examination is feasible and well tolerated. The two cameras complement each other to detect more SB lesions.

Konstantinos Triantafyllou, Ioannis S Papanikolaou, Kostis Papaxoinis, Spiros D Ladas

2011-03-01

385

Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours  

Energy Technology Data Exchange (ETDEWEB)

To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection. Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19-85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies. Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89-100 %], 96 % [90-100 %], 93 % [83-100 %], 98 % [94-100 %] and 96 % [92-100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56-85 %] and 93 % [83-100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P = 0.008). MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection. (orig.)

Amzallag-Bellenger, Elisa; Hoeffel, Christine [Hopital Robert Debre, Department of Radiology, Reims Cedex (France); Soyer, Philippe [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Radiology, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Barbe, Coralie [Hopital Robert Debre, Department of Statistics, Reims Cedex (France); Diebold, Marie-Daniele [Hopital Robert Debre, Department of Pathology, Reims Cedex (France); Cadiot, Guillaume [Hopital Robert Debre, Department of Gastroenterology, Reims Cedex (France)

2013-07-15

386

Small bowel transplantation complicated by cytomegalovirus tissue invasive disease without viremia.  

Science.gov (United States)

We report on a small bowel transplant patient, donor/recipient seropositive (D+/R+) for cytomegalovirus (CMV), with a clinical course complicated by CMV disease. Anti-CMV prophylaxis was given for 100 days. Immunosuppression consisted of alemtuzumab, tacrolimus, mycophenolate mofetil and prednisolone. Five months posttransplant, CMV tissue invasive disease of the upper gastrointestinal tract was evident without the presence of viremia, tested by quantitative polymerase chain reaction (PCR). Complete viral load suppression was achieved with intravenous ganciclovir, followed by valganciclovir for secondary prophylaxis. Mycophenolate mofetil and prednisolone were discontinued. Shortly thereafter the patient presented with recurrent CMV and candida esophagitis. While on ganciclovir and caspofungin, the patient developed CMV tissue invasive disease of the ileal graft, with persistent absence of viremia. Foscarnet and CMV immunoglobulin were added. Viral load declined to undetectable levels; however, clinical improvement did not occur due to occurrence of graft rejection. Despite infliximab and high dose prednisolone, graft rejection was progressive, requiring surgical explantation of the graft. This case highlights the importance of additional diagnostic tools such as endoscopy including PCR analysis of tissue samples. Extension of primary antiviral prophylaxis interval up to 6 months and prolonged retreatment for recurrent CMV disease may be useful to avoid severe CMV-related complications. PMID:24703746

Avsar, Yesim; Cicinnati, Vito R; Kabar, Iyad; Wolters, Heiner; Anthoni, Christoph; Schmidt, Hartmut H J; Beckebaum, Susanne

2014-06-01

387

Assessment of Crohn's disease activity in the small bowel with MR and conventional enteroclysis: preliminary results  

International Nuclear Information System (INIS)

Every single imaging finding that can be disclosed on conventional and MR enteroclysis was correlated with the Crohn's disease activity index (CDAI). Nineteen consecutive patients with Crohn's disease underwent colon endoscopy and both conventional and MR enteroclysis examinations. Seventeen MR imaging findings and seven conventional enteroclysis findings were ranked on a four-point grading scale and correlated with CDAI, with a value of 150 considered as the threshold for disease activity. Six patients had active disease in the colon according to colon endoscopy. In the remaining 13 patients, the presence of deep ulcers (P=0.002), small bowel wall thickening (P=0.022) and gadolinium enhancement of mesenteric lymph nodes (P=0.014) identified on MR enteroclysis images were strongly correlated to disease activity. The product of deep ulcers and enhancement of lymph node ranks identified on MR enteroclysis were the optimum combination for discriminating active from non-active disease (F-test: 55.95, P<0.001). Additionally, the ranking of deep ulcers on conventional enteroclysis provided statistically significant differences between active and non-active patients (F-test: 14.12, P=0.004). Abnormalities strongly suggestive of active Crohn's disease can be disclosed on MR enteroclysis examinations and may provide pictorial information for local inflammatory activity. (orig.)

388

CT findings of patients with small bowel obstruction due to bezoar: a descriptive study.  

Science.gov (United States)

PURPOSE. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types. MATERIALS AND METHODS. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. RESULTS. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum (n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. CONCLUSIONS. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis. PMID:23690741

Altintoprak, Fatih; Degirmenci, Bumin; Dikicier, Enis; Cakmak, Guner; Kivilcim, Taner; Akbulut, Gokhan; Dilek, Osman Nuri; Gunduz, Yasemin

2013-01-01

389

Tailoring the small-bowel follow-through examination postoperatively in gastroschisis patients.  

Science.gov (United States)

The purpose of this paper is to establish a small-bowel follow-through (SBFT) protocol in post-operative gastroschisis patients. In 15 years, 19 SBFT examinations have been performed to diagnose or exclude obstruction in 61 gastroschisis patients. The average examination required 6.7 overhead films (range 3-15) and lasted 34 h (1-190 h). The diagnosis of intestinal obstruction was supported on SBFT in only 1 of 19 patients who underwent this examination. In the other 18, the examination showed no obstruction (13 patients) or was nonconclusive (5 patients). The inherent dysmotility associated with gastroschisis can result in redundant overhead films being made during SFBT. We recommend that an SBFT examination in gastroschisis patients consist of (1) fluoro-evaluation of esophagus, stomach, and duodenum; (2a) if normal peristalsis is noted, then an overhead film at 30 min, or (2b), if altered peristalsis or little movement of contrast medium is noted on the 30-min overhead film, then an overhead film at 4 and 12 h. This is followed by overhead films every 24 h if required. This protocol can result in a decrease in patient radiation, department costs, and staff work load. PMID:7567233

Soboleski, D; Daneman, A; Manson, D; Ein, S

1995-01-01

390

Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: Experience with Rifaximin  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To estimate the prevalence of small intestinal bacterial overgrowth (SIBO in our geographical area (Western Sicily, Italy by means of an observational study, and to gather information on the use of locally active, non-absorbable antibiotics for treatment of SIBO.METHODS: Our survey included 115 patients fulfilling the Rome II criteria for diagnosis of irritable bowel syndrome (IBS; a total of 97 patients accepted to perform a breath test with lactulose (BTLact, and those who had a positive test, received Rifaximin (Normix®, Alfa Wassermann 1200 mg/d for 7 d; 3 wk after the end of treatment, the BTLact was repeated.RESULTS: Based on the BTLact results, SIBO was present in about 56% of IBS patients, and it was responsible for some IBS-related symptoms, such as abdominal bloating and discomfort, and diarrhoea. 1-wk treatment with Rifaximin turned the BTLact to negative in about 50% of patients and significantly reduced the symptoms, especially in those patients with an alternated constipation/diarrhoea-variant IBS.CONCLUSION: SIBO should be always suspected in patients with IBS, and a differential diagnosis is done by means of a “breath test”. Rifaximin may represent a valid approach to the treatment of SIBO.

Sergio Peralta, Claudia Cottone, Tiziana Doveri, Piero Luigi Almasio, Antonio Craxi

2009-06-01

391

Measurement of small bowel transit time by 99Tcm-SC imaging: preliminary clinical study  

International Nuclear Information System (INIS)

Objective: To develop a method of measuring small bowel transit time (SBTT) by 99Tcm-sulfur collide (SC) imaging and to compare with the method of added lactose in the test meal. Methods: 20 healthy volunteers and 26 patients with gastrointestinal disorders were studied. In fasting state, the subjects were asked to ingest the 99Tcm-SC labelled solid meal within 5 minutes, then the image acquisition was immediately started with SPECT. The images were acquired every 15 min during the first hour, at 30 min intervals during 2?4 hours and hourly thereafter until 80% radioactivity had entered the colon. One week later, the same procedure of imaging with 15 g lactulose added in the test meal was performed. The regions of interest (ROIs) were taken at stomach and colon, and the SBTT was calculated by deconvolution or by subtraction of the 50% time of gastric emptying from the 50% time of colon filling. Results: 1) The mean SBTT of 20 healthy volunteers was (4.2 +- 0.5) h, oral-caecum transit time (OCTT) was (4.3 +- 0.6) h; lactulose shortened the SBTT by (1.8 +- 0.6) h; 2) 26 patients showed different results of SBTT due to their different gastrointestinal disorders bases. Conclusions: 99Tcm-SC imaging was a noninvasive and useful method to measure SBTT. The added lactulose can shorten the examination time and help to identify the time of food to the ileocecal region

392

Bacteria and the mucus blanket in experimental small bowel bacterial overgrowth.  

Science.gov (United States)

Self-filling blind loops were created experimentally in jejunal segments of specific pathogen-free male Wistar rats, and the loop contents and mucosa were examined over an 8-week period for evaluation of the interaction between mucus and luminal bacteria. Corresponding jejunal segments from rats that did not undergo surgery were used as controls. Proliferation of anaerobic bacteria developed in the test animals by the first week after surgery. Despite anaerobic bacterial proliferation, no adherence by bacteria to the intestinal microvillus surface was observed by scanning or transmission electron microscopy. Rather, bacteria were present within the mucus layer overlying the intestinal mucosal surface. Immunoassay of goblet cell mucin demonstrated an increase in the proportion of mucin present in the intestinal lumen and a decrease in mucin levels in the jejunal mucosa. These results suggest that the interaction of bacteria with mucus is an important mechanism of protection of the mucosal surface in experimental small bowel bacterial overgrowth. Images Figure 3 Figure 4 Figure 1 Figure 2 Figure 5 PMID:2950765

Sherman, P.; Fleming, N.; Forstner, J.; Roomi, N.; Forstner, G.

1987-01-01

393

Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses  

Science.gov (United States)

AIM: To investigate the influence of remote ischemic preconditioning (RIPC) on anastomotic integrity. METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10) had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34) varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9). On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range). RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg) in the control group. The experimental groups did not show a statistically significant difference (P > 0.05). Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group. CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning. PMID:21455330

Holzner, Philipp Anton; Kulemann, Birte; Kuesters, Simon; Timme, Sylvia; Hoeppner, Jens; Hopt, Ulrich Theodor; Marjanovic, Goran

2011-01-01

394

IGF-2 is necessary for retinoblastoma-mediated enhanced adaptation after small-bowel resection.  

Science.gov (United States)

Previously, we have demonstrated that genetically disrupting retinoblastoma protein (Rb) expression in enterocytes results in taller villi, mimicking resection-induced adaption responses. Rb deficiency also results in elevated insulin-like growth factor-2 (IGF-2) expression in villus enterocytes. We propose that postoperative disruption of Rb results in enhanced adaptation which is driven by IGF-2. Inducible, intestine-specific Rb-null mice (iRbIKO) and wild-type (WT) littermates underwent a 50% proximal small-bowel resection (SBR) at 7-9 weeks of age. They were then given tamoxifen on postoperative days (PODs) 4-6 and harvested on POD 28. The experiment was then repeated on double knockouts of both IGF-2 and Rb (IGF-2 null/iRbIKO). iRbIKO mice demonstrated enhanced resection-induced adaptive villus growth after SBR and increased IGF-2 messenger RNA (mRNA) in ileal villus enterocytes compared to their WT littermates. In the IGF-2 null/iRbIKO double-knockout mice, there was no additional villus growth beyond what was expected of normal resection-induced adaptation. Adult mice in which Rb is inducibly deleted from the intestinal epithelium following SBR have augmented adaptive growth. IGF-2 expression is necessary for enhanced adaptation associated with acute intestinal Rb deficiency. PMID:25002022

Choi, Pamela M; Sun, Raphael C; Sommovilla, Josh; Diaz-Miron, Jose; Guo, Jun; Erwin, Christopher R; Warner, Brad W

2014-11-01

395

Peristalsis gap sign at cine magnetic resonance imaging for diagnosing strangulated small bowel obstruction. Feasibility study  

International Nuclear Information System (INIS)

The aim of this study was to determine the feasibility of cine magnetic resonance imaging (MRI) for diagnosing strangulated small bowel obstruction (SBO). This study included 38 patients with clinically confirmed SBO who had undergone cine MRI. Cine MRI scans were evaluated regarding the presence of the 'peristalsis gap sign' (referring to an akinetic or severely hypokinetic closed loop), indicating strangulation. Computed tomography (CT) was performed in 34 of 38 patients with (n=25) or without (n=9) contrast enhancement. CT images were evaluated using a combination of criteria (presence of hyperattenuation, poor contrast enhancement, mesenteric edema, wall thickening, massive ascites) indicating strangulation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cine MRI and CT for the diagnosis of strangulation were calculated and compared using surgical findings and the clinical course as the reference standard. Sensitivity, specificity, PPV, and NPV of cine MRI were 100%, 92.9%, 83.3%, and 100%, respectively; and those of CT (of which 26.5% was performed without contrast enhancement) were 66.7%, 92.0%, 75.0%, and 88.5%, respectively. There was no significant difference in diagnostic accuracy between the two methods (P=0.375). Cine MRI is a feasible and promising technique for diagnosing strangulation. (author)

396

Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To investigate the influence of remote ischemic preconditioning (RIPC on anastomotic integrity.METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10 had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34 varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9. On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range.RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg in the control group. The experimental groups did not show a statistically significant difference (P > 0.05. Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group.CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning.

Philipp Anton Holzner, Birte Kulemann, Simon Kuesters, Sylvia Timme, Jens Hoeppner, Ulrich Theodor Hopt, Goran Marjanovic

2011-03-01

397

Strangulated Incisional Richter’s Hernia Complicated by Small Bowel Perforation and Phlegmon of Anterior Abdominal Wall  

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Full Text Available We reported an abnormal case of strangulated incisional Richter’s hernia complicated by small bowel perforation and phlegmon of anterior abdominal wall. The observation is interesting due to the fact that now strangulated Richter’s hernia is rather rare but extremely dangerous concerning the following complications due to scant clinical presentation in strangulation. We represented a case of a female patient with two-day past history of strangulation. She had a classical clinical picture of strangulated Richter’s hernia (strangulation, necrosis, small bowel perforation, the anterior abdominal wall phlegmon, enterocutaneous fistula, the absence of peritonitis and peritoneal irritation signs, and the presence of paralytic ileus. The surgical management was performed followed by a patient’s complete recovery.

V.L. Titarenko

2013-03-01

398

Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery  

International Nuclear Information System (INIS)

Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small-bowel damage. Animal experiments demonstrated tolerance to high-dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow-up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh-related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy

399

Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery  

Energy Technology Data Exchange (ETDEWEB)

Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small-bowel damage. Animal experiments demonstrated tolerance to high-dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow-up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh-related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy.

Devereux, D.F.; Chandler, J.J.; Eisenstat, T.; Zinkin, L.

1988-01-01

400

Sporadic Desmoid Tumor of the Small Bowel Mesentery in a Male Patient: A Case Report and Literature Review  

OpenAIRE

Aggressive fibromatosis arising from the small bowel mesentery is extremely rare. It may occur in association with previous trauma, abdominal surgery, drugs, Gardner’s syndrome, or familial adenomatous polyposis. This paper presents a 32-year-old man with no significant medical or surgical history, complaining of diffuse abdominal pain and discomfort. His computed tomography scan revealed a well-defined soft tissue mass in the peritoneal cavity. He underwent surgical excis...

Lamiae Amaadour; Zineb Benbrahim; Khadija Benhayoune; Layla Chbani; Samia Arifi; Nawfel Mellas

2014-01-01

401

Management of small bowel volvulus in a patient with simultaneous pancreas-kidney transplantation (SPKT): a case report  

OpenAIRE

Abstract There are several surgical complications which can occur following simultaneous pancreas-kidney transplantation (SPKT). Although intestinal obstruction is known to be a common complication after any type of abdominal surgery, the occurrence of small bowel volvulus, which is one of the rare causes of intestinal obstruction, following SPKT has not been published before. A 24-year-old woman suffering from type I diabetes mellitus with complications of nephropathy resulting in end stage ...

Aydin Unal; Yazici Pinar; Toz Huseyin; Hoscoskun Cuneyt; Coker Ahmet