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1

Diverticular Disease of the Small Bowel  

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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

Sigmoid motility in diverticular disease and the irritable bowel syndrome.  

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Intraluminal pressures were measured with four open ended, water perfused tubes in the fasting state and after a standard liquid meal (400 KCal, 375 ml, protein 15 g, carbohydrate 55 g, lipid 13.4 g) in six patients with sigmoid diverticular disease, 20 with the irritable bowel syndrome and in 13 controls. The pressure sensors were positioned in the true sigmoid colon at colonoscopy at 25, 35, 45, and 55 cm from the anus. Colonic pressures were significantly higher in diverticular disease tha...

Trotman, I. F.; Misiewicz, J. J.

1988-01-01

3

Small bowel mesentery fibroma  

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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.; Micev Marjan; Zogovi? Sergej; Grubor Nikica M.; Stojkovi? Mirjana

2002-01-01

4

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

5

Scintigraphic demonstration of inflammatory bowel pathologies in radionuclides Meckel's diverticular studies  

International Nuclear Information System (INIS)

Radionuclide Meckel's diverticular studies are commonly requested to help distinguish the source of chronic gastrointestinal blood loss. However, several aetiologies may contribute to false-positive scan findings, for example inflammatory pathologies such as Crohn's disease, ulcerative colitis, regional enteritis and intussusception, all of which commonly localise pertechnetate. In this paper, two cases of incidental findings on Meckel's diverticular studies and their impact on patient management will be presented

1998-12-01

6

Scintigraphic demonstration of inflammatory bowel pathologies in radionuclides Meckel`s diverticular studies  

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Radionuclide Meckel`s diverticular studies are commonly requested to help distinguish the source of chronic gastrointestinal blood loss. However, several aetiologies may contribute to false-positive scan findings, for example inflammatory pathologies such as Crohn`s disease, ulcerative colitis, regional enteritis and intussusception, all of which commonly localise pertechnetate. In this paper, two cases of incidental findings on Meckel`s diverticular studies and their impact on patient management will be presented 4 refs., 2 figs.

Ciavarelle, F

1998-12-01

7

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 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

2007-04-01

8

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)

2007-06-01

9

Small bowel intussusception in adults.  

Science.gov (United States)

Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults. We report a case of small bowel intussusception in an adult male patient. We have also performed a literature review of this rare condition. PMID:24417823

Potts, J; Al Samaraee, A; El-Hakeem, A

2014-01-01

10

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

11

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 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 like chronic renal failure (n=2) and hepat

2004-10-09

12

Small bowel faeces sign in patients without small bowel obstruction  

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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 (<2.5 cm) and mildly (2.5-2.9 cm), moderately (3-4 cm) or severely (>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 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.

Jacobs, S.L. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States)]. E-mail: stacylynnjacobs@yahoo.com; Rozenblit, A. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States); Ricci, Z. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States); Roberts, J. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States); Milikow, D. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States); Chernyak, V. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States); Wolf, E. [Department of Radiology, Montefiore Medical Center, Bronx, NY (United States)

2007-04-15

13

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

14

Clinical applications of small bowel capsule endoscopy  

Directory of Open Access Journals (Sweden)

Full Text Available Uri Kopylov, Ernest G Seidman Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada Abstract: Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy. Keywords: small bowel video capsule endoscopy, obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, patency capsule

Kopylov U

2013-07-01

15

Leiomyoma of the small bowel  

International Nuclear Information System (INIS)

Diagnosis and surgical treatment of a leiomyoma of the small bowel are described. The special findings in this case are the unusual location of this tumors and the fact that histological examination revealed a benign process, although the tumor had a diameter of more than 16 cm. (orig.)

1986-01-01

16

Two kinds of diverticular disease.  

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Two kinds of acquired diverticular disease were identified. The more common variety presented with pain, bowel symptoms or fistulae, and the less common with bleeding. The former patients rarely had a history of bleeding and among the latter pain and bowel symptoms were uncommon. In contrast to the few, chiefly sigmoid, diverticular often found in the former group, barium enemas of those presenting with bleeding usually showed densely packed and extensive diverticula. Even where there was no ...

Nathan, B.

1991-01-01

17

Tumor of small bowel  

International Nuclear Information System (INIS)

Young woman who is having episodes of overt obscure gastrointestinal bleeding that requires transfusions. The endoscopic study consists of 2 endoscopies of the upper digestive system and two colonoscopies. The tests do not find the cause of the digestive hemorrhage. A double-balloon enteroscopy is performed and it is found that the Ileum has an ulcerate subepithelial lesion with neoplasia appearance which is marked with Chinese ink and biopsies are taken from the tissue which are not diagnosed. Studies of staging are performed ant the result is negative. A laparotomy is performed for diagnosis and treatment which includes the intestinal resection of ileum where the tumor is placed. The result of the test shows to be a neuroendocrine carcinoma of high degree of large cells undifferentiated. One appears in addition a revision to overt obscure gastrointestinal bleeding and neuroendocrine tumor of small

2009-01-01

18

Actinomycosis complicating sigmoid diverticular disease: a case report  

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A 63-year-old Caucasian woman was admitted to hospital as hypotensive with abdominal tenderness and vaginal discharge. Laboratory investigations showed microcytic anaemia, low albumin and high white cell count. Computerised tomography scans revealed small bowel dilatation, sigmoid diverticula, ascites and pelvic fluid. The endometrial pipelle was positive and vaginal swab was negative for actinomyces. Post mortem examination revealed widespread sigmoid diverticular disease and bowel perforati...

Vodovnik, Aleksandar; Logishetty, Kartik

2009-01-01

19

Clinical applications of small bowel capsule endoscopy  

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Uri Kopylov, Ernest G Seidman Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada Abstract: Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future c...

Kopylov U; Eg, Seidman

2013-01-01

20

CT findings in acute small bowel diverticulitis  

International Nuclear Information System (INIS)

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.)

2004-02-01

 
 
 
 
21

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.

Pavel, Mihai; Lacy, Antonio

2014-01-01

22

Pneumobilia associated with small-bowel obstruction  

Energy Technology Data Exchange (ETDEWEB)

The authors present a patient who admitted complaining of nausea, vomiting, and abdominal distention. A roentgenogram of the abdomen revealed a dilated stomach and pneumobilia. At surgery, he was found to have proximal small-bowel obstruction. To their knowledge, this is the first case of pneumobilia associated with proximal small-bowel obstruction not associated with a gallstone.

Bautista, J.L.; Budhraja, M.D.; Barcia, T.D.; Shankel, S.W.

1988-10-07

23

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

24

Laparoscopic Management of Diverticular Disease  

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Despite its potential advantages, laparoscopic management of diverticular disease is currently performed by a minority of surgeons on a small group of patients. However, the role for laparoscopy in diverticular disease continues to develop. At present, adequate evidence exists for the routine use of laparoscopy for uncomplicated diverticular disease. Complicated disease, including fistulizing disease and free perforation requires additional expertise and study. As the experience grows among i...

Lipman, Jeremy M.; Reynolds, Harry L.

2009-01-01

25

Small bowel neoplastic disease: demonstration by MRI.  

Science.gov (United States)

This study demonstrates the appearance of small bowel tumors on MR images. Sixteen patients with tumors involving small bowel were studied by MRI. All tumors were proven with histopathology. Eleven patients had primary tumors of the small bowel, which included the following: four carcinoid tumors, three adenocarcinomas, two lymphomas, one leiomyosarcoma, and one leiomyoma. Five patients had recurrent or metastatic disease to small bowel: two patients had colon cancer, one patient had pancreatic cancer, one patient had uterine leiomyosarcoma, and one patient had chloroma (leukemia). MR examination included breath-hold T1-weighted spoiled gradient echo (all patients), immediate postgadolinium-spoiled gradient echo (10 patients), and 2 to 4 minutes postgadolinium T1-weighted, fat-suppressed images (all patients). Tumor size, local extent, signal intensity, and enhancement features of tumor and adjacent tissue were determined. Tumor ranged in diameter from 1 to 9 cm (mean, 4.0 cm). Tumors had similar signal intensity to normal small bowel on precontrast images. Fourteen malignant tumors showed heterogeneous enhancement greater than adjacent bowel on gadolinium-enhanced images. Tumor local extent was best shown on precontrast-spoiled gradient-echo images and postgadolinium T1-weighted fat-suppressed images. Image quality was most consistent on breath-hold images. The results of this study show that small bowel tumors are demonstrable on MR images. Precontrast breath-hold T1-weighted spoiled gradient-echo images and gadolinium-enhanced fat suppressed images demonstrate tumor extent most reliably. PMID:8956128

Semelka, R C; John, G; Kelekis, N L; Burdeny, D A; Ascher, S M

1996-01-01

26

Minimization of small bowel volume within treatment fields using customized small bowel displacement system (SBDS)  

International Nuclear Information System (INIS)

Authors designed a customized Small Bowel Displacement System(SBDS) to displace the small bowel from the pelvic radiation fields and minimize treatment-related bowel morbidities. From August 1995 to May 1996, 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized styrofoam compression device which can displace the small bowel from the radiation fields and an individualized immobilization abdominal board for easy daily setup in prone position. After opacifying the small bowel with Barium, the patients were laid prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The areas of the small bowel included in the radiation fields with and without the SBDS were compared. Using the SBDS, the mean small bowel area was reduced by 59% on PA and 51% on LAT films (P=0.0001). In six patients (6/55, 11%), it was possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Only 15% (8/55) of patients treated with the SBDS manifested diarrhea requiring medication. The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and reduce the radiation therapy morbidities. Compliance with setup is excellent when the SBDS is used. (author)

1997-09-01

27

Small Bowel Obstruction from Capsule Endoscopy  

Directory of Open Access Journals (Sweden)

Full Text Available Over the past decade, capsule endoscopy has become the accepted modality for small bowel imaging in the United States. It is very helpful in making the diagnosis of Crohn’s disease; however, this patient population is also at an increased risk of small bowel obstruction secondary to capsule impaction. We present the case of a 60-year-old female with undiagnosed Crohn’s disease who presented to the emergency department with small bowel obstruction after capsule ingestion. She was successfully disimpacted with diatrizoate upper gastrointestinal (GI series with small bowel follow-through and intravenous steroids. Review of the endoscopic video images revealed findings consistent with Crohn’s disease. [West J Emerg Med. 2010; 11(1:71-73.

Boysen, Megan M

2010-02-01

28

Small Bowel Obstruction due to Phytobezoar  

Directory of Open Access Journals (Sweden)

Full Text Available Bezoars are foreign bodies impacted in the digestive tract resulting of their ingestion and accumulation, involving mainly the stomach,small bowel. Phytobezoars are a rare cause of acute small bowel obstruction. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery and a history suggestive of increased fiber intake. The aim of this work was to identify the diagnostic difficulties and treatment of this rare entity.

Bar?? Morkavuk

2012-10-01

29

Small bowel emergency surgery: literature's review.  

Science.gov (United States)

Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity. PMID:21214933

Vallicelli, Carlo; Coccolini, Federico; Catena, Fausto; Ansaloni, Luca; Montori, Giulia; Di Saverio, Salomone; Pinna, Antonio D

2011-01-01

30

Small bowel emergency surgery: literature's review  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.

Di Saverio Salomone

2011-01-01

31

Small bowel function after aortic surgery.  

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One cause of post-operative morbidity in the elective repair of abdominal aortic aneurysms is the development of a paralytic or 'adynamic' ileus. In a series of 20 consecutive patients undergoing such a procedure, the maintenance of small bowel motility and absorptive capacity in the immediate post-operative period was assessed using barium sulphate and xylose passed down a naso-duodenal tube sited at the time of surgery. This simple study demonstrated that small bowel function was preserved ...

Barker, S. G.; Dodds, R. D.; Middlemiss, A.; Bennett, C. E.; Russell, M. H.; Sellick, B. C.; Thomas, M. H.

1991-01-01

32

Diverticular disease: A therapeutic overview  

Directory of Open Access Journals (Sweden)

Full Text Available Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis. When diverticulosis becomes symptomatic, it becomes diverticular disease. Diverticular disease is common in Western and industrialized countries, and it is associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation. Standard medical therapies with antibiotics are currently recommended for patients affected by diverticular disease. However, changing concepts on the pathophysiology of the disease suggest that diverticular disease may share many of the hallmarks of inflammatory bowel diseases. On this basis, the addition of therapies using mesalazine and probiotics may enhance treatment efficacy by shortening the course of the disease and preventing recurrences.

Antonio Tursi

2010-02-01

33

Jejunal diverticular disease complicated by enteroliths: Report of two different presentations  

Directory of Open Access Journals (Sweden)

Full Text Available Jejunal diverticula are quite rare. Furthermore, small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention. In this manuscript, we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature. The first case was that of a 79-year-old male who presented with abdominal pain and was found, on computed tomography (CT scan, to have evidence of intestinal perforation. A laparotomy showed that he had perforated jejunal diverticulitis. The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction. A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease. Although a rare entity, familiarity with jejunal diverticular disease, its complications, and its management, should be part of every surgeon’ s base of knowledge when considering abdominal pathology.

Paul Chugay

2010-01-01

34

Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure  

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Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the ...

Chen, Natalie; Lamba, Ramit; Lee, John; Lall, Chandana

2012-01-01

35

Effect of small bowel preparation with simethicone on capsule endoscopy*  

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Background: Capsule endoscopy is a novel non-invasive method for visualization of the entire small bowel. The diagnostic yield of capsule endoscopy depends on the quality of visualization of the small bowel mucosa and its complete passage through the small bowel. To date, there is no standardized protocol for bowel preparation before capsule endoscopy. The addition of simethicone in the bowel preparation for the purpose of reducing air bubbles in the intestinal lumen had only been studied by ...

Fang, You-hong; Chen, Chun-xiao; Zhang, Bing-ling

2009-01-01

36

Left paraduodenal hernia causing small bowel obstruction.  

Science.gov (United States)

A case of small bowel obstruction secondary to a left paraduodenal hernia is illustrated together with its radiological features and intra-operative appearance. Paraduodenal hernias are rare congenital causes of small bowel obstruction, and various approaches to surgical treatment are available including conventional open and minimally invasive laparoscopic techniques. This case presents one possible option for surgical management and briefly reviews the literature for the various surgical techniques and strategies available to the surgeon when faced with a left paraduodenal hernia. PMID:24771461

Poh, Benjamin R; Sundaramurthy, Senthilkumar R; Mirbagheri, Naseem

2014-07-01

37

Association between colonic polyps and diverticular disease  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate the association between colonic polyps and diverticular disease in Japan.METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex.RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7.CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.

Tetsuo Hirata, Yuko Kawakami, Nagisa Kinjo, Susumu Arakaki, Tetsu Arakaki, Akira Hokama, Fukunori Kinjo, Jiro Fujita

2008-04-01

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Multiple myelomatosis: an unusual cause of small bowel intussusception.  

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A 55 year old woman with multiple myeloma presented with a pathological fracture of the right neck of femur. Following internal fixation, and during subsequent radiotherapy, she developed small bowel obstruction. Laparotomy revealed an intussusception about a small bowel myeloma deposit. This is a previously unreported cause of small bowel intussusception.

Hill, S. A.; Yudelman, P. L.

1986-01-01

39

[Diverticular disease - diagnosis and classification].  

Science.gov (United States)

A reliable diagnosis is fundamental for operative, interventional and conservative treatment of the different facets of diverticular disease. Not only differential diagnoses but also overlap or coincidence with other entities sharing similar symptoms must be considered. Furthermore, an adequate surgical strategy and correct stratification of complications is mandatory. Subsequently, in the light of currently validated diagnostic techniques, the consensus conference of the German Societies of Gastroenterology (DGVS) and Visceral Surgery (DGAV) has released a new classification of diverticulitis displaying the different facets of diverticular disease. This classification also comprises symptomatic uncomplicated diverticular disease (SUDD), largely resembling irritable bowel syndrome, as well as diverticular bleeding. While detailed history, physical examination and laboratory testing are of great importance for exploring a patient with diverticular disease, they are not sufficient to diagnose (or stratify) diverticulitis without cross-sectional imaging using ultrasonography (US) or computed tomography (CT). The diagnostic value of qualified US is equipotent to qualified CT, complies with relevant legislation for radiation exposure protection and is frequently effective for diagnosis. Therefore, US is considered to be the first choice for imaging in diverticular disease. In contrast, CT has definite indications in unclear, discrepant situations or insufficient US performance. Strengths and weaknesses of both methods are discussed. Endoscopy is not required for the diagnosis of diverticulitis and should not be performed in an acute attack. Colonoscopy, however, is warranted after healing of diverticulitis, prior to elective surgery and in cases of an atypical course. Prior exclusion of perforation is considered mandatory. An unequivocal indication for colonoscopy is diverticular bleeding and the rapid performance (within 12-24 h) allows better identification of sites of bleeding and endoscopic interventions. PMID:24718443

Lembcke, B

2014-04-01

40

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

 
 
 
 
41

Laparoscopic closure of small bowel perforation: Technique of small bowel anchoring to the abdominal wall  

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Introduction: More and more complicated laparoscopic abdominal surgeries are now being performed across the world. Laparoscopic suturing of the bowel perforations is being performed by experienced surgeons. We have developed our own technique of small bowel anchoring to the abdominal wall before suturing the perforation. Our Modification: A single stitch is taken at the corner of the perforation. The long end of the suture is retrieved by a suture retrieval needle and the sma...

Jagad Rajan

2009-01-01

42

Collagen dynamics of partial small bowel obstruction  

International Nuclear Information System (INIS)

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

1984-01-01

43

Transplante de intestino delgado / Small bowel transplantation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: 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.

44

Small bowel resistances and the gastroduodenal brake.  

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Osmoreceptors in the upper small bowel may delay gastric emptying by inhibiting fundal tone and/or by increasing outflow resistances. In this study we examined the contribution of postpyloric resistances to this braking system. Seven dogs had gastric emptying of 250 ml 15% dextrose, labelled with 99mTc-DTPA, measured by gamma camera imaging (preoperative studies: n = 21). A proximal duodenal cannula was inserted and studies repeated in four modes: with the cannula closed (n = 14); with total ...

Parr, N. J.; Grime, J. S.; Baxter, J. N.; Critchley, M.; Mackie, C. R.

1987-01-01

45

Updates in small bowel imaging and endoscopy.  

Science.gov (United States)

The field of gastroenterology has had an abundance of technological advances in recent years, especially in the field of endoscopy. These advances are helpful to clinicians approaching gastrointestinal blood loss, especially in the small bowel. The authors report a case of a man who presented to the emergency department with obscure gastrointestinal blood loss. Results of an esophagogastroduodenoscopy and a colonoscopy suggested the source of the blood loss was within the small bowel. On an outpatient basis, the patient underwent video capsule endoscopy, which revealed scattered distal duodenal arteriovenous malformations. He then underwent oral double balloon endoscopy with ablation of the arteriovenous malformations, with no further bleeding or drop in hemoglobin. The authors review advances in small bowel imaging and endoscopy, including video capsule endoscopy, double balloon endoscopy, and computed tomography enterography. A comprehensive data review was conducted by searching the National Library of Medicine's PubMed database to identify recent published literature in the fields of radiology and gastroenterology. The authors apply these findings to the workup and diagnosis of obscure gastrointestinal blood loss. PMID:21178153

Raphael, Michael; Patel, Reena; Warren, Bradley J

2010-12-01

46

Transient small bowel angioedema due to intravenous iodinated contrast media  

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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...

2012-01-01

47

Laparoscopic management of small bowel obstruction with associated intestinal ischemia  

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Obstruction is the most common surgical disorder of the small bowel. Complete small bowel obstruction (SBO) is usually treated surgically because bowel strangulation cannot be excluded with certainty. Acute SBO has been previously considered a relative contraindication for laparoscopic management especially due to the laparotomy conversion rate. We present a case of SBO for which laparoscopic management resulted in earlier return of bowel function, shorter hospital stay, faster overall recove...

Narh-martey, P.; Bello, A.; Orr, D.; Galdyn, I.

2012-01-01

48

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 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)

2010-01-01

49

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 technique for diagnosing small bowel disorders, allowing, in most cases, a satisfactory distension of the small bowel without the use of an enteral tube.

2007-05-00

50

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

1987-12-04

51

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

1986-12-05

52

Radiology in primary small bowel adenocarcinoma  

International Nuclear Information System (INIS)

In a retrospective study, films from radiologic examinations of 13 patients with primary adeno-carcinoma of the small bowel were reviewed. All patients had a barium examination and in 5 cases angiography was also performed. The barium studies disclosed strictures with overhanging edges in 11 patients, in 4 of whom there was a pronounced prestenotic dilation. Angiographically the predominant findings were in all cases hypovascularity and displacement of vessels. In 4 patients there was also encasement. Neovascularity was present in 2 patients. One patient showed angiographic changes due to intussusception. (orig.)

1980-01-01

53

Absence of mucosal inflammation in uncomplicated diverticular disease  

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Uncomplicated diverticular disease is a common condition in patients older than 50 years. Symptoms are aspecific and overlapping with those of irritable bowel syndrome. Nowadays, patients are often treated with antinflammatory drugs (5-aminosalicilic acid).

Elli, Luca; Roncoroni, Leda Rosalba; Bardella, Maria Teresa; Terrani, Claudia; Bonura, Antonella; Ciulla, Michele Mario

2011-01-01

54

Small bowel angiodysplasia and novel disease associations: a cohort study.  

LENUS (Irish Health Repository)

Gastrointestinal angiodysplasias recurrently bleed, accounting for 3-5% of obscure gastrointestinal bleeding. The advent of small bowel capsule endoscopy (SBCE) has led to an increased recognition of small bowel angiodysplasias (SBAs) but little is known about their etiology. Previous small cohorts and case reports suggest an equal gender incidence and associations with cardiovascular disease, renal impairment, and coagulopathies.

Holleran, Grainne

2013-04-01

55

CADAVERIC SMALL BOWEL AND SMALL BOWEL–LIVER TRANSPLANTATION IN HUMANS1,2  

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Five patients had complete cadaveric small bowel transplants under FK506 immunosuppression, one as an isolated graft and the other 4 in continuity with a liver. Three were children and two were adults. The five patients are living 2–13 months posttransplantation with complete alimentation by the intestine. The typical postoperative course was stormy, with sluggish resumption of gastrointestinal function. The patient with small intestinal transplantation alone had the most difficult course o...

Todo, Satoru; Tzakis, Andreas G.; Abu-elmagd, Kareem; Reyes, Jorge; Fung, John J.; Casavilla, Adrian; Nakamura, Kenjiro; Yagihashi, Atsuhito; Jain, Ashok; Murase, Noriko; Iwaki, Yuichi; Demetris, Anthony J.; Thiel, David; Starzl, Thomas E.

1992-01-01

56

Perforated small bowel in omphalocele at birth  

Directory of Open Access Journals (Sweden)

Full Text Available The rupture of an omphalocele sac during birth is a well recognized entity. The associated lesions due to vascular compromise can result in necrosis of the bowel with perforation. Spontaneous bowel perforation in an omphalocele at birth is not reported in the literature. We describe a case with bowel perforation at the fundus of an omphalocele in a newborn.

Kale R

2006-01-01

57

Contrast enema depiction of small-bowel volvulus in complicated neonatal bowel obstruction  

Energy Technology Data Exchange (ETDEWEB)

About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)

Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2004-12-01

58

Gastric, small bowel, and colorectal cancer  

International Nuclear Information System (INIS)

The majority of gastrointestinal (GI) tract malignancies are adenocarcinomas. In the colon, adenocarcinoma is practically the only clinically significant tumor, and it is the second most common tumor in the small bowel, with carcinoid being the most common. The stomach harbors the greatest variety of malignant neoplasms. Adenocarcinoma, however, is still the predominant cell type, followed by lymphoma and leiomyosarcoma. Various diagnostic procedures have been used to screen patients for GI tract tumors. Fiberoptic endoscopic examination has been advocated as the study of choice to screen the population at risk of developing stomach and colon cancer because of its ability to directly visualize the mucosa and to permit biopsy of suspicious lesions. However, because fiberoptic endoscopy requires patient sedation, the number of endoscopists is limited, and the number of patients is large, single-contrast and double-contrast roentgenographic examinations of the GI tract remain the most widely accepted screening procedures

1985-01-01

59

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. 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.

2010-11-01

60

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

 
 
 
 
61

Advances in radiologic evaluation of small bowel diseases.  

Science.gov (United States)

There are various methods that could be used for small bowel imaging. Although conventional enteroclysis has a high sensitivity in the diagnosis of most of the small bowel diseases, it cannot provide any direct information about the mural-extramural diseases and the other abdominal structures. Besides, enteroclysis-based techniques have risk of additional radiation exposure, and they are poorly tolerated because placement of nasojejunal tube is required. New enterographic methods have been developed, and the number of enterographic techniques increased significantly in the recent years to overcome those limitations. The other modalities including ultrasound, small bowel follow-through, or capsule-endoscopy are often used as complementary methods in evaluation of the small bowel diseases. In this review, technique and clinic details, advantages, and disadvantages of the radiologic techniques that are used in the diagnosis of small bowel diseases, and the imaging findings of common pathologic conditions were discussed in the light of current literature. PMID:24270107

Algin, Oktay; Evrimler, Sehnaz; Arslan, Halil

2013-01-01

62

Diagnostic yield of small bowel capsule endoscopy depends on the small bowel transit time  

Digital Repository Infrastructure Vision for European Research (DRIVER)

AIM: To investigate whether the small bowel transit time (SBTT) influences the diagnostic yield of capsule endoscopy (CE). METHODS: Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed. SBTT and CE findings were recorded. A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman’s correlation test. Subgroup analyses were performed for the various indications for the procedure. RESULTS: There was a positive co...

Jessie Westerhof; Koornstra, Jan J.; Hoedemaker, Reinier A.; Sluiter, Wim J.; Kleibeuker, Jan H.; Weersma, Rinse K.

2012-01-01

63

Management of Diverticular Hemorrhage  

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Diverticular hemorrhage is the most common cause of lower gastrointestinal bleeding in Westernized cultures. Fortunately, the majority of diverticular bleeds will spontaneously resolve; however, 20% of patients will require therapeutic interventions to obtain hemostasis. The diagnostic and therapeutic options for the management of diverticular hemorrhage are discussed.

Adams, John B.; Margolin, David A.

2009-01-01

64

Diagnostic yield of small bowel capsule endoscopy depends on the small bowel transit time  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To investigate whether the small bowel transit time (SBTT influences the diagnostic yield of capsule endoscopy (CE. METHODS: Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed. SBTT and CE findings were recorded. A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman’s correlation test. Subgroup analyses were performed for the various indications for the procedure. RESULTS: There was a positive correlation between the diagnostic yield and SBTT (Spearman’s rho 0.58, P < 0.01. Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding (r = 0.54, P < 0.01, for polyposis and carcinoid combined (r = 0.56, P < 0.01 and for the other indications (r = 0.90, P <0.01, but not for suspected Crohn’s disease (r = -0.40. CONCLUSION: The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time. This is true for all indications except for suspected Crohn’s disease.

Jessie Westerhof

2012-01-01

65

Effect of customized small bowel displacement system in pelvic irradiation  

International Nuclear Information System (INIS)

Purpose: Authors designed a customized small bowel displacement system (SBDS) to displace the small bowel out of the pelvic radiation fields and to minimize treatment related bowel morbidity. Methods and Materials: From August 1995 to May 1996, 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized Styrofoam compression device that can displace the small bowel out of the radiation fields and an individualized immobilization abdominal board for easy daily setup of the patient in prone position. After opacifying the small bowel with barium, the patients were laid prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The volume of the small bowel included in the radiation fields with and without the SBDS were compared. Results: Using the SBDS, the mean small bowel volume was reduced by 59% on PA and 51% on LAT films (p 0.0001). In six patients (6 of 55, 11%), it was possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Patients treated with the SBDS manifested a significantly lower incidence of diarrhea requiring medication (8 of 55, 15%) vs. those without the SBDS (24 of 39, 62%) (p < 0.05). Conclusion: The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and to reduce the radiation therapy morbidity. Compliance with setup is excellent

1998-02-01

66

Colon vs small bowel rejection after total bowel transplantation in a pig model.  

Science.gov (United States)

With the advent of FK 506, small bowel transplantation has become clinically feasible. Both clinically and experimentally, jejunal and ileal biopsies are used for early diagnosis of rejection. More recently, the colon, in addition to the small bowel, has been transplanted to decrease the high incidence of diarrhea after small bowel transplantation. A Bishop-Koop ileostomy allows biopsies on a regular basis, but the diagnosis of rejection remains a problem after takedown of the ileostomy. Rejection of the ileum is more frequent and more severe than rejection of the jejunum or the colon. Colon biopsy after ileostomy takedown would not rule out rejection of the ileum. PMID:8959844

Nakhleh, R E; Gruessner, A C; Pirenne, J; Benedetti, E; Troppmann, C; Gruessner, R W

1996-01-01

67

CT enteroclysis in the diagnostics of small bowel diseases  

International Nuclear Information System (INIS)

Background: The role of CT enteroclysis is gaining on importance in the diagnostics of small bowel diseases. The aim of the study was to present own experiences in CT enteroclysis application, with the use of a 64-detector CT unit. Material/Methods: CT enteroclyses were performed in 60 patients: 53 with the suspicion of the Crohns disease, 2 suspected for carcinoid, 1 with suspicion of the fistula between the small bowel and the bladder, 2 suspected for the tumor of the ileo-caecal region, and in 1 case, the aim of examination was to carry out an evaluation of the postsurgical state of the bowel-bowel anastomosis. We used own endoscopic technique of catheter insertion into the bowel, which shortens the examination time and improves patients comfort. Results: The catheter was correctly introduced into the small bowel in 58 patients (endoscopy had to be repeated in 4 cases). Only 2 examinations failed, because patients refused repeated endoscopy. Radiological signs of the Crohns disease were found in 50 out of 53 patients. In the 3 remaining patients, the appearance of the small bowel was normal. In 5 non-Crohns disease patients, CT enteroclysis enabled a good visualization of the pathology (tumors, fistula). Conclusions: CT enteroclysis with the use of the 64-detector CT unit is a valuable method in the diagnostics of small bowel diseases. It could supplement or precede capsule endoscopy. (authors)

2010-01-01

68

Small bowel intussusception causing a postoperative bowel obstruction following laparoscopic low anterior resection in an adult  

Science.gov (United States)

Adult intussusception usually presents with nonspecific symptoms such as abdominal pain, bloating, nausea, vomiting, and a change in bowel habits. Although postoperative intussusception has been described in the pediatric population, there has been little description of it in the adult population. Postoperative intussusception has unique challenges, as hydrostatic reduction may compromise bowel anastomoses. Surgery is the universal treatment in these patients. In adults, delay in diagnosis and definitive treatment may be a direct result of common symptomatology between postoperative ileus and intussusception. We present a case of an adult patient who underwent laparoscopic low anterior resection for rectal cancer and developed a small bowel intussusception causing obstruction requiring surgery. To our knowledge, this is the first report of a small bowel intussusception masquerading as a postoperative ileus in an adult. While most postoperative delayed bowel function is attributed to ileus, abscess formation, or anastomotic leak, other uncommon etiologies, including intussusception, may occur and are important to include in the differential diagnosis.

Hussain, Ahmad S.; Warrier, Rajalakshmi

2014-01-01

69

Transient small-bowel intussusception in children on CT  

Energy Technology Data Exchange (ETDEWEB)

To determine the frequency and significance of small-bowel intussusception identified in children on CT. All abdomen CT reports between July 1995 and April 2002 were reviewed to identify patients with small-bowel intussusception. Intussusceptions were identified as an intraluminal mass with a characteristic layered appearance and/or continuity with adjacent mesenteric fat. Ileocolic intussusceptions and intussusceptions related to feeding tubes were excluded. Imaging studies and medical records were reviewed. Twenty-five pediatric patients (16 boys, 9 girls; mean age 11.2 years) were identified with small-bowel intussusception on CT. No patient had a persistent intussusception requiring surgery. Fourteen had limited immediate repeat CT images as part of the same examination, ten of which demonstrated resolution of the CT abnormality. Follow-up CT [n=13 (6 within 24 h)], ultrasound (n=3), small-bowel follow-through (n=4) and surgery (n=3) showed no intussusception. In four patients with persistent symptoms, underlying pathology was identified requiring treatment (giardiasis, 2; small-bowel inflammation/strictures, 1; abscess and partial small-bowel obstruction after perforated appendicitis, 1). In 21 other patients, direct correlation of symptoms to CT abnormality was absent or questionable, no treatment was required, and there was no clinical or imaging evidence of persistence or recurrence. Most small-bowel intussusceptions identified in children by CT are transient and of no clinical significance. (orig.)

Strouse, Peter J. [Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI (United States); C.S. Mott Children' s Hospital, 1500 E. Medical Center Drive, F3503, Ann Arbor, MI 48109-0252 (United States); DiPietro, Michael A.; Saez, Fermin [Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI (United States)

2003-05-01

70

Normal small bowel wall characteristics on MR enterography  

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Purpose: To assess the normal small bowel parameters, namely bowel diameter, bowel wall thickness, number of folds (valvulae connivientes) per 2.5 cm (in.), fold thickness and interfold distance per small bowel segment (duodenum, jejunum, proximal ileum, distal ileum and terminal ileum) on MR enterography. Materials and methods: Between September 2003 and January 2008, 280 MR enterography examinations were performed for investigation of known or suspected small bowel pathology. 120 of these examinations were normal. Sixty-five (m = 29, f = 36, mean age = 34 years, range = 17-73 years) of 120 examinations without a prior small bowel diagnosis, with no prior or subsequent abnormal radiology or endoscopy examinations, no prior small bowel surgery and with a minimum 3 years follow-up demonstrating normality were retrospectively evaluated for the described small bowel parameters. Results: We found the mean diameter of the duodenum to be 24.8 mm (S.D. = 4.5 mm), jejunum to be 24.5 mm (S.D. = 4.2 mm), proximal ileum to be 19.5 mm (S.D. = 3.6 mm), distal ileum to be 18.9 mm (S.D. = 4.2 mm) and terminal ileum to be 18.7 mm (S.D. = 3.6 mm). The number of folds per 2.5 cm varied from 4.6 in the jejunum to 1.5 in the terminal ileum. The fold thickness varied from 2.1 mm in the duodenum to 1.8 mm in the terminal ileum. The small bowel parameters gradually decreased in size from the duodenum to the smallest measurements which were in the terminal ileum. The bowel wall is similar in size throughout the small bowel measuring 1.5 {+-} 0.5 mm. Conclusion: These results provide the mean, range of normality and standard deviation of the small bowel parameters per segment on the current population on MR enterography. From our experience, knowledge of these parameters is extremely helpful and essential in the everyday assessment of MR enterography studies.

Cronin, Carmel G., E-mail: carmelcronin2000@hotmail.co [Department of Radiology, University College Hospital, Galway (Ireland); Delappe, Eithne; Lohan, Derek G.; Roche, Clare; Murphy, Joseph M. [Department of Radiology, University College Hospital, Galway (Ireland)

2010-08-15

71

Normal small bowel wall characteristics on MR enterography  

International Nuclear Information System (INIS)

Purpose: To assess the normal small bowel parameters, namely bowel diameter, bowel wall thickness, number of folds (valvulae connivientes) per 2.5 cm (in.), fold thickness and interfold distance per small bowel segment (duodenum, jejunum, proximal ileum, distal ileum and terminal ileum) on MR enterography. Materials and methods: Between September 2003 and January 2008, 280 MR enterography examinations were performed for investigation of known or suspected small bowel pathology. 120 of these examinations were normal. Sixty-five (m = 29, f = 36, mean age = 34 years, range = 17-73 years) of 120 examinations without a prior small bowel diagnosis, with no prior or subsequent abnormal radiology or endoscopy examinations, no prior small bowel surgery and with a minimum 3 years follow-up demonstrating normality were retrospectively evaluated for the described small bowel parameters. Results: We found the mean diameter of the duodenum to be 24.8 mm (S.D. = 4.5 mm), jejunum to be 24.5 mm (S.D. = 4.2 mm), proximal ileum to be 19.5 mm (S.D. = 3.6 mm), distal ileum to be 18.9 mm (S.D. = 4.2 mm) and terminal ileum to be 18.7 mm (S.D. = 3.6 mm). The number of folds per 2.5 cm varied from 4.6 in the jejunum to 1.5 in the terminal ileum. The fold thickness varied from 2.1 mm in the duodenum to 1.8 mm in the terminal ileum. The small bowel parameters gradually decreased in size from the duodenum to the smallest measurements which were in the terminal ileum. The bowel wall is similar in size throughout the small bowel measuring 1.5 ± 0.5 mm. Conclusion: These results provide the mean, range of normality and standard deviation of the small bowel parameters per segment on the current population on MR enterography. From our experience, knowledge of these parameters is extremely helpful and essential in the everyday assessment of MR enterography studies.

2010-08-01

72

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma.  

Science.gov (United States)

Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well. PMID:21103257

Shiba, Hiroaki; Mitsuyama, Yoshinobu; Hanyu, Ken; Ikeuchi, Kenji; Hayashi, Hirotaka; Yanaga, Katsuhiko

2009-01-01

73

Complicated diverticular disease: the changing paradigm for treatment Doença diverticular complicada: alterando o padrão de tratamento  

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The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulit...

Abe Fingerhut; Nicolas Veyrie

2012-01-01

74

Unusual causes of small bowel obstruction and contemporary diagnostic algorithm  

International Nuclear Information System (INIS)

Intestinal obstruction is a common clinical abnormaltiy. In 60-80% of cases, the small bowel is affected. Although postoperative adhesions are responsible in 60% of cases, the other frequently observed causes are hernia, strangulation and tumours, such as carcinoid, lymphona or adenocarcinoma. In this pictorial essay, we presented the radiological findings of uncommon causes of small bowel obstruction as well as the suggested diagnostic algorithm.

2008-06-01

75

Computer-assisted ex vivo, normothermic small bowel perfusion  

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Background: In the present study, a technique for computer-assisted, normothermic, oxygenated, ex vivo, recirculating small bowel perfusion was established as a tool to investigate organ pretreatment protocols and ischemia/reperfusion phenomena. A prerequisite for the desired setup was an organ chamber for ex vivo perfusion and the use of syngeneic whole blood as perfusate. Methods: The entire small bowel was harvested from Lewis rats and perfused in an organ chamber ex vivo for at least 2 h....

Stangl, M. J.; Krapp, J.; Theodorou, D.; Eder, M.; Hammer, C.; Land, W.; Schildberg, Friedrich Wilhelm

2000-01-01

76

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

International Nuclear Information System (INIS)

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

2010-01-01

77

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

78

Capsule Endoscopy in the Small Bowel Crohn's Disease  

Science.gov (United States)

CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

Arguelles-Arias, Federico; Rodriguez-Oballe, Juan; Duarte-Chang, Calixto; Castro-Laria, Luisa; Garcia-Montes, Josefa Maria; Caunedo-Alvarez, Angel; Herrerias-Gutierrez, Juan Manuel

2014-01-01

79

Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure  

Science.gov (United States)

Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT) findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

Chen, Natalie; Lamba, Ramit; Lee, John; Lall, Chandana

2012-01-01

80

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

 
 
 
 
81

Perfuração de intestino delgado por doença diverticular jejunal Intestinal perforation in consequence of small intestine's diverticulitis  

Directory of Open Access Journals (Sweden)

Full Text Available Small Intestine's diverticulosis is an uncommon pathology of intestine. It's more evident at jejune and can be complicated by intestinal perforation, obstruction or diverticulitis, increasing the mortality. We describe a forty years old female patient that arrived at emergency service complained of diffuse abdominal pain. There aren't signals of peritonitis and the radiological evaluation showed small intestine's distension. Surgical intervention was performed revealing multiples diverticulums at jejune and intestinal perforation. The aim of this article is present a case of Small Intestine's diverticulosis and its complications that had precise intervention resulting in a favorable resolution.

Vilmar Moura Leal

2010-02-01

82

Perfuração de intestino delgado por doença diverticular jejunal / Intestinal perforation in consequence of small intestine's diverticulitis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in english Small Intestine's diverticulosis is an uncommon pathology of intestine. It's more evident at jejune and can be complicated by intestinal perforation, obstruction or diverticulitis, increasing the mortality. We describe a forty years old female patient that arrived at emergency service complained of [...] diffuse abdominal pain. There aren't signals of peritonitis and the radiological evaluation showed small intestine's distension. Surgical intervention was performed revealing multiples diverticulums at jejune and intestinal perforation. The aim of this article is present a case of Small Intestine's diverticulosis and its complications that had precise intervention resulting in a favorable resolution.

Leal, Vilmar Moura; Andrade, Ana Paula Santos de; Tavares, Cléciton Braga; Almeida, Kelson James Silva de.

83

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 small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration

2004-09-01

84

Abdominal cocoon with small bowel obstruction: two case reports.  

Science.gov (United States)

Abdominal cocoon is a rare condition that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Treatment is surgical resection of the membrane and free the bowel. Preoperative diagnosis is possible with combination of sonography and CT scan. We report two cases where the diagnosis of abdominal cocoon was suggested preoperatively based on the sonography and CT scan of abdomen. PMID:21643736

Kaur, Ravinder; Chauhan, Dinesh; Dalal, Usha; Khurana, Ujjawal

2012-04-01

85

Complete small bowel recovery after prolonged total venous occlusion.  

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Acute small bowel ischaemia is a mostly irreversible condition associated with high mortality. Here we report the case of a patient after severe abdominal trauma in whom the superior mesenteric vein (SMV) was completely occluded for more than 15 h in the absence of any collateral venous drainage. Following surgical reconstruction of the SMV and with scheduled relaparotomies for 5 days, the bowel showed slow recovery. Now the patient is well and on complete oral nutrition.

Von Woellwarth, Julie; Zu Vilsendorf, Andreas Meyer; Schlitt, Hans J.

2002-01-01

86

Imaging of Colonic Diverticular Disease  

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Diverticular disease affects approximately two thirds of the population over the age of 70. While only a small fraction of these patients will develop diverticulitis, adequate radiological evaluation of diverticulitis and its complications is imperative in determining proper medical and surgical treatment. Clinical examination and laboratory tests alone have been found to be inaccurate in defining many aspects of the disease in up to 60% of cases. Over the past 30 years, contrast enema, compu...

Snyder, Michael Jesse

2004-01-01

87

Laparoscopic treatment for acute diverticular disease  

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Diverticular disease of the sigmoid colon involves more than 50% of population over 60 years, and much more in people older than 80 years. Most patients remain asymptomatic, but, about 10-20% develop complications requiring surgery. Colonic diverticulitis represents an acute bowel inflammation, in many cases, confined only to the sigmoid and descending colon. Recurrent attacks and complications of diverticulitis require surgical procedure, although most cases can be managed medically. The cau...

Pignata Giusto

2006-01-01

88

Original article: Natural history of acute colonic diverticular bleeding: prospective study in 133 consecutive patients  

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Abstract Background: Bleeding recurrence rate after spontaneous haemostasis of colonic diverticular haemorrhage varies in the literature, and a small minority of patients will require endoscopic, radiological or surgical intervention. Aim: To study the natural history of colonic diverticular bleeding in consecutive patients. Methods: We prospectively studied consecutive patients admitted for colonic diverticular bleeding from 1997 to 2005. Data on age, gender, 30-day mortalit...

2010-01-01

89

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.

Jeffrey D. Wayne

2011-03-01

90

Extraskeletal osteosarcoma, telangiectatic variant arising from the small bowel mesentery.  

Science.gov (United States)

Extraskeletal osteosarcoma (EOS) is a highly aggressive and rare malignant soft tissue tumor, characterized by the production of neoplastic osseous tissue without attachment to the bone or periosteum. It rarely involves the visceral organs. Only 3 cases of mesenteric EOS have been reported in English literature. Here, we describe a male patient of 40 years, who was diagnosed to have EOS arising from small bowel mesentery. This patient presented with lower gastrointestinal (GI) bleeding. Upper GI endoscopy and colonoscopy were normal. Computed tomography scan demonstrated a well defined multi-loculated mixed density mass lesion measuring about 13x7x7 cm in lower abdomen adjacent to small bowel loops with liver metastasis. Palliative en bloc resection of tumor with adjacent small bowel was performed. The histopathology revealed a telangiectatic type osteosarcoma of mesentery. Diagnosis of EOS, its management and the outcome in context of the current literature are discussed. PMID:21894362

Hussain, Muhammad I; Al-Akeely, Mohammed H; Alam, Mohammed K; Jasser, Nayel A

2011-09-01

91

Diospyrobezoar as a Cause of Small Bowel Obstruction  

Science.gov (United States)

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

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

2012-01-01

92

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

Directory of Open Access Journals (Sweden)

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

Enteroscopy in small bowel Crohn’s disease: A review  

Directory of Open Access Journals (Sweden)

Full Text Available Crohn’s disease (CD is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel. Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist, aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy (WCE is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy (DAE as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy (DBE, single balloon enteroscopy (SBE and more recently spiral enteroscopy (SE]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn’s. These excluded topics already have comprehensive reviews. Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D (based on expert opinion. The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial’s in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.

Benjamin Tharian

2013-01-01

94

Acute small bowel obstruction due to chicken bone bezoar  

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Full Text Available Preadeepan Vetpillai,1 Ayo Oshowo21CT2 Surgery in General, Charing Cross Hospital, 2Colorectal and Laparoscopic Surgery, Whittington Hospital, London, UKAbstract: Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted undigested chicken bone.Keywords: small bowel obstruction, chicken bone, bezoar

Vetpillai P

2012-12-01

95

Enteroscopy in small bowel Crohn's disease: A review.  

Science.gov (United States)

Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel. Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist, aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy (WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy (DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy (DBE), single balloon enteroscopy (SBE) and more recently spiral enteroscopy (SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn's. These excluded topics already have comprehensive reviews. Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D (based on expert opinion). The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial's in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD. PMID:24147191

Tharian, Benjamin; Caddy, Grant; Tham, Tony Ck

2013-10-16

96

Small-bowel lymphoma and regional enteritis: radiographic similarities  

International Nuclear Information System (INIS)

Lymphoma and regional enteritis may demonstrate strikingly similar patterns in the small bowel. Fifty cases of regional enteritis and small-bowel lymphoma were reviewed. Of these, there were 12 cases of both diseases in which a confident radiographic distinction could not be made. Both diseases may narrow the terminal ileum, present as inflammatory processes, and demonstrate nodular patterns. Other similarities include aneurysmal dilatation, several types of ulceration, fistula formation, mesenteric masses, and involvement of the terminal ileum either alone or in association with skip areas. Clinical implications and the pathologic processes responsible for the radiographic similarity between these entities are discussed

1984-08-01

97

The utility of computed tomography in acute small bowel obstruction  

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Small bowel obstruction is a significant cause of acute surgical admissions. Surgeons are tending to favour an initial trial of conservative management. Due to the unreliability of clinical signs to predict accurately those patients requiring early intervention there is an increasing tendency to utilize imaging investigations, particularly computed tomography (CT), to help define the severity, cause and complications of acute small bowel obstruction. The aim of this pictorial review is to demonstrate the contribution CT can make to the management of these patients. Burkill, G.J.C., Bell, J.R.G. and Healy, J.C. (2001)

Burkill, Guy J.C.; Bell, James R.G.; Healy, Jeremiah C

2001-05-01

98

MR enterography in the evaluation of small bowel dilation  

International Nuclear Information System (INIS)

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.

2009-10-01

99

Giant midesophageal diverticular  

International Nuclear Information System (INIS)

The midesophageal diverticular (in the thoracic esophagus) are strange entities. They are diagnosed unexpectedly since most of the patients do not show any symptoms. They are Zenker diverticular and epiphrenic diverticular and in more than 2/3 of the cases they are associated with cases of esophageal motility disorders. Only the patients with symptoms and specially those with secondary respiratory signs and inhalation episodes require endoscopic or surgical treatment. We have a case of one man with this disease who was treated at our institution.

2008-01-01

100

[Post-traumatic small-bowel obstruction: two case studies].  

Science.gov (United States)

Post-traumatic small-bowel obstructions are rare and late complications following blunt abdominal trauma. Timely diagnosis is frequently impeded because of nonspecific associated symptoms, and furthermore, the degree of urgency is frequently underestimated due to the accidental cause. During the last 6 years (2005-2011), we have observed only 2 cases (4 and 10 years old) with post-traumatic small-bowel obstruction. On admission the patients had a contusion on the abdominal wall, duodenal hematoma and a Chance fracture of the lumbar spine on the computed tomography (CT) scan. Although early clinical improvement was noted, progression of the disorder was observed for the following 15 days like an occlusive syndrome (abdominal distension, nausea, emesis). Abdominal ultrasound and computed tomography scan revealed small-bowel obstruction. At laparotomy, jejunal stenosis was found associated with mesenteric tears, which was resected with end-to-end anastomosis. Six to 8 months of follow-up ascertained the therapeutic efficacy of the procedure. Post-traumatic small-bowel obstructions are rare; the clinical presentation is unspecific and appears with a time lag following the trauma. Echography and computed tomography scan can establish both the diagnosis and therapeutic choice. PMID:22463958

Faure, A; Maurin, C; Lauron, J; Jouve, J-L; De Lagausie, P; Merrot, T

2012-05-01

 
 
 
 
101

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

2007-08-01

102

Small bowel hemangiomas: Diagnostic role of capsule endoscopy  

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Vascular anomalies involving the small bowel are an uncommon cause of gastrointestinal bleeding in childhood. We present here an 11-year-old boy who presented with severe anemia and malena. The routine investigations did not reveal any pathology. A capsule endoscopy study was performed, which clinched the diagnosis and identified two intestinal hemangiomas. The hemangiomas were resected and the child recovered.

Khanna Sanat; Kanojia Ravi; Menon Prema; Rana Surinder; Thapa B; Bhasin D; Rao K. L. N

2010-01-01

103

Orthotopic neobladder perforation: an unusual presentation of small bowel obstruction  

Science.gov (United States)

Orthotopic bladder reconstruction is becoming increasingly popular in patients who have undergone radical cystectomy. One of the rare complications is spontaneous rupture, which presents with various symptoms, but in particular, abdominal pain. We report a case of orthotopic bladder perforation in a patient who presented with the symptoms and signs of small bowel obstruction.

Gill, Jonathan D.; Cast, James E.I.; Thomas, Philip J.; Simms, Matthew S.

2013-01-01

104

Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report  

Science.gov (United States)

Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.

Tunio, Mutahir A.; AlAsiri, Mushabbab; Saleh, Rasha M.; Akbar, Shomaila Amir; Ali, Nagoud M.; Senosy Hassan, Mohamed Abdalazez

2014-01-01

105

Obstructive small bowel metastasis from uterine leiomyosarcoma: a case report.  

Science.gov (United States)

Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents. PMID:24716034

Tunio, Mutahir A; Alasiri, Mushabbab; Saleh, Rasha M; Akbar, Shomaila Amir; Ali, Nagoud M; Senosy Hassan, Mohamed Abdalazez

2014-01-01

106

Neonatal intestinal obstruction secondary to a small bowel duplication cyst.  

Science.gov (United States)

A 3-week-old neonate developed abdominal distension and vomiting which subsided after conservative management. However, there was a recurrence of symptoms for which a lower gastrointestinal tract contrast study was performed. The infant had a filling defect in the area of the transverse colon. A CT scan was performed, showing a duplication cyst arising from the small bowel and indenting the transverse colon. Resection of the duplication cyst and end-to-end anastomosis of the bowel was performed. The duplication cyst was of tubular type, and a sealed perforation was noted in the cyst wall. PMID:25006055

Puralingegowda, Anil Kumar; Mohanty, Pankaj Kumar; Razak, Abdul; Nagesh N, Karthik; Chandrayya, Ramachandra

2014-01-01

107

Aspects on diverticular disease  

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Objective: The aims of this thesis were to evaluate the influence of ethnicity and other sociodemographic factors on the rate of diverticular disease (DD) (Paper I), to compare findings specific for DD and acceptance of CT Colonography (CTC) and conventional Colonoscopy (CC) in patients examined after diverticulitis (AD) (Paper II), to evaluate the value of antibiotics in conservative treatment of patients with mild AD (Paper III) and to study patients with diverticular fist...

Hjern, Fredrik

2006-01-01

108

Small bowel obstruction secondary to Crohn disease: CT findings.  

Science.gov (United States)

We investigated the computed tomographic (CT) findings in patients with small bowel obstruction (SBO) and Crohn disease (CD). Fourteen patients, seven men and seven women (mean age, 41.3 years), were retrospectively reviewed. All presented with clinical symptoms and signs of SBO. Eleven had a history of CD, whereas three experienced the bowel obstruction as the first manifestation of the disease. On CT, features of complete SBO were seen in nine patients, whereas incomplete obstruction was found in the other five. One patient had CT findings of an adhesive obstruction. The other 13 were diagnosed as having CD-related SBO; a markedly stenotic bowel segment caused the obstruction in one patient, and a thickened-wall small bowel segment with luminal narrowing was evident at the transition zone in the other 12. The mural thickening had a target appearance in seven and homogeneous thickening in the other five. Additional thickened bowel segments were found in five patients and mesenteric involvement was found in 10. Five patients were treated conservatively, and the other nine underwent surgery (one with adhesiolysis only). Resection of the stenotic bowel was performed in six patients and stricturoplasty was done in the other two, with associated intestinal biopsy in one of these two patients. Histopathology revealed findings of active on chronic disease in all. CT is frequently performed for suspected SBO, so radiologists should be aware of the diagnosis of CD, because SBO may be its first manifestation. Alternatively, radiologists can accurately diagnose a CD-related obstruction in a patient with known CD and differentiate it from an obstruction due to adhesions. Patient management in these cases, however, is based most often on the clinical condition. PMID:15354340

Zissin, R; Hertz, M; Paran, H; Bernheim, J; Shapiro-Feinberg, M; Gayer, G

2004-01-01

109

Diffuse small bowel thickening in aids patient - a case report  

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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

110

Capsule endoscopy and imaging tests in the elective investigation of small bowel disease  

Energy Technology Data Exchange (ETDEWEB)

Capsule endoscopy enables high-resolution depiction of small bowel mucosa and has been shown, by several studies, to have a high diagnostic yield in a variety of small bowel diseases. In this review, we critically assess the contributions of capsule endoscopy and imaging tests in common small bowel disorders. Radiological tests that only assess the small bowel mucosa will be less useful in the era of capsule endoscopy.

Sandrasegaran, K. [Department of Radiology, Indiana University School of Medicine (United States)], E-mail: ksandras@iupui.edu; Maglinte, D.D.T.; Jennings, S.G. [Department of Radiology, Indiana University School of Medicine (United States); Chiorean, M.V. [Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine (United States)

2008-06-15

111

Capsule endoscopy and imaging tests in the elective investigation of small bowel disease  

International Nuclear Information System (INIS)

Capsule endoscopy enables high-resolution depiction of small bowel mucosa and has been shown, by several studies, to have a high diagnostic yield in a variety of small bowel diseases. In this review, we critically assess the contributions of capsule endoscopy and imaging tests in common small bowel disorders. Radiological tests that only assess the small bowel mucosa will be less useful in the era of capsule endoscopy

2008-06-01

112

Video capsule endoscopy in small-bowel malignancy: A multicenter Belgian study  

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Background and Study Aims: Early diagnosis of small-bowel tumors is crucial for therapy. Video capsule endoscopy has improved the diagnosis of small-bowel diseases, but data concerning the role of this technique in detecting small-bowel malignancy are scarce. The aim of this paper was to review all capsule endoscopy findings at Belgian hospitals, in order to evaluate the diagnostic yield of capsule endoscopy in the field of small-bowel malignancy. Patients and Methods: For this retrospective ...

Urbain, D.; Looze, D.; Demedts, I.; Louis, Edouard; Dewit, O.; Macken, E.; Gossum, A.

2006-01-01

113

Human gut microbiome adopts an alternative state following small bowel transplantation  

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Small bowel transplants provide an exceptional opportunity for long-term study of the microbial ecology of the human small bowel. The ileostomy created at time of transplant for ongoing monitoring of the allograft provides access to samples of ileal effluent and mucosal biopsies. In this study, we used qPCR to assay the bacterial population of the small bowel lumen of 17 small bowel transplant patients over time. Surprisingly, the posttransplant microbial community was found to be dominated b...

Hartman, Amber L.; Lough, Denver M.; Barupal, Dinesh K.; Fiehn, Oliver; Fishbein, Thomas; Zasloff, Michael; Eisen, Jonathan A.

2009-01-01

114

Myelofibrosis complicated by intestinal extramedullary haemopoiesis and acute small bowel obstruction.  

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A 78 year old woman with myelofibrosis presented with an acute small bowel obstruction. Pathology of the resected small bowel showed extramedullary haemopoiesis leading to acute small bowel obstruction. As far as we know this is the first such reported case.

Mackinnon, S.; Mcnicol, A. M.; Lee, F. D.; Mcdonald, G. A.

1986-01-01

115

Diverticular disease: A therapeutic overview  

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Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis. When diverticulosis becomes symptomatic, it becomes diverticular disease. Diverticular disease is common in Western and industrialized countries, and it is associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation). Standard medical therapies with antibiotics are currently recommended for patients affected by diverticular d...

Tursi, Antonio

2010-01-01

116

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

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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

117

Imaging of the small bowel: Crohn's disease in paediatric patients.  

Science.gov (United States)

In more than 20% of all patients, the Crohn's disease presents before the age of 18years. The diagnosis and management of Crohn's disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography- positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn's disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging. PMID:24976933

Casciani, Emanuele; De Vincentiis, Chiara; Polettini, Elisabetta; Masselli, Gabriele; Di Nardo, Giovanni; Civitelli, Fortunata; Cucchiara, Salvatore; Gualdi, Gian Franco

2014-06-28

118

Cápsula endoscópica del intestino delgado / Small bowel capsule endoscopy  

Scientific Electronic Library Online (English)

Full Text Available SciELO Peru | Language: Spanish Abstract in spanish La Cápsula Endoscópica permite la evaluación del tracto digestivo sin la incomodidad, necesidad de sedación y los riesgos propios de la endoscopía tradicional. Esta revisión presenta una actualización en cápsula endoscópica del intestino delgado desde su aparición en 2001. Revisaremos las caracterís [...] ticas tecnológicas de los diversos sistemas de cápsula endoscópica de intestino delgado disponibles, las indicaciones clínicas, complicaciones posibles y situación especiales del estudio. Abstract in english Capsule endoscopy enables inspection of the gastrointestinal tract without discomfort or need for sedation and thus obviates the risks associated with traditional endoscopy. This review presents an update on small bowel capsule endoscopy since its introduction in 2001. We will review salient feature [...] s of the small-bowel capsule endoscopy devices, clinical indications, possible complications and special situations during the study.

Cedrón-Cheng, Hugo.

119

Imaging of the small bowel: Crohn's disease in paediatric patients  

Science.gov (United States)

In more than 20% of all patients, the Crohn’s disease presents before the age of 18years. The diagnosis and management of Crohn’s disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography- positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn’s disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

Casciani, Emanuele; De Vincentiis, Chiara; Polettini, Elisabetta; Masselli, Gabriele; Di Nardo, Giovanni; Civitelli, Fortunata; Cucchiara, Salvatore; Gualdi, Gian Franco

2014-01-01

120

Abnormalities of mucosal folds of the small intestine: a guide in interpretation of small bowel series  

International Nuclear Information System (INIS)

Normal small intestinal folds are less than 2mm in thickness and criss-cross in appearance. Many diseases of the small intestine produce an abnormality in mucosal folds, namely thickening and parallel (perpendicular to the bowel lumen) arrangement of folds, nodularity, destruction, and ulcer. Diseases causing submucosal edema produce regular smooth thickening whereas diseases producing submucosal hemorrhage produce regular spiky thickening. Inflammatory bowel diseases and lymphoma produce irregular (in width, or distorted or bent at peculiar angles to the bowel lumen) thickening nodularity of the mucosa. Severe inflammatory processes as well as malignant tumors produce mucosal destruction and ulcer. Proposed here is an approach to narrow the category of disease processes based on mucosal fold abnormality. This approach with sufficient clinical history is invaluable in the interpretation of small bowel series

1994-11-01

 
 
 
 
121

Sonographic diagnosis of ascariasis causing small bowel obstruction.  

Science.gov (United States)

Acute right lower quadrant pain is a common, but nonspecific presenting symptom of a wide variety of diseases in children. Sonography (US) can play a significant role in the accurate and early diagnosis of right lower quadrant pain. In this article, we report a case of small bowel obstruction due to intestinal ascariasis diagnosed at bedside US and confirmed by MRI and describe a new US sign of intestinal ascariasis. PMID:24132881

Aydin, Ramazan; Bekci, Tumay; Bilgici, Meltem Ceyhan; Polat, Ahmet Veysel

2014-05-01

122

Oral purgative and simethicone before small bowel capsule endoscopy  

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AIM: To evaluate small bowel cleansing quality, diagnostic yield and transit time, comparing three cleansing protocols prior to capsule endoscopy. METHODS: Sixty patients were prospectively enrolled and randomized to one of the following cleansing protocols: patients in Group A underwent a 24 h liquid diet and overnight fasting; patients in Group B followed protocol A and subsequently were administered 2 L of polyethylene glycol (PEG) the evening before the procedure; patients in Group C foll...

Bruno Joel Ferreira Rosa; Mara Barbosa; Joana Magalhães; Ana Rebelo; Moreira, Maria Jo Xe O.; José Cotter

2013-01-01

123

Small bowel hemangiomas: Diagnostic role of capsule endoscopy  

Directory of Open Access Journals (Sweden)

Full Text Available Vascular anomalies involving the small bowel are an uncommon cause of gastrointestinal bleeding in childhood. We present here an 11-year-old boy who presented with severe anemia and malena. The routine investigations did not reveal any pathology. A capsule endoscopy study was performed, which clinched the diagnosis and identified two intestinal hemangiomas. The hemangiomas were resected and the child recovered.

Khanna Sanat

2010-01-01

124

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma  

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Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reductio...

2009-01-01

125

Blind bedside insertion of small bowel feeding tubes.  

LENUS (Irish Health Repository)

The use of Naso-Jejunal (NJ) feeding is limited by difficulty in feeding tube placement. Patients have traditionally required transfer to Endoscopy or Radiology for insertion of small bowel feeding tubes, with clear resource implications. We hypothesised that the adoption of a simple bedside procedure would be effective and reduce cost. Clinical nutrition and nurse specialist personnel were trained in the 10\\/10\\/10 method of blind bedside NJ insertion.

Duggan, S

2009-12-01

126

Small bowel adenocarcinoma mimicking a large adrenal tumor  

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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 p...

Ivovi? Miomira; Živaljevi? Vladan; Vujovi? Svetlana; Marina Ljiljana; Tan?i?-Gaji? Milina; Dun?erovi? Dušan; Bara? Marija; Mici? Dragan

2013-01-01

127

SMALL BOWEL - A RARE METASTASIS FROM OVARIAN CANCER  

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Full Text Available Small bowel obstruction in an oncology patient is a common and serios medical problem, associated with diagnostic and therapeutic dilemmas. We report a case of small bowel obstruction caused by a metastatic tumor secondary to bilateral recurrent ovarian cancer. The clinical diagnosis is difficult because of lack of specific signs and simptoms. The computed tomography becomes essential in the preoperative diagnostic. The treatment has two targets: to solve the obstruction and to control the metastatic desease. The case is particular because of the presence of a jejuno-colic intratumoral fistula. The anatomopathological examination reveals the character of metastatic tumor secondary to ovarian cancer. Good general status, with no severe comorbidities and the significant response to anti-cancer chemotherapy, make a good prognosis after radical resection of the metastasis. The posibility of a metastasis in the bowel wall as a potential cause of an obstruction requires a high level of suspipicion and sould be considered as a differential diagnosis in any patient with a history of cancer.

Maria-Gabriela Ro?ca

2009-05-01

128

Merkel cell carcinoma metastatic to the small bowel mesentery  

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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...

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

2011-01-01

129

Right-Sided Sigmoid Diverticular Perforation  

Directory of Open Access Journals (Sweden)

Full Text Available Diverticulosis is a common disorder among geriatric patients, of whom 10% to 25% go on to develop diverticulitis. Known complications of diverticulitis include formation of phlegmon, fistula, bowel obstruction, bleeding, perforation, and colonic abscess. A less common complication is perforation with formation of an extra-abdominal necrotizing abscess. This case is a report of an 83-year-old female who presented to the emergency department with a necrotizing abdominal wall abscess secondary to right-sided diverticular microperforation. [West J Emerg Med. 2012;13(1:103–105.

Andrew Little

2012-04-01

130

What I Need to Know about Diverticular Disease  

Science.gov (United States)

... Diverticular Disease What I need to know about Diverticular Disease On this page: What is diverticular disease? ... Pronunciation Guide For More Information Acknowledgments What is diverticular disease? Diverticular * disease affects the colon. The colon ...

131

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)

2008-01-01

132

Finding the solution for incomplete small bowel capsule endoscopy  

Science.gov (United States)

AIM: To evaluate whether the use of real time viewer (RTV) and administration of domperidone to patients with delayed gastric passage of the capsule could reduce the rate of incomplete examinations (IE) and improve the diagnostic yield of small bowel capsule endoscopy (SBCE). METHODS: Prospective single center interventional study, from June 2012 to February 2013. Capsule location was systematically checked one hour after ingestion using RTV. If it remained in the stomach, the patient received 10 mg domperidone per os and the location of the capsule was rechecked after 30 min. If the capsule remained in the stomach a second dose of 10 mg of domperidone was administered orally. After another 30 min the position was rechecked and if the capsule remained in the stomach, it was passed into the duodenum by upper gastrointestinal (GI) endoscopy. The rate of IE and diagnostic yield of SBCE were compared with those of examinations performed before the use of RTV or domperidone in our Department (control group, January 2009 - May 2012). RESULTS: Both groups were similar regarding age, sex, indication, inpatient status and surgical history. The control group included 307 patients, with 48 (15.6%) IE. The RTV group included 82 patients, with 3 (3.7%) IE, P = 0.003. In the control group, average gastric time was significantly longer in patients with IE than in patients with complete examination of the small bowel (77 min vs 26 min, P = 0.003). In the RTV group, the capsule remained in the stomach one hour after ingestion in 14/82 patients (17.0%) vs 48/307 (15.6%) in the control group, P = 0.736. Domperidone did not significantly affect small bowel transit time (260 min vs 297 min, P = 0.229). The capsule detected positive findings in 39% of patients in the control group and 49% in the RTV group (P = 0.081). CONCLUSION: The use of RTV and selective administration of domperidone to patients with delayed gastric passage of the capsule significantly reduces incomplete examinations, with no effect on small bowel transit time or diagnostic yield.

Cotter, Jose; de Castro, Francisca Dias; Magalhaes, Joana; Moreira, Maria Joao; Rosa, Bruno

2013-01-01

133

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

134

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

135

MRI of the small-bowel: how to differentiate primary neoplasms and mimickers.  

Science.gov (United States)

MRI of the gastrointestinal tract is gaining clinical acceptance and is increasingly used to evaluate patients with suspected small-bowel diseases. MRI may be performed with enterography or enteroclysis, both of which combine the advantages of cross-sectional imaging with those of conventional enteroclysis. In this paper, MRI features of primary small-bowel neoplasms, the most important signs for differential diagnosis and the diseases that can be considered as mimickers of small-bowel neoplasms, are discussed. PMID:22422388

Masselli, G; Colaiacomo, M C; Marcelli, G; Bertini, L; Casciani, E; Laghi, F; D'Amico, P; Caprasecca, S; Polettini, E; Gualdi, G

2012-06-01

136

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

1986-01-01

137

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

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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...

2008-01-01

138

New strategies for the management of diverticular disease: insights for the clinician  

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Diverticulosis is one of the most common gastrointestinal conditions affecting the general population in the Western world. It is estimated that over 2.5 million people are affected by diverticular disease in the United States. The spectrum of clinical manifestations of diverticulosis ranges from asymptomatic diverticulosis to complicated diverticulitis. Treatment for symptomatic diverticular disease is largely based on symptoms. Traditional therapy includes fiber, bowel rest, antibiotics, pa...

2013-01-01

139

Diagnostic approach to small bowel involvement in inflammatory bowel disease: view of the endoscopist.  

Science.gov (United States)

Recent advances in endoscopic small bowel (SB) techniques have revolutionalized the diagnostic approach of patients with suspected or known inflammatory bowel disease (IBD). Wireless capsule endoscopy (WCE) has become an important diagnostic tool for the evaluation of suspected CD of the SB or in patients with known IBD to rule out SB involvement. The greatest utility of WCE has been observed in cases of suspected CD, where the initial evaluation with traditional radiographic and endoscopic studies has failed to establish the diagnosis. WCE can detect early SB lesions that can be overlooked by traditional radiological studies. The sensitivity of diagnosing SB CD by WCE is superior to other endoscopic or radiological methods such as push enteroscopy, computed tomography or magnetic resonance enteroclysis. The utility of WCE in patients with known CD, IBD unclassified (IBDU) and a select group of patients with ulcerative colitis (UC) can better define the diagnosis and extent of the disease and may lead to reclassification of IBD from UC/IBDU to definitive CD. In addition, previously diagnosed patients with CD may be found to have more significant disease burden in the SB. This information may facilitate more targeted and effective therapies and potentially lead to better patient outcomes. A disadvantage of WCE is its low specificity and the risk of being retained in a strictured area of the SB. Balloon-assisted enteroscopy has essentially replaced push enteroscopy, and has been used to treat CD strictures, obtain biopsies from areas of SB involvement and even retrieving a retained capsule. PMID:19897963

Papadakis, Konstantinos A

2009-01-01

140

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

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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)

2005-01-01

 
 
 
 
141

Noninvasive videomicroscopic monitoring of rat small-bowel rejection.  

Science.gov (United States)

Successful small-bowel transplantation requires an early diagnosis of graft rejection. To date, little is known about macroscopic mucosal alterations during rejection. In the present study, these changes were analyzed in detail. Videomicroscopic monitoring of an enterostoma was performed after allogeneic heterotopic small-bowel transplantation in the rat (BN to LEW). Up to postoperative day (POD) 3 a mucosal edema was noticed (stage I of videomicroscopical alterations). The earliest changes related to rejection appeared on POD 6. The mucosa of the grafted intestine developed patchy paleness and interruptions in mucosal architecture. Crypts were slightly widened and their color turned to dark red (stage IIa). Progressively, these alterations spread over the mucosa on POD 7 (stage IIb). On POD 9, the mucosa appeared pale, villi were shortened, and crypts appeared wide and rounded. The mucosal surface was coated with fibrinous membranes (stage III). The videomicroscopic findings were closely related to the histological grading of rejection. We regard this technique of mucosal monitoring a simple and noninvasive method of detecting allograft rejection. PMID:10188832

Hoppe, H; Gasser, M; Gassel, A M; Vowinkel, T; Timmermann, W; Otto, C; Tykal, K; Thiede, A

1999-01-01

142

Quadruple immunosuppression in a pig model of small bowel transplantation.  

Science.gov (United States)

Rejection remains a major obstacle to successful small bowel transplantation in humans, irrespective of the immunosuppressants. Previous large animal studies have not used quadruple immunosuppression (with high-dose intravenous cyclosporine A [CSA]) for induction, followed by triple immunosuppression for maintenance therapy. Nor have immunosuppressive doses been comparable to clinical solid organ transplants. We studied, in 78 nonrelated outbred pigs, the effect of quadruple immunosuppression (including horse anti-pig thymocyte globulin [ATG] and high-dose intravenous CSA) on the incidence and severity of rejection in the early, critical posttransplant period. Group A (n = 19) pigs were nonimmunosuppressed. Group B (n = 20) received quadruple immunosuppression: pig ATG (10 mg/kg/day x 10 days), intravenous CSA (3.0 mg/kg/day), prednisolone (2 mg/kg/day), and azathioprine (2.5 mg/kg/day); prednisolone and azathioprine were each reduced by 50% on posttransplant Days 8 and 15. Trough CSA levels were > or = 400 ng/ml for the first 7 days posttransplant, > 200 ng/ml thereafter. Recipient pigs underwent resection of large and small bowel; orthotopic transplants (proximal duodenojejunostomy, distal ileostomy) were done with systemic vein drainage. We developed a scoring system (no, mild, moderate, severe rejection) to grade the extent of both interstitial and vascular rejection: biopsies were obtained daily from the ileostomy. Rejection-free graft survival at posttransplant Days 7, 10, and 14 was 32, 26, and 16% in the nonimmunosuppressed group versus 95, 90, and 85% in the immunosuppressed group (P < 0.0001). Rejection grades were significantly better over the whole observation period in immunosuppressed pigs: interstitial rejection was not present in up to 67% of all daily biopsy specimens. Rejection was present in all specimens of nonimmunosuppressed pigs. Vascular rejection was uncommon (incidence < 10%) in both groups. Isolated vascular rejection without interstitial rejection was not found. Graft-versus-host reaction was noted in both groups in the skin only; liver and native bowel were not involved. We conclude that quadruple immunosuppression with pig ATG and high-dose intravenous CSA for induction effectively prevents moderate and severe rejection in this model. Since clinical transplant complications (rejection, lymphomas) have persisted under FK 506 treatment, our immunosuppressive regimen should be considered an alternative for bowel transplantation in humans to prevent early rejection. PMID:8769976

Gruessner, R W; Fasola, C; Fryer, J; Nakhleh, R E; Kim, S; Gruessner, A C; Beebe, D; Moon, C; Troppmann, C; Najarian, J S

1996-02-15

143

Factors associated with incomplete small bowel capsule endoscopy studies  

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Full Text Available AIM: To identify patient risk factors associated with incomplete small bowel capsule endoscopy (CE studies.METHODS: Data from all CE procedures performed at St. Paul’s Hospital in Vancouver, British Columbia, Canada, between December 2001 and June 2008 were collected and analyzed on a retrospective basis. Data collection for complete and incomplete CE study groups included patient demographics as well as a number of potential risk factors for incomplete CE including indication for the procedure, hospitalization, diabetes mellitus with or without end organ damage, limitations in mobility, renal insufficiency, past history of bowel obstruction, abdominal surgery, abdominal radiation therapy and opiate use. Risk factors were analyzed using a univariable and multivariable logistic regression model.RESULTS: From a total of 535 CE procedures performed, 158 were incomplete (29.5%. The univariable analysis showed that CE procedures performed for overt gastrointestinal bleeding (P = 0.002, and for patients with a prior history of abdominal surgery (P = 0.023 or bowel obstruction (P = 0.023 were significantly associated with incomplete CE studies. Patients on opiate medications (P = 0.094 as well as hospitalized patients (P = 0.054 were not statistically significant, but did show a trend towards incomplete CE. The multivariable analysis showed that independent risk factors for an incomplete CE procedure include prior history of bowel obstruction [odds ratios (OR 2.77, P = 0.02, 95% confidence intervals (CI: 1.17-6.56] and procedures performed for gastrointestinal bleeding (Occult OR 2.04, P = 0.037, 95% CI: 1.04-4.02 and Overt OR 2.69, P = 0.002, 95% CI: 1.44-5.05. Patients with a prior history of abdominal surgery (OR 1.46, P = 0.068, 95% CI: 0.97-2.19, those taking opiate medications (OR 1.54, P = 0.15, 95% CI: 0.86-2.76 and hospitalized patients (OR 1.82, P = 0.124, 95% CI: 0.85-3.93 showed a trend towards statistical significance.CONCLUSION: We have identified a number of risk factors for incomplete CE procedures that can be used to risk-stratify patients and guide interventions to improve completion rates.

Mitchell M Lee, Andrew Jacques, Eric Lam, Ricky Kwok, Pardis Lakzadeh, Ajit Sandhar, Brandon Segal, Sigrid Svarta, Joanna Law, Robert Enns

2010-11-01

144

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

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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

145

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 obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction

2007-12-01

146

Removal of a phytobezoar through exploratory laparoscopy: a case of small bowel obstruction  

Directory of Open Access Journals (Sweden)

Full Text Available Brian Nguyen1, Andrew Barleben2, Brian S Buchberg2, Michael J Stamos2, Steven Mills21Department of Biological Sciences, 2Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, CA, USAAbstract: Small bowel obstruction due to bezoars occurs rarely. Traditionally, laparotomy has been the preferred approach to obstruction secondary to bezoars. We report on an 81-year-old female who presented to the emergency room with abdominal pain and vomiting. Computed tomography (CT scan showed evidence of a small bowel obstruction and laparoscopic exploration of the transition point found on CT revealed a phytobezoar. The small bowel obstruction was managed with laparoscopy and a small access site for specimen removal. In select patients with small bowel obstruction, laparoscopy may be used as a diagnostic and possibly therapeutic technique.Keywords: laparoscopy, phytobezoar, small bowel obstruction, laparotomy

Brian Nguyen

2010-07-01

147

Laparoscopy in diverticular disease: Controversies.  

Science.gov (United States)

A minimally invasive approach to the management of diverticular disease has gained acceptance over the last number of years. Certainly, in the elective setting, laparoscopic sigmoid resection compares favourably with open surgery. The use of laparoscopy in the context of emergency surgery for complicated diverticular disease remains controversial however recent studies have demonstrated a defined role for laparoscopy in the acute setting. PMID:24485264

Collins, Danielle; Winter, Desmond C

2014-02-01

148

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

Energy Technology Data Exchange (ETDEWEB)

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.

Lee-Elliott, C., E-mail: Catherine.Lee-Elliott@poole.nhs.uk [Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, Dorset (United Kingdom); Ayer, R. [Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, Dorset (United Kingdom)

2012-06-15

149

CT and MRI of the small bowel; CT und MRT des Duenndarms  

Energy Technology Data Exchange (ETDEWEB)

MDCT and MRT are valuable methods for diagnosing small bowel diseases. This article provides an overview of the techniques, indication spectrum, and advantages and disadvantages. Characteristic morphological image findings and diagnosing tips and tricks are explained on the basis of a selection of relevant small bowel diseases including inflammation, tumours and gastrointestinal bleeding. (orig.)

Wessling, Johannes; Buerke, Boris [Universitaetsklinikum Muenster (Germany). Inst. fuer Klinische Radiologie

2012-09-15

150

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

151

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

Energy Technology Data Exchange (ETDEWEB)

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.

Fischer, W.W.; Nice, C.M. Jr.

1984-04-01

152

Canine small bowel transplantation. A study of the immunological responses  

International Nuclear Information System (INIS)

A canine small bowel allograft model was used to determine the effects of radiation to the graft in modifying the immunological effects of the passenger leukocytes. When untreated allografts were transplanted, death of the recipient animals occurred at a mean of nine days. The allograft was well-preserved and showed no signs of rejection. The reasons for attributing death to graft-versus-host (GVH) disease are discussed. When allografts were treated with 150 rads prior to transplantation, allograft rejection occurred, with death of the recipient animals at a mean of 9.2 days. This was the only group in which cell-mediated immunity developed. When allografts were treated with 50 rads, prolonged survival of the recipients to a mean of 28 days was noted. It is postulated that in this group a balance was struck between the allograft rejection reaction and GVH disease, with prolongation of allograft survival

1976-01-01

153

Non-specific granulomatous inflammatory lesions of small bowel.  

Science.gov (United States)

The entity of nonspecific granulomatous inflammatory lesions(NSGIL) of the small bowel is a diagnostic and therapeutic dilemma. Data of 52 histopathologically proven cases of NSGIL seen by us between 1986 and 1991 were analysed. All these patients presented with either intestinal obstruction or perforation. They were thoroughly evaluated and investigated for tuberculosis. Of the 52 patients, 6 patients received antitubercular therapy (ATT) before and after surgery and 32 patients only after surgery. Fourteen patients did not receive ATT. Surgical procedures undertaken included stricturoplasty, resection/anastomosis and simple suturing of perforation. No complications were seen in patients who received ATT; however, six of 14 patients who did not receive ATT developed wound sepsis and 2 developed partial wound dehiscence. Many of these NSGIL lesions could be tuberculous in etiology though typical caseating granulomas were not seen. PMID:10740689

Bapat, R D; Ravishankar, D K; Rohandia, O; Joshi, A S; Vora, I M

1995-01-01

154

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

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.

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

2001-01-01

156

Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review  

Digital Repository Infrastructure Vision for European Research (DRIVER)

AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE).

2012-01-01

157

Biomagnetic Techniques for Assessing Gastric and Small Bowel Electrical Activity  

Science.gov (United States)

Recent advances in electrophysiology of the gastrointestinal tract have emphasized the need for methods of noninvasive assessment of gastric and small intestinal electrical activity (GEA and IEA). While the cutaneous electrogastrogram (EGG) may reveal the frequency dynamics of gastric electrical activity, other parameters important for characterizing the propagating electrical activity are not available from EGG recordings. Recent studies on the electroenterogram (EENG) are promising, but low-conductivity abdominal layers have complicated the identification of small intestinal electrical rhythms in cutaneous recordings. The magnetogastrogram (MGG) and magnetoenterogram (MENG) are able to characterize gastric and intestinal electrical activity noninvasively in terms of its frequency, power and characteristics of its propagation. Superconducting QUantum Interference Device (SQUID) magnetometers are used to detect the minute magnetic fields associated with electrical activity of the gastrointestinal syncytium formed by interstitial cells of Cajal and smooth muscle networks. Changes in GEA and IEA that occur in response to disease or abnormal conditions are reflected in MGG and MENG signals. Magnetic methods for assessing the electrical activity of the stomach and small bowel thus show great clinical promise.

Bradshaw, L. Alan

2004-09-01

158

Uncommon cause of small bowel obstruction - gallstone ileus: a case report  

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Gallstone ileus is an uncommon cause of small bowel obstruction. We present a case of small intestinal obstruction owing to a large gallstone in lower ileum in a 65 years old man. The diagnosis was made by computed tomography.

Zahid, Fatima Ezzahra; Benjelloun, El Bachir; Ousadden, Abdelmalek; Mazaz, Khalid; Taleb, Khalid Ait

2009-01-01

159

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

International Nuclear Information System (INIS)

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 cm3 (49.8% reduction). The SB volumes that received a dose of 10 ? 50 Gy were significantly reduced in 3D-CRT (65 ? 80% reduction) and IMRT plans (54 ? 67% reduction) using the SBDS. When the SB volumes that received 20 ? 50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6? 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

2004-06-01

160

Diverticular disease of the colon  

International Nuclear Information System (INIS)

The high incidence of diverticular disease, its clinical symptoms, pathology and anatomy are discussed. In the author's opinion, the valuable method of double-contrast examination in the hypotonic state is frequently neglected in favour of endoscopy, a method putting the patient under strain. Double-contrast examination should be the method of choice; it determines the extend and, in most cases, also the complications of diverticular disease with sufficient accuracy and reliability. The radiological criteria of diverticular disease are illustrated by a number of figures. (orig.)

1983-12-01

 
 
 
 
161

Diverticular disease of the colon  

Energy Technology Data Exchange (ETDEWEB)

The high incidence of diverticular disease, its clinical symptoms, pathology and anatomy are discussed. In the author's opinion, the valuable method of double-contrast examination in the hypotonic state is frequently neglected in favour of endoscopy, a method putting the patient under strain. Double-contrast examination should be the method of choice; it determines the extend and, in most cases, also the complications of diverticular disease with sufficient accuracy and reliability. The radiological criteria of diverticular disease are illustrated by a number of figures.

Fuchs, H.F.

1983-12-01

162

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.

Nischal Krishnappa

2013-08-01

163

Investigation of the small bowel in gastrointestinal bleeding--enteroscopy and capsule endoscopy.  

Science.gov (United States)

The last frontier in luminal endoscopy has been conquered. Bleeding lesions in the small intestine can present a frustrating clinical problem, but recent advances have made investigating the small bowel easier and less invasive. Capsule endoscopy and double balloon enteroscopy are two new technologies that promise to lower the barrier to evaluation of the entire small intestine. Recent studies show that capsule endoscopy improves outcomes in patients who have OGIB. Although outcome studies regarding double balloon enteroscopy have not been performed, the opportunity to treat lesions throughout the small bowel without resorting to surgery is a tremendous advance. These improvements suggest that the corner may have been turned in the diagnosis and management of small bowel bleeding. Perhaps to the next generation of gastroenterologists, small bowel bleeding will not be obscure. PMID:16303579

Carey, Elizabeth J; Fleischer, David E

2005-12-01

164

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

Science.gov (United States)

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

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

2014-03-01

165

Sonographic diagnosis of multiple small-bowel intussusceptions in Peutz-Jeghers syndrome: a case report  

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Peutz-Jeghers syndrome (PJS) is a rare, though well-described, hereditary polyposis syndrome associated with mucocutaneous pigmentation that typically presents in the second decade of life with complications related to intestinal polyps. We present two cases of teenaged girls presenting with small-bowel intussusceptions within a 3-month period. Sonographic examinations readily revealed small-bowel intussusceptions with secondary small-bowel obstruction. In both the symptoms were less severe than one would expect given the underlying pathology found at subsequent surgery. Sonographic imaging with pathologic correlation is provided. (orig.)

Harris, John P. [Baylor College of Medicine, Dept. of Radiology, Houston, TX (United States); Munden, Martha M. [Department of Diagnostic Imaging, Texas Children' s Hospital, Baylor College of Medicine, 6621 Fannin Street MC2-2521, Houston, TX 777030-2399 (United States); Minifee, Paul K. [Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX (United States)

2002-09-01

166

Radiological aspects of diagnosis and staging of small bowel lymphoma - a case report  

International Nuclear Information System (INIS)

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)

1999-01-01

167

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

Directory of Open Access Journals (Sweden)

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

Mazaz Khalid

2009-05-01

168

Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives.  

Science.gov (United States)

This article describes the recent advances in radiological imaging of malignant neoplasms of the mesenteric small bowel and provides an outline of new trends and perspectives that can be anticipated. The introduction of multidetector row technology, which allows the acquisition of submillimeter and isotropic voxels, has dramatically improved the capabilities of computed tomography in the investigation of the mesenteric small bowel. This technology combined with optimal filling of small bowel loops through the use of appropriate enteral contrast agents has markedly changed small bowel imaging. Computed tomography-enteroclysis, which is based on direct infusion of enteral contrast agent into the mesenteric small bowel through a naso-jejunal tube, provides optimal luminal distension. By contrast, computed tomography-enterography is based on oral administration of enteral contrast agent. These two techniques are now well-established ones for the detection and the characterization of small bowel neoplasms. During the same time, combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging has gained wide acceptance for the evaluation of patients with suspected small bowel neoplasms. Rapid magnetic resonance imaging sequences used in combination with specific enteral contrast agents generate superb images of the mesenteric small bowel so that magnetic resonance-enteroclysis and magnetic resonance-enterography are now considered as effective diagnostic tools for both the detection and the characterization of neoplasms of the mesenteric small bowel. Recent improvements in image post-processing capabilities help obtain realistic three-dimensional representations of tumors and virtual enteroscopic views of the small bowel that are useful for the surgeon and the gastroenteroenteologist to plan surgical or endoscopic interventions. Along with a better knowledge of the potential and limitations of wireless capsule endoscopy and new endoscopic techniques, these recent developments in radiological imaging reasonably suggest that substantial changes in the investigation of small bowel tumors may be anticipated in a near future, thus potentially create a new paradigm shift after standard small bowel follow-through study has been universally abandoned. PMID:21035353

Soyer, Philippe; Boudiaf, Mourad; Fishman, Elliot K; Hoeffel, Christine; Dray, Xavier; Manfredi, Riccardo; Marteau, Philippe

2011-10-01

169

Laparoscopic Management of Diverticular Disease  

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Laparoscopy surgery has achieved wide acceptance for the treatment of benign disease of the colon. A review of the literature regarding the indications, surgical technique, and outcomes of laparoscopic surgery for diverticular disease is presented.

Larach, Sergio

2004-01-01

170

Laparoscopic treatment for acute diverticular disease  

Directory of Open Access Journals (Sweden)

Full Text Available Diverticular disease of the sigmoid colon involves more than 50% of population over 60 years, and much more in people older than 80 years. Most patients remain asymptomatic, but, about 10-20% develop complications requiring surgery. Colonic diverticulitis represents an acute bowel inflammation, in many cases, confined only to the sigmoid and descending colon. Recurrent attacks and complications of diverticulitis require surgical procedure, although most cases can be managed medically. The cause of acute diverticulitis remains obscure. It has been speculated that obstruction at the mouth of the diverticulum results in diverticulitis, similar to appendicitis, but this is no longer the accepted theory, and some feel that chronic inflammation precedes clinical diverticulitis. .

Pignata Giusto

2006-01-01

171

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

Energy Technology Data Exchange (ETDEWEB)

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

Maglinte, Dean D.T. [Indiana University School of Medicine, Department of Radiology, Indianapolis, IN (United States)

2006-05-15

172

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.)

1988-01-01

173

Changing incidence of diverticular disease of the colon in the Koreans: a radiological study  

International Nuclear Information System (INIS)

Diverticular disease of the colon is the commonest pathological process in the large bowel in the aged caucasians, but this is rare in oriental races.In Korea, diverticular disease of the colon was known to be rare as reported by Kim in 1964. Since then, however, we have had an impression that the diverticular disease of the colon is not so rare as was reported by Kim previously from our department. The present study has been undertaken to substantiate our impression. We received 1,143 consecutive cases of double-contrast barium performed at the Department of radiology, St. Mary's Hospital, Catholic Medical College during the past 7 years to analyzed diverticular disease patterns of the colon in the Koreans. 1. The present study revealed 29 patients of diverticular disease of the colon, an incidence of 2.5%. The age distribution was shown in Table 1. 2. The mean number of diverticular were 9 and the mean size as follows: the cecum, 6.4 mm; the proximal 1/3 of the ascending colon, 5.6 mm, The mid 1/3 of ascending colon, 4.9 mm; and the distal 1/3 of the ascending colon, 4.4 mm. 3. The average age of patients with diverticular disease of the colon was 49.5 years. Chief complaints were change of bowel habit (31.6%), abdominal pain (28.9%) and indigestion (18.4%). 4. The associated radiological findings of diverticular disease of the colon were: (1) spasm in 16 cases (46%); (2) a marginal irregularity in 16 cases (25%); and (3) asymmetrical haustra in 16 cases (30%). In 13 cases no associated signs seen. We have found that incidence of the diverticular disease of the colon in the present series is very significantly higher than that of the previous report from our department (Kim, 1964). We postulate that the possible factors operational in such increase in the incidence of the clonic diverticular disease in the last decade are: (1) changing dietary pattern characterized by high-protein and high refined-sugar consumption, and (2) routine use of the double contrast technique which permitted us to see more diverticular outpouchings of the colon compared to the conventional simple barium enema study.

1979-06-01

174

Value of cine MRI for better visualization of the proximal small bowel in normal individuals  

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While enteroclysis seems to be the most efficacious method in achieving bowel distension, enterographic methods have become widespread due to the unpleasantness of enteroclysis and the radiation involved with positioning the catheter. Cine images in MRI can be done without radiation. Our aim is to see if and how cine MR imaging can improve visualization of bowel loops by capturing them while distended. Ten healthy individuals were asked to drink up to 2,000 ml of an oral solution made locally over a 60-min period. Then they underwent MRI using coronal balanced fast field echo (b-FFE) covering small bowel loops. If the initial exam revealed collapsed bowel loops an additional 50 mg of erythromycine was given intravenously with the subject still in the scanner and then cine imaging was performed. The degree of distension of different segments of the small bowel was measured before and after cine imaging and compared. The distension score was significantly higher after addition of the cine images as well, being only significant for depiction of the duodenum and jejunum. Our preliminary study suggests that cine MRI can give better image depiction of the proximal small bowel in healthy volunteers, perhaps circumventing the need for enteroclysis in some cases. There is a need for validation of these results in patients with small bowel disease. (orig.)

Torkzad, Michael R.; Blomqvist, Lennart [Karolinska University Hospital Solna, Department of Diagnostic Radiology, Stockholm (Sweden); Karolinska University Hospital Solna, Stockholm (Sweden); Karolinska Institutet, Stockholm (Sweden); Vargas, Roberto [Karolinska University Hospital Solna, Department of Diagnostic Radiology, Stockholm (Sweden); Karolinska University Hospital Solna, Stockholm (Sweden); Tanaka, Chikako [Karolinska University Hospital Solna, Department of Diagnostic Radiology, Stockholm (Sweden); Karolinska University Hospital Solna, Stockholm (Sweden); Karolinska Institutet, Stockholm (Sweden); Keio University School of Medicine, Department of Radiology, Tokyo (Japan)

2007-11-15

175

Value of cine MRI for better visualization of the proximal small bowel in normal individuals  

International Nuclear Information System (INIS)

While enteroclysis seems to be the most efficacious method in achieving bowel distension, enterographic methods have become widespread due to the unpleasantness of enteroclysis and the radiation involved with positioning the catheter. Cine images in MRI can be done without radiation. Our aim is to see if and how cine MR imaging can improve visualization of bowel loops by capturing them while distended. Ten healthy individuals were asked to drink up to 2,000 ml of an oral solution made locally over a 60-min period. Then they underwent MRI using coronal balanced fast field echo (b-FFE) covering small bowel loops. If the initial exam revealed collapsed bowel loops an additional 50 mg of erythromycine was given intravenously with the subject still in the scanner and then cine imaging was performed. The degree of distension of different segments of the small bowel was measured before and after cine imaging and compared. The distension score was significantly higher after addition of the cine images as well, being only significant for depiction of the duodenum and jejunum. Our preliminary study suggests that cine MRI can give better image depiction of the proximal small bowel in healthy volunteers, perhaps circumventing the need for enteroclysis in some cases. There is a need for validation of these results in patients with small bowel disease. (orig.)

2007-11-01

176

Small Bowel Transglutaminase 2-specific IgA Deposits in Dermatitis Herpetiformis.  

Science.gov (United States)

Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease. Untreated coeliac disease patients are known to have transglutaminase 2 (TG2)-targeted IgA deposits in the small bowel mucosa. To evaluate whether similar intestinal IgA deposits are also present in DH and whether the deposits disappear with gluten-free diet, 47 untreated and 27 treated DH patients were studied. Seventy-nine percent of untreated and 41% of the treated DH patients had TG2-specific IgA deposits in the small bowel, and the presence of the deposits showed a significant association with the degree of small bowel villous atrophy (p?DH patients. The results show that the majority of untreated DH patients have similar gluten-dependent TG2-specific IgA deposits the small bowel mucosa as coeliac disease patients. PMID:24352382

Salmi, Teea T; Hervonen, Kaisa; Laurila, Kaija; Collin, Pekka; Mäki, Markku; Koskinen, Outi; Huhtala, Heini; Kaukinen, Katri; Reunala, Timo

2014-06-24

177

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

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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.

He, Qiong; Bai, Yang; Zhi, Fa-chao; Gong, Wei; Gu, Hong-xiang; Xu, Zhi-min; Cai, Jian-qun; Pan, De-shou; Jiang, Bo

2013-01-01

178

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

Energy Technology Data Exchange (ETDEWEB)

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

Frazzini, V.I. Jr.; English, W.J.; Bashist, B.; Moore, E. [Columbia Univ. College of Physicians and Surgeons, New York, NY (United States)

1996-05-01

179

Constitutive basal and stimulated human small bowel contractility is enhanced in obesity  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Small bowel contractility may be more prominent in obese subjects, such that there is enhanced nutrient absorption and hunger stimulation. However, there is little evidence to support this. This study examined in vitro small bowel contractility in obese patients versus non-obese patients. Samples of histologically normal small bowel were obtained at laparoscopic Roux-en-Y gastric bypass from obese patients. Control specimens were taken from non-obese patients undergoing small bowel resection for benign disease or formation of an ileal pouch-anal anastamosis. Samples were transported in a pre-oxygenated Krebs solution. Microdissected circular smooth muscle strips were suspended under 1 g of tension in organ baths containing Krebs solution oxygenated with 95% O2/5% CO2 at 37°C. Contractile activity was recorded using isometric transducers at baseline and in response to receptor-mediated contractility using prostaglandin F2a, a nitric oxide donor and substance P under both equivocal and non-adreneregic, non-cholinergic conditions (guanethidine and atropine. Following equilibration, the initial response to the cholinergic agonist carbachol (0.1 mmol/L was significantly increased in the obese group (n = 63 versus the lean group (n = 61 with a mean maximum response: weight ratio of 4.58 ± 0.89 vs 3.53 ± 0.74; (p = 0.032. Following washout and re-calibration, cumulative application of substance P and prostaglandin F2a produced concentration-dependent contractions of human small bowel smooth muscle strips. Contractile responses of obese small bowel under equivocal conditions were significantly increased compared with non-obese small bowel (p Stimulated human small bowel contractility is increased in obese patients suggesting faster enteric emptying and more rapid intestinal transit. This may translate into enhanced appetite and reduced satiety.

Baird Alan W

2009-04-01

180

Ingestion of a foreign body unmasks an asymptomatic small bowel carcinoid tumor  

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Bowel obstruction is a common surgical admission around the world. On the other hand, small intestinal tumors, such as midgut carcinoid, are uncommon neoplasms and an infrequent cause of intestinal obstruction leading to hospitalization. A foreign body is an extremely rare cause of intestinal obstruction and when ingested, foreign bodies most often lodge in the narrowest portion of the gastrointestinal tract. Narrowing of the small bowel due to a neoplasm can prohibit the passage of an accide...

Yi-Zarn Wang; Patrick Greiffenstein

2012-01-01

 
 
 
 
181

Fecal calprotectin is equally sensitive in Crohn's disease affecting the small bowel and colon  

DEFF Research Database (Denmark)

The utility of fecal calprotectin (fCal) in small bowel Crohn's disease (CD) remains to be clarified. The primary aim of this study was to determine levels of fCal in CD restricted to the small bowel compared with CD affecting the colon, in patients undergoing their first diagnostic work-up. In addition, the study assessed the sensitivity and specificity of fCal in suspected CD.

Jensen, Michael Dam; Kjeldsen, Jens

2011-01-01

182

Evidence for peptidoglycan absorption in rats with experimental small bowel bacterial overgrowth.  

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Surgical creation of jejunal self-filling blind loops (SFBL) causes small bowel bacterial overgrowth which is associated with hepatobiliary inflammation in the susceptible Lewis and Wistar rat strains. Since hepatic injury occurs when small bowel anaerobic bacterial concentrations are increased 4 to 6 log10 units per ml and hepatic bacterial cultures are negative, we postulate that the inflammation is caused by absorption of phlogistic cell wall polymers originating from bacteria within the l...

Lichtman, S. N.; Keku, J.; Schwab, J. H.; Sartor, R. B.

1991-01-01

183

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

Science.gov (United States)

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

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

2013-01-01

184

Low-Radiation-Dose Modified Small Bowel CT for Evaluation of Recurrent Crohn's Disease  

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Crohn's disease affects any part of the GI tract, commonly the terminal ileum. To decrease radiation exposure we developed a low-radiation-dose unenhanced CT (modified small Bowel CT, MBCT) to evaluate the small bowel using hyperdense oral contrast. Technique. MBCT was investigated in patients with pathologically proven Crohn's disease presenting with new symptoms from recurrent inflammation or stricture. After ethics board approval, 98 consecutive patients were retrospectively evaluated. Kap...

Kielar, A. Z.; Tao, H.; Mckeever, C.; El-maraghi, R. H.

2012-01-01

185

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center  

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AIM: To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. METHODS: Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed. The patients’ characteristics, pre-anesthetic problems, anesthetic techniques, anesthetic agents, anesthetic time, type and route of proc...

Somchai Amornyotin; Udom Kachintorn; Siriporn Kongphlay

2012-01-01

186

Bowel Perforation after Erlotinib Treatment in a Patient with Non-Small Cell Lung Cancer  

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Erlotinib is accepted as a standard second-line chemotherapeutic agent in patients with non-small cell lung cancer who are refractory or resistant to first-line platinum-based chemotherapy. There has been no previous report of bowel perforation with or without gastrointestinal metastases related to erlotinib in patients with non-small cell lung cancer. The exact mechanism of bowel perforation in patients who received erlotinib remains unclear. In this report, we report the first case of enter...

Cheon, Yun-hong; Kim, Moon Jin; Kang, Min Gyu; Kim, Hee Jin; Lee, Sang Su; Kim, Cha Young; Jeon, Dae-hong; Kim, Yu Eun; Lee, Gyeong-won

2011-01-01

187

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

188

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 MR

2012-07-01

189

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

190

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.)

2011-05-01

191

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 presence of SDD (p = 0.829). Conclusions: Bowel cleansing and distension at CTC were not influenced by the presence of diverticular disease.

2012-03-01

192

Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures  

Science.gov (United States)

The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations.

Bini, Roberto; Quiriconi, Fabrizio; Viora, Tiziana; Leli, Renzo

2013-01-01

193

Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures.  

Science.gov (United States)

The use of external fixation for the initial treatment of unstable, complex pelvic injuries with hemodynamic instability remains an effective treatment for multiply injured patients. Bowel entrapment within a pelvic fracture is a rarely reported, potentially fatal complication. Here, we report a polytrauma patient with pelvic fractures who developed an intestinal obstruction after an external fixation. At an explorative laparotomy, we found an ileum segment trapped in the sacral fracture. Reported cases of bowel entrapment in pelvic fractures, especially in sacral fractures, are exceedingly rare. The diagnosis is often delayed due to difficulty distinguishing entrapment from the more common adynamic ileus. In conclusion, clinicians and radiologists should be aware of this potentially lethal complication of pelvic fractures treatment. To exclude bowel entrapment, patients with persistent ileus or sepsis should undergo early investigations. PMID:23960383

Bini, Roberto; Quiriconi, Fabrizio; Viora, Tiziana; Leli, Renzo

2013-07-01

194

Diet, ageing and genetic factors in the pathogenesis of diverticular disease  

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Diverticular disease (DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK. This high prevalence ranks it as one of the most common bowel disorders in western nations. The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum. Despite this public health ...

Commane, Daniel Martin; Arasaradnam, Ramesh Pulendran; Mills, Sarah; Mathers, John Cummings; Bradburn, Mike

2009-01-01

195

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 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

2004-05-01

196

Case report of small bowel obstruction caused by small intestinal metastasis of bilateral breast cancer  

Science.gov (United States)

A 41-year-old female was admitted into hospital due to recurrent abdominal pain with bloating. An enteroscopy was carried out and stenosis in the lower jejunal lumen was identified. This led to a diagnosis of small bowel obstruction caused by inflammation. During the laparotomy, the resection and anastomosis of a narrow segment of small intestine was performed. In combination with the results of immunohistochemical analysis, the postoperative pathology indicated the presence of a poorly differentiated/undifferentiated carcinoma of the small intestine, which was considered to have arisen from breast cancer. Postoperative examination showed bilateral breast masses, and the pathology of the right breast tumor biopsy prompted the diagnosis of invasive lobular carcinoma. A breast MRI was reviewed following five cycles of XT chemotherapy and the evaluation was stable disease (SD). Since the mass was not sensitive to chemotherapy, a bilateral modified radical mastectomy was performed, and postoperative pathology confirmed the mass to be primary bilateral invasive lobular carcinoma.

LV, LIQIONG; ZHAO, YUN; LIU, HUI; PENG, ZHONGYI

2013-01-01

197

SOME MECHANISMS OF THE DEVELOPMENT DIVERTIKULYARNOY DISEASE OF THE BOWELS  

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Full Text Available Stigma dysplasia of connective tissue, indications of diffuse endocrine system (enterocells immunopositive substance P (SP and vasoactive intestinal polypeptide (VIP, mast cells (mastocyte in patients with diverticular disease of bowels are discussed in the article.

Yu.N. Myalina

2008-06-01

198

SOME MECHANISMS OF THE DEVELOPMENT DIVERTIKULYARNOY DISEASE OF THE BOWELS  

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Stigma dysplasia of connective tissue, indications of diffuse endocrine system (enterocells immunopositive substance P (SP) and vasoactive intestinal polypeptide (VIP), mast cells (mastocyte)) in patients with diverticular disease of bowels are discussed in the article.

Kozlova, I. V.; Myalina, Yu N.

2008-01-01

199

Long Term Survival after Resection of a Small Bowel Metastasis of Lung Adenocarcinoma: A Case Report  

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Background: Small bowel metastases of lung adenocarcinoma represent a rare clinical entity, often diagnosed after complications due to obstruction, bleeding or bowel perforation. Case Report: We report a case of ileal metastasis discovered during an intestinal perforation. The patient was a 47-year-old man hospitalized in emergency for acute abdominal pain, with right lower quadrant abdominal defense and a clinical history of left lower pulmonary lobectomy for lung adenocarcinoma 6 months bef...

Laurent Sulpice; Emanuele D’Errico; Alexis Arnaud; Michel Rayar; Karim Boudjema; Bernard Meunier

2011-01-01

200

The use of Ankaferd in diverticular bleeding: two case reports.  

Science.gov (United States)

Bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Using epinephrine injection, heater probe or bipolar coagulation, endoclips and endoscopic band ligation all have been shown in small case series to achievehemostasis. In the present two cases, we evaluated the effectiveness of Ankaferd Blood Stopper in colonic diverticular hemorrhage. PMID:24557969

Aslan, Ekrem; Akyüz, Ümit; Pata, Cengiz

2013-01-01

 
 
 
 
201

Metastatic squamous cell carcinoma from hand skin causing small bowel obstruction: an unusual case presentation.  

Science.gov (United States)

The small bowel rarely suffers from metastatic tumors from outside the abdomen. Small bowel obstructions caused by the metastatic spread of squamous cell carcinoma (SCC) of the hand to the intestines are even rarer. A 71-year-old man with intermittent abdominal distension and pain for 4 months was diagnosed with partial bowel obstruction. The patient underwent a video capsule endoscopic examination; however, the patient was unable to pass the capsule, which worsened the abdominal distension. He was transferred to our department for acute intestinal obstruction, and an emergency exploratory laparotomy was performed. Intraoperatively, a tumoral stricture of the intestine at a distance of 150 cm from the ileo-cecum and dilation of the proximal bowel was found. The involved segment was resected, and ileo-ileal anastomosis was performed. The pathological sections confirmed the lesion to be a moderately differentiated SCC with whole bowel layer infiltration. Immunohistochemical staining showed positive expression of cytokeratin 5/6 and p63. The patient had an uneventful recovery. However, 6 months later, he was hospitalized again with intestinal obstruction. Reoperation was performed and revealed multiple metastases in the small bowel. He died 4 months later. In this unusual case, metastasizing SCC of the hand skin led to intestinal obstruction and poor prognosis. Therefore, follow-up procedures regarding intestinal spread should be performed in patients with SCC who present with abdominal symptoms. PMID:24885006

Li, Ruixin; Chen, Zihua; Wen, Qiaocheng; Chen, Zhikang

2014-01-01

202

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  

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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

203

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

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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

204

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 multicystic mesothelioma and lymphangiomyoma. Immunohistochemical study for factor VIII-related antigen, D2-40, calretinin and human melanoma black-45 (HMB-45 are essential for diagnosis. Factor VIII-related antigen and D2-40 are positive in lymphangioma but negative in benign multicystic mesothelioma. HMB-45 shows positive study in the smooth-muscle cells around the lymphatic spaces of the lymphangiomyoma. We report a case of small-bowel volvulus induced by mesenteric lymphangioma in a 2-year-and-9-mo-old boy who presented with rapid abdominal distension and vomiting. The abdominal computed tomography scan showed a multiseptated mass at the right lower quadrant with a whirl-like small-bowel dilatation, suggestive of a mesenteric cyst with midgut volvulus. The intraoperative findings revealed a huge, lobulated, yellowish pink, cystic mass measuring 20 cm × 20 cm × 10 cm, that was originated from the small bowel mesentery with small-bowel volvulus and small-bowel dilatation. Cut surface of the mass revealed multicystic spaces containing a milky white fluid. The patient underwent tumor removal with small-bowel resection and end-to-end anastomosis. Microscopic examination revealed that the cystic walls were lined with flat endothelial cells and comprised of smooth muscle in the walls. The flat endothelial cells were positive for factor VIII-related antigen and D2-40 but negative for calretinin. HMB-45 showed negative study in the smooth-muscle cells around the lymphatic spaces. Thus, the diagnosis was lymphangioma of the small bowel mesentery with associated small bowel volvulus.

Worapop Suthiwartnarueput

2012-01-01

205

Clinical variables related to small bowel obstruction: comparison of patients with and without Crohn’s disease  

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Small bowel obstruction is a known complication of Crohn’s disease. Determining need for operation is a demanding task. The aim of this study was to fine tune the decision-making process by evaluating standard clinical and laboratory parameters in small bowel obstruction of any cause and compare etiologies. Consecutive patients with Crohn’s disease and small bowel obstruction were selected retrospectively and compared to a randomly selected group of non Crohn’s patients with obstruction...

Awad Al Qahtani; Christina Holcroft; Philip Gordon; Andrew Szilagyi

2012-01-01

206

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

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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.

Kim, Hong Soo; Kang, Hee Woong; Bahk, Yong Whee [St Mary' s Hospital Catholic Medical College, Seoul (Korea, Republic of)

1972-12-15

207

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

1972-12-01

208

Small Bowel Adenocarcinoma Presenting with Refractory Iron Deficiency Anemia - Case Report and Review of Literature  

Science.gov (United States)

Cancers of the small bowel are relatively rare and account for approximately 1–2% of all gastrointestinal neoplasms. The most common histologic subtype – adenocarcinoma – constitutes 40% of all cases. These cancers generally present with vague abdominal discomfort and are often diagnosed at a late stage and carry a poor prognosis. The treatment of choice of early-stage small bowel adenocarcinoma is surgical resection. No standard treatment protocol has been defined for unresectable or metastatic disease. Here, we report a case of a 56-year-old woman who presented with unexplained iron deficiency anemia. Extensive initial studies with serial CT scans of the abdomen, esophagogastroduodenoscopy, small bowel capsule endoscopy and colonoscopy were noncontributory. She was later found to have a metastatic small bowel adenocarcinoma and treated with palliative chemotherapy. She achieved a modest response to the treatment. Interestingly, in our case, the sole presentation was unexplained iron deficiency anemia. Physician's awareness regarding the possibility of small bowel cancer especially in the setting of iron deficiency and its workup has been emphasized. This enhances the chance of early detection and hence better survival.

Poddar, Nishant; Raza, Shahzad; Sharma, Bhawna; Liu, Ming; Gohari, Arash; Kalavar, Madhumati

2011-01-01

209

Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To evaluate the effectiveness and safety of capsule endoscopy (CE in patients with recurrent subacute small bowel obstruction.METHODS: The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through.RESULTS: CE made a definitive diagnosis in 12 (38.7% of 31 cases: four Crohn’s disease (CD, two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine, one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three (9.7% of 31 patients, and was caused by CD (2 or tumor (1. Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 mo. No case had an acute small bowel obstruction caused by performance of CE.CONCLUSION: CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.

Xiao-Yun Yang, Chun-Xiao Chen, Bing-Ling Zhang, Li-Ping Yang, Hua-Jing Su, Li-Song Teng, You-Ming Li

2009-05-01

210

Evaluation and management of small-bowel tumors in the era of deep enteroscopy.  

Science.gov (United States)

In summary, small-intestine tumors are a rare phenomenon, but they are being discovered more frequently with newer diagnostic techniques. Prior studies of the small bowel were limited, making the diagnosis difficult. With the advent of CE and deep enteroscopy, gastroenterologists are finding these tumors at an earlier stage, thereby offering better management options for these patients. Although the incidence of small-bowel tumors has increased, the survival rates have remained the same. This may be a lag-time bias but could be a future area of research in this emerging field. PMID:24365041

Islam, R Sameer; Leighton, Jonathan A; Pasha, Shabana F

2014-05-01

211

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

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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

212

Water-soluble contrast media in radiography of small bowel obstruction  

International Nuclear Information System (INIS)

Fifty patients with possible gastrointestinal obstruction, referred for enteric follow-through examination, were randomized for a double-blind, parallel comparison of the hyperosmolar contrast medium Gastrografin and the low-osmolar Omnipaque. The result was that Omnipaque retained its radiographic density in the small bowel better than Gastrografin. Omnipaque was thus a better alternative than Gastrografin in follow-through examinations of intestinal obstruction. Also, 23 patients out of 28 with small bowel obstruction due to peritoneal adhesions, had spontaneous relief of symptoms during the observation period following contrast medium ingestion with no significant difference between the two media. This indicated that enteric follow-through procedures may have a therapeutic efficacy similar to the treatment of small bowel obstruction using nasogastric suction and gastrointestinal rest. Possible mechanisms for this action of the contrast media are discussed. (orig.)

1988-01-01

213

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

214

Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication.  

Science.gov (United States)

Small bowel duplications are congenital structures commonly lined by heterotopic gastric or pancreatic mucosa. Though benign in children, small bowel duplications have the potential for malignant degeneration in adulthood. Here, we present the first reported case of metastatic adenocarcinoma arising from a small bowel duplication lined by gastroesophageal mucosa. The cancer demonstrated overexpression of the HER2/neu oncoprotein and amplification of the HER2/neu gene. This represents the only report of HER2 overexpression in this type of lesion. The patient is being treated with traditional chemotherapeutic agents in addition to monoclonal antibody therapy directed at the HER2 protein, and has demonstrated a clinical benefit from treatment. This case demonstrates that the anatomic location of a mass may be distinct from its biological origin, and this difference may have important practical implications for diagnostic testing and treatment. PMID:24576036

Nussbaum, Daniel P; Bhattacharya, Syamal D; Jiang, Xiaoyin; Cardona, Diana M; Strickler, John H; Blazer, Dan G

2014-03-01

215

Application of fecal hemoglobin-haptoglobin complex testing for small bowel lesions.  

Science.gov (United States)

Abstract Objective. Fecal hemoglobin-haptoglobin (Hb-Hpt) complex testing is theoretically superior to immunochemical fecal occult blood test detecting human hemoglobin (Hb), as Hb-Hpt is more stable compared to Hb during passage through the gastrointestinal (GI) tract. The aim was to examine the role of fecal Hb-Hpt complex testing in predicting small bowel lesions detected by video capsule endoscopy (VCE). Materials and methods. Stools from patients undergoing small bowel VCE for obscure GI bleeding (OGIB) without ongoing overt bleeding were included. Two stool specimens were obtained on different days just before VCE to measure Hb-Hpt complex by ELISA and Hb by latex agglutination turbidimetric immunoassay. Results. Seventy-six patients (39 men and 37 women, average age 66 years) with suspected small bowel lesions entered. Median Hb-Hpt complex and Hb levels were significantly higher (p 10 ng/ml and Hb-Hpt complex >5 ng/ml), the sensitivity and specificity of the Hb-Hpt complex test to predict small bowel lesions were 71.4% and 73.3%, and those of the Hb test were 61.2% and 89.3%. Small bowel lesions were found in 58.3% with only Hb-Hpt complex positive results (15.8% of total subjects) compared to 83.3% when both were positive (55.3% of total). Conclusions. Measuring fecal Hb-Hpt complex in addition to Hb may be useful to predict the presence of small bowel lesions in patients with OGIB. PMID:24621414

Shiotani, Akiko; Tarumi, Ken-Ichi; Honda, Keisuke; Fujita, Minoru; Matsumoto, Hiroshi; Manabe, Noriaki; Kamada, Tomoari; Hata, Jiro; Haruma, Ken

2014-05-01

216

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

Directory of Open Access Journals (Sweden)

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

217

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

218

Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Transmission of oesophageal images may vary between different small-bowel capsule endoscopy models. A retrospective review of 100 examinations performed with 2 different Small-bowel capsule endoscopy (SBCE) systems (PillCam® and MiroCam®) was performed. The oral cavity/aero-digestive tract (i.e., tongue, uvula and/or epiglottis) was captured/identified in almost all (99%) of PillCam® videos but in none of MiroCam® cases, P < 0.0001. Furthermore, oesophageal images (i.e....

Anastasios Koulaouzidis

2012-01-01

219

Air or methyl cellulose as double contrast medium in small bowel radiography?  

International Nuclear Information System (INIS)

The value of enteroclysma in comparison to peroral roentgenologic imaging of the small bowel is beyond doubt. For the use of applicable double contrast media comparative investigations were carried out in 118 patients with inflammable diseases of the small bowel. 92 patients were investigated with air and 26 with 1% methyl cellulose solution in double contrast. Advantages and disadvantages of both methods are discussed. For the diagnostic results as well as for the application of complementing techniques air seems to be better for double contrast studies than methyl cellulose. (author)

1990-01-01

220

History of endoscopic devices for the exploration of the small bowel.  

Science.gov (United States)

The small bowel has gained new attention since the development of the wireless videocapsule in 2000, opening up the last 'black box' of the gastrointestinal tract. Although conventional push enteroscopy has been available for decades, since the wireless videocapsule new enteroscopes have been developed to examine the entire small bowel endoscopically in order to perform all conventional endoscopic procedures. The present review highlights the historic evolution of enteroscopy, from the first complete enteroscopy in 1971 over the current balloon-assisted and over-tube-guided methods of enteroscopy to future directions of evolutions towards perfection. PMID:19902867

Moreels, T G

2009-01-01

 
 
 
 
221

Sonography of the small bowel mesentery: Normal anatomy and pathologic changes  

International Nuclear Information System (INIS)

The leaves of the normal small-bowel mesentery may be identified in virtually all subjects undergoing abdominal US as elongated images of about 0.5-cm in thickness and separated, one from another, by peritoneal surfaces. Mesenteric vessels are visible within them. Such images never show peristaltic movements; at their end, the small-bowel loops may be identified and seen while changing shape during peristalsis. Pathologic changes may be recognized. Mesenteric edema is seen in cirrhosis and profound hypoalbuminemia, dilated mesenteric vessels are seen in portal hypertension; and enlarged nodes are seen in lymphoma. Matted mesenteric leaves or metastatic nodules may be observed in neoplastic peritoneal disease

1986-12-05

222

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

223

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish 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.

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

224

Small bowel perforation caused by a sharp bone: laparoscopic diagnosis and treatment.  

Science.gov (United States)

Small bowel perforation caused by sharp or pointed foreign bodies rarely is diagnosed preoperatively because clinical symptoms usually are nonspecific and can mimic other surgical conditions such as appendicitis and cecal diverticulitis. We report the case of a 57-year-old man who underwent diagnostic laparoscopy for abdominal pain of unknown etiology. Swelling and erythema were noted in a segment of small bowel in the right lower abdomen. A tiny sharp-pointed object was found penetrating the inflamed portion of the bowel. This foreign body was removed and the perforation immediately repaired under laparoscopic guidance. The postoperative course was uneventful. We believe that in cases of lower abdominal pain with peritoneal irritation, laparoscopy can provide not only a wide field of examination to localize intraabdominal pathology, but in some instances it can aid in case management. PMID:10804008

Yao, C C; Yang, C C; Liew, S C; Lin, C S

1999-06-01

225

Diagnosis and management of small bowel and mesentery injury following blunt abdominal trauma in 12 cases.  

Science.gov (United States)

Over four years (April 2004 to December 2008) 12 patients with blunt small bowel and mesenteric injuries were treated at three hospi-tals dealing with trauma. Ten cases were victims of traffic accidents, of whom 70% wore seat belts. There were 11 small bowel injuries (4 full-thickness & 7 seromuscular) and 9 mesenteric injuries (3 with & 6 without a de-vascularized bowel segment). All were managed initially following the Advanced Trauma Life Support (ATLS) guidelines. Emergency room ultrasound was positive for blood in 5/7 cases (71%) and CT scan in 2/4 (50%). Diagnostic peritoneal lavage (DPL) was performed in one case and was positive for blood. PMID:19530607

Helmy, Mohamed A; Alafifi, Aser M; Ali, Ahmed H

2009-04-01

226

Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon. Case presentation We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction. Conclusion Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.

Slesser Alistair AP

2010-09-01

227

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 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

2001-10-01

228

Metastatic melanoma causing small bowel intussusception: diagnosis by {sup 1}8F-FDG PET/CT  

Energy Technology Data Exchange (ETDEWEB)

Malignant melanoma is a common and aggressive disease that frequently causes metastases to the small bowel. This study illustrates a case of small bowel intussusception secondary to metastatic melanoma visualized at {sup 1}8F-FDG PET/CT in a 48-year-old woman who had this examination for restaging purposes. (author)

Souza, Frederico Ferreira de; Johnston, Ciaran [Harvard Medical School, Boston, MA (United States). Brigham and Women' s Hospital. Dana Farber Cancer Institute], e-mail: ffsouza@partners.org; Souza, Felipe Ferreira de; Souza, Daniel Andrade Tinoco de [Harvard Medical School, Boston, MA, (United States). Brigham and Women' s Hospital

2009-09-15

229

Diverticular Disease and the Obese Patient  

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Diverticular disease is common in the Western world and is a considerable source of morbidity. Many have proposed an association between diverticular disease, its complications, and obesity. We examine this question through a review of the available literature. While it is likely that an association between diverticular disease and obesity exists, there is no evidence suggesting that obese patients should be managed any differently from the non-obese.

Johnson, Eric K.; Champagne, Bradley J.

2011-01-01

230

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

Science.gov (United States)

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. PMID:25013338

Buero, Agustín; Silberman, Ezequiel A; Medina, Pablo; Morra, Matias E; Bogetti, Diego J; Porto, Eduardo A

2014-07-01

231

Diseases of the small bowel in chronic diarrhea: diagnosis and treatment  

Directory of Open Access Journals (Sweden)

Full Text Available The incidence of chronic diarrhea in Asia is between 0.8-1.0%. The diseases and abnormalities according to the location, which can cause chronic diarrhea, are divided into three locations: the small bowel, the large bowel and extraintestinal. The small bowel diseases include infectious and non-infectious diseases. The infectious diseases are bacterial infections, parasitic infections etc. The non-infectious diseases include of Crohn’s disease, Celiac sprue, NSAID enteropathy, lactose intolerance, benign tumor, carcinoid tumor, carcinoma, post surgery complications, laxative etc. The approaches to diagnosis include good anamnesis, careful physical examination, supporting laboratory tests, more specialized supporting examinations including X-ray of the colon, esophagogastroduodenum follow-through, enteroclysis, ileo-colonoscopy and endoscopy on the upper portion of the digestive tract including the small intestine with biopsy for histopathology examinations. The treatment for chronic diarrhea is divided into supportive and causal therapy. (Med J Indones 2002; 11: 179-89 Keywords: small bowel, chronic diarrhea, approaches to diagnosis, treatment

M. Simadibrata

2002-09-01

232

Spontaneous perforation of small bowel lymphoma causing massive pneumoperitoneum: a case report  

International Nuclear Information System (INIS)

The gastrointestinal lymphoma is a well known entity for bleeding or perforation during treatment, but spontaneous perforation is not common. We report the CT findings of an unusual case of small bowel lymphoma which presented with massive pneumoperitoneum following spontaneous perforation

1996-01-01

233

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

2007-08-01

234

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

Directory of Open Access Journals (Sweden)

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

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

2008-04-01

235

Double contrast technique of the small bowel with barium and methyl cellulose  

International Nuclear Information System (INIS)

A modified technique of the small bowel enema is described. Diluted barium followed by an aqueous suspension of 0,5% methylcellulose is injected through a duodenal tube. Pathologic findings can be better recognized by the resulting double-contrast images than by other techniques. A detailed description of this method, and of our own experience, is given. (orig.)

1981-01-01

236

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.)

1985-01-01

237

Double-balloon enteroscopy to remove a strangulated enteroclysis catheter from the small bowel.  

Science.gov (United States)

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 jejunum and traction resulted in painful backward intussusception of the small bowel. In order to avoid surgical intervention, we decided to perform urgent proximal double-balloon enteroscopy to remove the enteroclysis catheter. Under fluoroscopic guidance, the enteroscope was introduced into the jejunum until the tip of the enteroscope reached the tip of the catheter. By straightening the enteroscope, the catheter could then be retracted from the jejunum, using the enteroscope as a guide wire along the catheter. Urgent surgical intervention was avoided and the patient completely recovered the same day. PMID:21490896

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

2008-01-01

238

Penetrating ectopic peptic ulcer in the absence of Meckel's diverticulum ultimately presenting as small bowel obstruction.  

LENUS (Irish Health Repository)

We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a patient with multiple previous negative investigations. The clinical presentation, radiographic features and pathological findings of this case are described, along with the salient lessons learnt. The added value of wireless capsule endoscopy (WCE) in such circumstances is debated.

Hurley, Hilary

2012-02-03

239

Serotonin Signaling in Diverticular Disease  

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Diverticulosis is extremely common in Western societies and is associated with complications in up to 15 percent of cases. Altered motility is an important feature of the pathogenesis of diverticular disease, and serotonin (5-HT) release is a primary trigger of gut motility. This study aims to determine whether colonic 5-HT signaling is altered in patients with diverticulosis or diverticulitis, and whether differences in serotonin signaling may distinguish patients with asymptomatic diverticu...

Costedio, Meagan M.; Coates, Matthew D.; Danielson, Amy B.; Buttolph, Thomas R.; Blaszyk, Hagen J.; Mawe, Gary M.; Hyman, Neil H.

2008-01-01

240

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

 
 
 
 
241

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.

2010-04-01

242

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

Energy Technology Data Exchange (ETDEWEB)

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 /sup 111/In-oxine 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 inflammed segments. The inability to show non-inflammed segments (n=5) and to localise small bowel stenoses exactly is disadvantageous in the scan. The advantage of the leucocyte scan is a noninvasive examination without specific bowel preparation and the ability to diagnose additionally inflammed 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.

Becker, W.; Jenett, M.; Fischbach, W.; Boerner, W.

1986-07-01

243

Diverticular disease in CT colonography  

International Nuclear Information System (INIS)

The aim of this study was to evaluate findings on CT colonography (CTC) in patients with diverticular disease. In a retrospective analysis of 160 consecutive patients, who underwent CTC and conventional colonoscopy (CC), patients with diverticular disease were retrieved. The CTC images were compared with CC and, if possible, with pathology. Findings on both 2D and 3D images are illustrated with emphasis on diagnostic problems and the possible solutions to overcome these problems. Several aspects of diverticulosis were detected: prediverticulosis (3%); global (55.6%); and focal wall thickening (4%) caused by thickened haustral folds, fibrosis, inflammation and adenocarcinoma; diverticula (52%); pseudopolypoid lesions caused by diverticular fecaliths (39%); inverted diverticula (1.2%); and mucosal prolapse (0.6%). Solutions to overcome pitfalls are described as abdominal windowing, content of the pseudopolypoid lesion, comparison of 2D and 3D images, prone-supine imaging and the aspect of the pericolic fat. In this series there were equivocal findings in case of mucosal prolapse (0.6%) and focal wall thickening (4%). Diverticulosis is a challenge for CTC to avoid false-positive diagnosis of polypoid and tumoral disease. Knowledge of possible false causes of polypoid disease and comparison of 2D and 3D images are necessary to avoid false-positive diagnosis. In case of equivocal findings additional conventional colonoscopy should be advised whenever a clinically significant lesion (?1 cm) is suspected. (orig.)

2003-12-01

244

Diverticular disease: reconsidering conventional wisdom.  

Science.gov (United States)

Colonic diverticula are common in developed countries and complications of colonic diverticulosis are responsible for a significant burden of disease. Several recent publications have called into question long-held beliefs about diverticular disease. Contrary to conventional wisdom, studies have not shown that a high-fiber diet protects against asymptomatic diverticulosis. The risk of developing diverticulitis among individuals with diverticulosis is lower than the 10% to 25% proportion that commonly is quoted, and may be as low as 1% over 11 years. Nuts and seeds do not increase the risk of diverticulitis or diverticular bleeding. It is unclear whether diverticulosis, absent diverticulitis, or overt colitis is responsible for chronic gastrointestinal symptoms or worse quality of life. The role of antibiotics in acute diverticulitis has been challenged by a large randomized trial that showed no benefit in selected patients. The decision to perform elective surgery should be made on a case-by-case basis and not routinely after a second episode of diverticulitis, when there has been a complication, or in young people. A colonoscopy should be performed to exclude colon cancer after an attack of acute diverticulitis but may not alter outcomes among individuals who have had a colonoscopy before the attack. Given these surprising findings, it is time to reconsider conventional wisdom about diverticular disease. PMID:23669306

Peery, Anne F; Sandler, Robert S

2013-12-01

245

Diverticular disease in CT colonography  

Energy Technology Data Exchange (ETDEWEB)

The aim of this study was to evaluate findings on CT colonography (CTC) in patients with diverticular disease. In a retrospective analysis of 160 consecutive patients, who underwent CTC and conventional colonoscopy (CC), patients with diverticular disease were retrieved. The CTC images were compared with CC and, if possible, with pathology. Findings on both 2D and 3D images are illustrated with emphasis on diagnostic problems and the possible solutions to overcome these problems. Several aspects of diverticulosis were detected: prediverticulosis (3%); global (55.6%); and focal wall thickening (4%) caused by thickened haustral folds, fibrosis, inflammation and adenocarcinoma; diverticula (52%); pseudopolypoid lesions caused by diverticular fecaliths (39%); inverted diverticula (1.2%); and mucosal prolapse (0.6%). Solutions to overcome pitfalls are described as abdominal windowing, content of the pseudopolypoid lesion, comparison of 2D and 3D images, prone-supine imaging and the aspect of the pericolic fat. In this series there were equivocal findings in case of mucosal prolapse (0.6%) and focal wall thickening (4%). Diverticulosis is a challenge for CTC to avoid false-positive diagnosis of polypoid and tumoral disease. Knowledge of possible false causes of polypoid disease and comparison of 2D and 3D images are necessary to avoid false-positive diagnosis. In case of equivocal findings additional conventional colonoscopy should be advised whenever a clinically significant lesion ({>=}1 cm) is suspected. (orig.)

Lefere, P.; Gryspeerdt, S.; Baekelandt, M.; Holsbeeck, B. van [Dept. of Radiology, Roeselare (Belgium); Dewyspelaere, J. [Dept. of Gastroenterology, Roeselare (Belgium)

2003-12-01

246

Multiscale texture descriptors for automatic small bowel tumors detection in capsule endoscopy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Conventional endoscopic exams do not allow the entire visualization of the gastrointestinal (GI) tract. Push enteroscopy (PE) is an effective diagnostic and therapeutic procedure, although it only allows exploration of the proximal small bowel (Pennazio et al., 1995). Simultaneously, convetional colonoscopy is limited at the terminal ileum. Therefore, prior to the wireless capsule endoscopy era, the small intestine was the conventional endoscopy’s last frontier, because it could not...

Barbosa, Daniel; Roupar, Dalila; Lima, C. S.

2011-01-01

247

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

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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

248

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

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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 adenocar...

Lior Drukker; Yair Edden; Petachia Reissman

2012-01-01

249

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

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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 adenocarcinom...

Drukker, Lior; Edden, Yair; Reissman, Petachia

2012-01-01

250

Etiology and Pathophysiology of Diverticular Disease  

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Diverticular disease is prevalent in Western countries and yet its pathogenesis remains poorly understood. The common theories of the cause of diverticular disease have focused on colonic motility, the structural aspects of the colonic wall, and the role of dietary factors, particularly fiber.

Hobson, Kristina G.; Roberts, Patricia L.

2004-01-01

251

Colorectal visceral perception in diverticular disease  

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Background and aims: The pathogenesis of asymptomatic diverticular disease (ADD) and symptomatic uncomplicated diverticular disease (SUDD) has not been elucidated. The aim of our study was to assess whether altered visceral perception or abnormal compliance of the colorectal wall play a role in these clinical entities.

Clemens, C. H. M.; Samsom, M.; Roelofs, J.; Berge Henegouwen, G. P.; Smout, A. J. P. M.

2004-01-01

252

Epidemiology of perforated colonic diverticular disease  

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Perforated colonic diverticular disease results in considerable mortality and morbidity. This review appraises existing evidence on the epidemiology and mechanisms of perforation, highlights areas of further study, and suggests an epidemiological approach towards preventing the condition. Computerised searches were used to identify published articles relating to the epidemiology, pathophysiology, and clinical features of perforated colonic diverticular disease. Several drug and dietary exposu...

Morris, C.; Harvey, I.; Stebbings, W.; Speakman, C.; Kennedy, H.; Hart, A.

2002-01-01

253

Serum Intestinal Fatty Acid Binding Protein in Patients with Small Bowel Obstruction  

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Full Text Available Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO. Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10 and non-ischemia (n = 27 groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p ? 7.660, r = 0.604, p = 0.0018. By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.

Kaoru Sakamoto

2013-05-01

254

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

255

Ingestion of a foreign body unmasks an asymptomatic small bowel carcinoid tumor  

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Full Text Available Bowel obstruction is a common surgical admission around the world. On the other hand, small intestinal tumors, such as midgut carcinoid, are uncommon neoplasms and an infrequent cause of intestinal obstruction leading to hospitalization. A foreign body is an extremely rare cause of intestinal obstruction and when ingested, foreign bodies most often lodge in the narrowest portion of the gastrointestinal tract. Narrowing of the small bowel due to a neoplasm can prohibit the passage of an accidentally ingested foreign object and produce an obstruction that neither the neoplasm nor the foreign body could have produced alone. We hereby report a case in which an accidentally ingested piece of foreign material leads to the finding of a small, early stage, asymptomatic, midgut carcinoid cancer in the proximal ileum that would have otherwise eluded detection for several years.

Patrick Greiffenstein

2012-01-01

256

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

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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

1974-01-01

257

Small bowel rupture due to blunt abdominal trauma.  

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Fourteen men with traumatic rupture of the small gut are analysed. Seven had alcohol intoxication. The diagnosis was made pre-operatively in eight. Ileal ruptures were the commonest, (11 of 14). Two patients died. PMID:263364

Minja, B M; Mahalu, W; Hiza, P R

1979-01-01

258

Effect of infliximab on small bowel stenoses in patients with Crohns disease  

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Full Text Available AIM: To assess prospectively small bowel stenoses in Crohn’s disease (CD patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS.METHODS: Twenty patients (M 12, age, 42.7 ± 11.8 years, 15 of whom showed obstructive symptoms indicating the presence of small bowel stenosis, and 5 without stenosis, were treated with infliximab (5 mg/kg at wk 0, 2, 6 and 5 mg/kg every 8 wk thereafter for steroid refractoriness, fistulizing disease, or to avoid high-risk surgery. SICUS was performed at the induction phase and at regular time intervals during the follow-up period of 34.7 ± 16.1 mo (range 7-58. Small bowel stenoses were detected by SICUS, endoscopy and MRI.RESULTS: In no case was progression of stenoses or the appearance of new ones seen. Of the 15 patients with stenosis, 5 stopped treatment after the induction phase (2 for no response, 3 for drug intolerance, one of whom showed complete regression of one stenosis. Among the remaining 10 patients, a complete regression of 8 stenoses (1 stenosis in 5 patients and 3 stenoses in one patient was observed after 6-22 infliximab infusions.CONCLUSION: In patients with CD treated with infliximab we observed: (a No progression of small bowel stenosis and no appearance of new ones, (b Complete regression of 1/22 stenosis after the induction phase and of 8/15 (53.3% stenosis after 6-22 infusions during maintenance therapy.

Nadia Pallotta, Fausto Barberani, Naima Abdulkadir Hassan, Danila Guagnozzi, Giuseppina Vincoli, Enrico Corazziari

2008-03-01

259

An unusual cause of small bowel obstruction caused by a Richter's-type hernia into the urinary bladder  

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INTRODUCTION The authors present an unusual case of small bowel obstruction in a 62-year-old man. PRESENTATION OF CASE A 62-year-old man with a background of transitional cell carcinoma (TCC) of the bladder presented to the emergency department with abdominal pain, distension, vomiting and had not opened his bowels for three days. 3 weeks previously he had a repeat Transurtheral resection of bladder tumour (TURBT), during which there was an iatrogenic perforation of the bladder. A CT scan of the abdomen and pelvis revealed small bowel obstruction but did not identify a cause. At laparotomy the cause of the obstruction was identified as a section of the small bowel that had partially herniated into the bladder, via the perforation. The defect was repaired and the patient made an uneventful recovery. DISCUSSION Herniation of the bowel into a defect in the bladder wall is a rare event with only 6 previous cases reported in the literature. It can cause signs and symptoms of bowel obstruction. CONCLUSION In patients with known bladder perforations who present with symptoms and signs of bowel obstruction, bowel herniation into the bladder should be considered. Early surgical intervention may be necessary if the patient is clinically unwell with appropriate symptoms and signs and imaging does not provide conclusive answer.

Sakai, Naomi S.; Acharya, Vikas; Mansour, Sami; Saleemi, Mohammed A.; Cheslyn-Curtis, Sarah

2014-01-01

260

Aspirin-induced small bowel injuries and the preventive effect of rebamipide  

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Full Text Available AIM: To evaluate the influence of taking low-dose aspirin for 4 wk on small intestinal complications and to examine the preventive effect of rebamipide. METHODS: This study was conducted as a single-center, randomized, double-blind, cross-over, placebo-controlled study. Eleven healthy male subjects were enrolled. Each subject underwent video capsule endoscopy after 1 and 4 wk of taking aspirin and omeprazole, along with either rebamipide or placebo therapy. The primary endpoint was to evaluate small bowel damage in healthy subjects before and after taking low-dose aspirin for 4 wk. RESULTS: The number of subjects with mucosal breaks (defined as multiple erosions and/or ulcers were 1 at 1 wk and 1 at 4 wk on the jejunum, and 6 at 1 wk (P = 0.0061 and 7 at 4 wk on the ileum (P = 0.0019. Rebamipide significantly prevented mucosal breaks on the ileum compared with the placebo group (P = 0.0173 at 1 wk and P = 0.0266 at 4 wk. CONCLUSION: Longer-term, low-dose aspirin administration induced damage in the small bowel. Rebamipide prevented this damage, and may be a candidate drug for treating aspirin-induced small bowel complications.

Kazuhiro Mizukami

2011-01-01

 
 
 
 
261

Delayed Presentation of Small Bowel Injury During Suprapubic Catheterisation  

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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

262

Imaging of small bowel-related complications following major abdominal surgery  

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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

2005-03-01

263

Imaging of small bowel-related complications following major abdominal surgery  

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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

264

Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: a case series.  

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Spontaneous small-bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum, and occur in patients who receive excessive anticoagulation with phenprocoumon/warfarin or who have additional risk factors for bleeding. We report three cases of intramural small-bowel hematoma, all complications of treatment with phenprocoumon, which nowadays is used extensively for therapeutic and prophylactic purposes. Diagnosis can be readily attained by sonography and confirmed using computed tomography. Early diagnosis is crucial because most patients can be treated successfully without surgery. Based on this experience and data from the literature, conservative treatment is recommended for intramural intestinal hematomas, when other complications needing laparotomy have been excluded. PMID:23135686

Abdel Samie, A; Sun, R; Huber, A; Höpfner, W; Theilmann, L

2013-03-01

265

Small bowel obstruction - the water-soluble follow-through revisited  

International Nuclear Information System (INIS)

AIMS: The aim of the present study to examine the use of a modified water-soluble follow-through in the diagnosis and management of small bowel obstruction (SBO). MATERIALS AND METHODS: Sixty-two patients were recruited to the study: 33 into the control group and 29 into the study group. A modified small bowel follow-through (SBFT) was performed in the study group patients. The control group was managed conventionally. Assessment was made by questionnaire documenting initial surgical diagnosis and likelihood of operative intervention, final diagnosis and surgical outcome (operative versus non-operative). RESULTS: SBFT changed the diagnosis in 12/24 of the study group (pp>0.05, chi-squared test). CONCLUSION: SBFT remains a valid and useful tool in surgical management of SBO. In particular it aids diagnostic confidence in planning surgical intervention, particularly in uncomplicated patients

2003-05-01

266

Complicated diverticular disease: the changing paradigm for treatment Doença diverticular complicada: alterando o padrão de tratamento  

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Full Text Available The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology. Treatment of infected diverticulitis has evolved enormously thanks to: 1 laparoscopic colonic resection followed or not (Hartmann's procedure by restoration of intestinal continuity, 2 simple laparoscopic lavage (for peritonitis +/- resection. Diverticulitis (inflammation may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV, a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.O termo diverticulite "complicada" é reservado para a doença diverticular complicada por sangramento, abscesso, peritonite, fístula ou obstrução intestinal. A hemorragia é melhor tratada por angioembolização (radiologia intervencionista. O tratamento de diverticulite infectada evoluiu enormemente graças a: 1 ressecção laparoscópica do cólon seguida ou não (procedimento de Hartmann pelo restabelecimento de continuidade intestinal, 2 lavado laparoscópico simples (peritonite + / - ressecção. A diverticulite (inflamação pode ser tratada somente com antibióticos, anti-inflamatórios, combinados com repouso e medidas de higiene. O abscesso diverticular (Hinchey graus I, II pode ser inicialmente tratado somente com antibióticos e / ou drenagem percutânea, dependendo do tamanho do abcesso. A peritonite purulenta generalizada (Hinchey III pode ser tratada pelo clássico procedimento Hartmann, pela exteriorização da perfuração, como se fosse um estoma, pela ressecção primária com ou sem anastomose, com ou sem desvio do trânsito e, por último, a simples lavagem laparoscópica, geralmente, sem drenagem. A peritonite por fezes (Hinchey IV, uma indicação para o tradicional procedimento de Hartmann, também pode se beneficiar da ressecção primária seguida de anastomose, com ou sem desvio e lavagem laparoscópica. A obstrução aguda (inflamação local, ou aderências, formação pseudotumoral, estenoses crônicas e fístula são, na maioria das vezes, tratadas por ressecção, preferencialmente, laparoscópica. Algoritmos terapêuticos pouco invasivos combinadas com indicações menos rigorosas para a o emprego da cirurgia radical antes de um padrão definido de recorrência, estão estabelecidos, ocasionando um número menor de ressecções e / ou estomas, reduzindo a morbidade e a mortalidade, melhorando a qualidade de vida após a intervenção, e geram uma tratamento menos dispendioso.

Abe Fingerhut

2012-08-01

267

Complicated diverticular disease: the changing paradigm for treatment / Doença diverticular complicada: alterando o padrão de tratamento  

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese O termo diverticulite "complicada" é reservado para a doença diverticular complicada por sangramento, abscesso, peritonite, fístula ou obstrução intestinal. A hemorragia é melhor tratada por angioembolização (radiologia intervencionista). O tratamento de diverticulite infectada evoluiu enormemente g [...] raças a: 1) ressecção laparoscópica do cólon seguida ou não (procedimento de Hartmann) pelo restabelecimento de continuidade intestinal, 2) lavado laparoscópico simples (peritonite + / - ressecção). A diverticulite (inflamação) pode ser tratada somente com antibióticos, anti-inflamatórios, combinados com repouso e medidas de higiene. O abscesso diverticular (Hinchey graus I, II) pode ser inicialmente tratado somente com antibióticos e / ou drenagem percutânea, dependendo do tamanho do abcesso. A peritonite purulenta generalizada (Hinchey III) pode ser tratada pelo clássico procedimento Hartmann, pela exteriorização da perfuração, como se fosse um estoma, pela ressecção primária com ou sem anastomose, com ou sem desvio do trânsito e, por último, a simples lavagem laparoscópica, geralmente, sem drenagem. A peritonite por fezes (Hinchey IV), uma indicação para o tradicional procedimento de Hartmann, também pode se beneficiar da ressecção primária seguida de anastomose, com ou sem desvio e lavagem laparoscópica. A obstrução aguda (inflamação local, ou aderências, formação pseudotumoral, estenoses crônicas) e fístula são, na maioria das vezes, tratadas por ressecção, preferencialmente, laparoscópica. Algoritmos terapêuticos pouco invasivos combinadas com indicações menos rigorosas para a o emprego da cirurgia radical antes de um padrão definido de recorrência, estão estabelecidos, ocasionando um número menor de ressecções e / ou estomas, reduzindo a morbidade e a mortalidade, melhorando a qualidade de vida após a intervenção, e geram uma tratamento menos dispendioso. Abstract in english The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously tha [...] nks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

Abe, Fingerhut; Nicolas, Veyrie.

268

Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: Experience with Rifaximin  

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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 po...

Sergio Peralta, Claudia Cottone

2009-01-01

269

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

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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...

Suthiwartnarueput, Worapop; Kiatipunsodsai, Siriphut; Kwankua, Amolchaya; Chaumrattanakul, Utairat

2012-01-01

270

Appendiceal duplication with simultaneous acute appendicitis and appendicular perforation causing small bowel obstruction  

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Acute appendicitis, as well as intestinal obstruction, is a common surgical emergencies. Both the conditions can present as an acute abdomen, however the diagnosis of acute appendicitis can be overlooked when it presents as a small bowel obstruction. Difficulties in correctly identifying the cause of pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. Appendiceal duplication although rare and di...

Bali, Rs; Wani, Mm; Mir, Si; Thakur, S.; Bhat, Ra

2011-01-01

271

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

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

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

1985-04-01

272

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 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

1985-01-01

273

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

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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 ...

Christodoulou, Dimitrios K.; Sigounas, Dimitrios E.; Katsanos, Konstantinos H.; Georgios Dimos; Tsianos, Epameinondas V.

2010-01-01

274

Enhanced Diagnostic Yield with Prolonged Small Bowel Transit Time during Capsule Endoscopy  

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Background: The effect of small bowel transit time (SBTT) on diagnostic yield during capsule endoscopy (CE) has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE. Methods: We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulce...

Jonathan M Buscaglia, Sumit Kapoor

2008-01-01

275

Can we improve the diagnostic yield of small bowel video-capsule endoscopy?  

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Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination’s diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy’s...

Konstantinos Triantafyllou

2010-01-01

276

Serum Intestinal Fatty Acid Binding Protein in Patients with Small Bowel Obstruction  

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Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were...

Kaoru Sakamoto; Tatsuo Kanda; Takeo Bamba; Hiroyuki Funaoka; Shin-ichi Kosugi; Kazuhito Yajima; Takashi Ishikawa

2013-01-01

277

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

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

2012-01-01

278

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

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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 ...

Qiong He; Yang Bai; Fa-Chao Zhi; Wei Gong; Hong-Xiang Gu; Zhi-Min Xu; Jian-Qun Cai; De-Shou Pan; Bo Jiang

2013-01-01

279

Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?  

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AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to...

2012-01-01

280

Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding  

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Full Text Available AIM: To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE procedures and to analyse their significance.METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed encountered during DBE.RESULTS: There were 228 (150 antegrade and 78 retrograde DBE procedures performed in 179 patients. The mean number of DBE procedures was 1.27 per patient. The mean age (SD of the patients was 62 ± 16 years old. There were 94 females (52.5%. The positive yield for a bleeding lesion was 65.9%. Of the 179 patients, 44 (24.6% had NSBLs (19 of them had dual pathology with small-bowel lesions and NSBLs; 27 (15.1% had lesions not detected by previous endoscopies. The most common type of missed lesions were vascular lesions.CONCLUSION: A significant proportion of patients (24.6% had lesions within reach of conventional endoscopy. Careful repeat examination with gastroscopy and colonoscopy might be required.

Hoi-Poh Tee, Arthur J Kaffes

2010-04-01

 
 
 
 
281

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)

2000-06-01

282

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

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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

283

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

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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

284

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

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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

285

Phytobezoar in Meckel's diverticulum: A rare cause of small bowel obstruction  

Science.gov (United States)

Introduction Meckel's diverticulum (MD) is the prevailing anomaly of the gastrointestinal tract, found in about 2% of the population; it rarely gives rise to symptoms and its discovery is usually accidental. Phytobezoar is a concretion of poorly digested fruit and vegetable fibres that is found in the alimentary tract and rarely can be the cause of small intestinal obstruction. Herein we report a rare case of intestinal obstruction due to phytobezoar formation into a MD. Presentation of case A 50 year-old patient, was admitted to author's institution with an history of abdominal pain, nausea and multiples episodes of vomiting. Plain X-ray showed dilated small-bowel loops. Computed tomography (CT) revealed jejunal loops with air-fluid levels. The patient underwent explorative laparotomy where we found a giant Meckel's diverticulum, filled by a phytobezoar that caused small bowel compression. We performed a segmental ileal, resection, containing the MD. The histological exam confirmed Meckel's diverticulum. Discussion Bowel obstruction due to a phytobezoar in a Meckel's diverticulum is rare: only 7 cases have been reported in literature. MD complications are rare and phytobezoar is one of them with only few cases described in literature. Conclusion The conventional x rays studies were inconclusive whereas abdominal contrast enhanced CT led to a definitive diagnosis. Explorative laparotomy or laparoscopy is mandatory in these cases.

Bini, Roberto; Quiriconi, Fabrizio; Tello, Aurelio; Fusca, Marcella; Loddo, Franca; Leli, Renzo; Addeo, Alfredo

2012-01-01

286

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

287

Diet, ageing and genetic factors in the pathogenesis of diverticular disease  

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Diverticular disease (DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK. This high prevalence ranks it as one of the most common bowel disorders in western nations. The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum. Despite this public health burden, relatively littl...

Commane, Daniel Martin; Arasaradnam, Ramesh Pulendran; Mills, Sarah; Mathers, John Cummings; Bradburn, Mike

2009-01-01

288

Small Bowel Evisceration Following Vaginal Hysterectomy is a General Surgical Emergency–A Case Report and Review of the Literature  

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Full Text Available Small bowel evisceration through the vagina is a rare condition, which tends to affect post-menopausal women who have undergone vaginal hysterectomy. It is a surgical emergency with a favourable outcome if diagnosed and treated in a timely fashion. Delay in diagnosis can precipitate infarction of small bowel loops with associated morbidity and mortality. Treatment involves laparotomy, reduction of the incarcerated loops (plus/minus small bowel resection and repair of the vaginal rupture. The purpose of this paper is to report a case of small bowel evisceration through the vagina, to review the literature pertaining to this topic and to raise awareness of this condition in the general surgical community.

Deb Maitra

2011-03-01

289

Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology  

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AIM: To determine whether magnetic resonance imaging (MRI) can be used to categorize small bowel Crohn’s disease (SB CD) into groups that correlate with response to medical therapy and surgical pathology.

Lawrance, Ian Craig; Welman, Christopher J.; Shipman, Peter; Murray, Kevin

2009-01-01

290

Metastatic osteosarcoma to the small bowel with resultant intussusception: a case report and review of the literature  

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Intussusception resulting from osteosarcoma metastasis to the small bowel is a rare diagnosis. This case report describes a patient with this diagnosis, demonstrates the CT appearance of this lesion, and reviews the literature. (orig.)

Wootton-Gorges, Sandra L.; Stein-Wexler, Rebecca; West, Danel C. [University of California, Davis, Department of Radiology, 4860 Y. Street, Suite 3100, 95817, Davis, CA (United States)

2003-12-01

291

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

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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

292

Virtual endoscopy of the small bowel: phantom study and preliminary clinical results  

International Nuclear Information System (INIS)

The purpose of this study was to determine the optimal scanning technique for lesion detection in a small bowel phantom and to evaluate the virtual endoscopy (VE) technique in patients. A small bowel phantom with a fold thickness of 7 mm and length of 115 cm was prepared with nine round lesions (3 x 1 mm, 2 x 2 mm, 2 x 3 mm, 2 x 4 mm). Spiral CT parameters were 7/7/4, 3/5/2, 3/5/1, 1.5/3/1 (slice thickness/table feed/reconstruction interval). VE was done using volume rendering technique with 1 cm distance between images and 120 viewing angle. Two masked readers were asked to determine the number and location of the lesions. Seven patients underwent an abdominal CT during one breathhold after placement of a duodenal tube and filling of the small bowel with methyl cellulose contrast solution. VE images were compared with the axial slices with respect to detectability of pathology. With the 7/7/4 protocol only the 4-mm lesions were visualised with fuzzy contours. The 3/5/2 protocol showed both 4-mm lesions, one 3-mm lesion and one false positive lesion. The 3/5/1 protocol showed both 4-mm and both 3-mm (one uncertain) lesions with improved sharpness, and no false positive lesions. One 2-mm and one 1-mm lesion were additionally seen with the 1.5/3/1 protocol. Path definition was difficult in sharp turns or kinks in the lumen. In all patients, no difference was found between VE and axial slices for bowel pathology; however, axial slices showed 'outside' information that was not included in VE. We conclude that the 3/5/2 protocol may be regarded as an optimal compromise between lesion detection, coverage during one breathhold, and number of reconstructed images in patients; round lesions of 4 mm in diameter can be detected with high certainty. (orig.)

1998-05-01

293

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) 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

1991-03-01

294

Lactose malabsorption in Greek adults: correlation of small bowel transit time with the severity of lactose intolerance.  

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Using breath hydrogen analysis after 139 mmol (50 g) oral lactose load, we investigated the prevalence of lactose malabsorption in 200 Greek adults and examined the relationship between symptoms and small bowel transit time. One hundred and fifty subjects had increased breath hydrogen concentrations (greater than 20 ppm) after the lactose load. In these individuals peak breath hydrogen concentration was inversely related to small bowel transit time (r = 0.63, 6 = 6.854, p less than 0.001) and...

Ladas, S.; Papanikos, J.; Arapakis, G.

1982-01-01

295

Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review  

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AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE). METHODS: Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008. authors searched for unexplained electrocardiogram (ECG)...

2012-01-01

296

Small bowel transit with radiopaque markers to localize intermittent small bowel obstruction; Magendarmpassage mit roentgendichten Tracerkugeln zur Lokalisation von Duenndarmstenosen bei intermittierenden Obstruktionen  

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Aim: In difficult diagnostic cases of partial small bowel obstruction, radiopaque, non-digestible markers were used to challenge and localize the site of obstruction. Material and Method: 32 patients (19 female, 13 male, 3 - 80 years) were examined. Each patient received 20 4-mm radiopaque markers orally. Abdominal radiographs were obtained at 4 - 8 h intervals. Mechanical obstruction was defined as the clustering of at least 3 markers for 4 hours or longer. The transit of radiopaque markers was compared to plain radiography, ultrasound, barium meal, computed tomography, enteroclysis and operative findings. Results: 18 of 32 patients showed small bowel clustering suggestive of obstruction. Diagnostic agreement was found in 12 of 14 cases with ultrasound, in 7 of 13 cases with plain radiography and in 3 of 6 cases with enteroclysis. 13 of the 18 patients with clustering had surgery. All of them (13/13) had adhesions with the need of resection. Conclusion: This investigation is an alternative diagnostic method for the decision between conservative and surgical treatment in cases of intermittent partial small bowel obstruction. (orig.) [German] Ziel: Bei diagnostisch schwierigen intermittierenden Duenndarmobstruktionsbeschwerden wurden Obstruktionen durch roentgendichte, unverdauliche Tracerkugeln simuliert und lokalisiert (Tracer-MDP). Material und Methode: 32 Patienten (19 weiblich, 13 maennlich; 3 - 80 Jahre) wurden untersucht. Pro Patient wurden 20 Tracerkugenl mit jeweils vier Millimeter Durchmesser oral verabreicht. Zur Verlaufsbeurteilung wurden Abdomenuebersichtsaufnahmen in 4 - 8 stuendlichen Intervallen durchgefuehrt. Als Vorliegen einer mechanischen Obstruktion wurde eine Clusterbildung von mehr als drei Tracern ueber mindestens 4 Stunden definiert. Die Tracerpassage wurde mit konventionellem Roentgen, Ultraschall, Magen - Darm-Passage, Computertomographie, Enteroklysma sowie mit Operationsbefunden verglichen. Ergebnisse: 18 der 32 Patienten zeigten eine obstruktionsverdaechtige Clusterbildung der Tracer im Duenndarm. Befundkonkordanz bestand in 12/14 Faellen mit dem Ultraschall, in 7/13 Faellen mit der konventionellen Roentgenaufnahme und in 3/6 Faellen mit dem Enteroklysma. 13 der 18 Patienten mit Clusterbildung wurden operiert. Alle (13/13) wiesen Adhaesionen mit Notwendigkeit der Resektion auf. Schlussfolgerung: Die Tracer-MDP ist eine alternative diagnostische Methode bei der Therapieentscheidung Operation versus konservative Behandlung bei intermittierenden Duenndarmobstruktionen. (orig.)

Hennigs, S.; Jaeger, H.; Gissler, M.; Roggenkamp, K.; Mathias, K. [Radiologische Klinik und Kinderradiologie, Staedtische Kliniken Dortmund (Germany); Loehlein, D. [Chirurgische Klinik, Staedtische Kliniken Dortmund (Germany); Albrecht, M. [Kinderchirurgische Klinik, Staedtische Kliniken Dortmund (Germany)

2000-12-01

297

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

Directory of Open Access Journals (Sweden)

Full Text Available The introduction of capsule endoscopy (CE in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY, safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn’s disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn’s disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy. Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.

Anastasios Koulaouzidis

2013-01-01

298

Complicated diverticular disease: the changing paradigm for treatment.  

Science.gov (United States)

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies. PMID:22936232

Fingerhut, Abe; Veyrie, Nicolas

2012-01-01

299

Advances in the diagnosis and treatment of small bowel lesions with Crohn's disease using double-balloon endoscopy.  

Science.gov (United States)

With the recent development of double-balloon endoscopy (DBE) and capsule endoscopy (CE), it has become possible to observe the entire small bowel endoscopically. DBE enables us to make detailed observations and at the same time takes biopsy samples. Single-balloon endoscopy (SBE), which has a balloon only at the tip of the overtube, has also been introduced. Since DBE and SBE are similar in the concept of insertion method, a general term 'balloon-assisted endoscopy' (BAE) is used when referring to these methods. Characteristic small bowel lesions observed with BAE in Crohn's disease are aphthoid ulcers, round ulcers, irregular ulcers and longitudinal ulcers. These ulcers tend to be located on the mesenteric side of the small bowel. Since BAE can determine the location (mesenteric or antimesenteric side) of the ulceration, it is useful in distinguishing Crohn's disease from other diseases that have ulcers in the small bowel. Strictures are a major clinical problem in the course of Crohn's disease. Traditionally, surgery was the main choice for small bowel strictures. In some cases, strictures located in distal ileum or proximal jejunum have been dilated using standard enteroscopes. DBE now enables balloon dilatation to be performed endoscopically even in the deep small bowel. PMID:21180582

Sunada, Keijiro; Yamamoto, Hironori; Yano, Tomonori; Sugano, Kentaro

2009-11-01

300

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.

2011-01-01

 
 
 
 
301

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

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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.

Delaney, J.P.; Bonsack, M.E.; Felemovicius, I. (Univ. of Minnesota Medical School, Minneapolis, MN (United States))

1994-03-01

302

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

1994-03-01

303

Diverticular disease: An experience at King Faisal specialist hospital  

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Full Text Available Background: Diverticular disease of the colon is rarely seen in Saudi Arabia and this paper describes our experience with 16 patients admitted to hospital during an 8-year period (March 1990 - February 1998. Patients and Methods: A computerized data base of patients having colorectal surgery was searched to identify patients admitted to the colorectal unit suffering from diverticular disease of the colon or it?s complications. The records of these patients were examined and form the basis of this report. Results: Sixteen patients were admitted to the colorectal unit for the management of diverticular disease or it?s complications during an 8-year period. One patient presented with a localized abscess which was drained percutaneously. Fifteen patients underwent one or more surgical interventions. There were three female patients. One patient was referred for stoma closure, four for elective surgery and ten with acute perforation of whom one underwent right hemicolectomy for a perforated caecal diverticulum and nine underwent Hartmann?s procedure for sigmoid perforation. Two patients required multiple abdominal washouts. Post-operatively two patients developed severe chest infections, one developed renal failure and two urinary infections. Four wounds became infected and two intra abdominal collections were drained percutaneously. No patient died. Eight stomata (89% were subsequently closed. The mean duration of follow up was 2.7 yr. Four patients were lost to follow up. Conclusion: This small series documents the presence of diverticular disease and it?s complications in the Kingdom of Saudi Arabia and suggests that the commonest method of presentation may be an acute one. Surgeons must thus be mindful of the condition and take appropriate action. Hartmann?s? operation was safe and resulted in a low morbidity and no mortality. 89% of the stomata were closed at a later procedure.

Isbister William

2001-01-01

304

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

305

Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohns disease  

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Full Text Available We report a case of jejunoileal intussusception in a 42-year-old patient with Crohn’s disease caused by a gastrointestinal stromal tumor. The patient complained of vague diffuse abdominal pain for a period of 4 mo. Intussusception was suspected at computer tomography and magnetic resonance imaging scans. Segmental resection of the small intestine was performed. Pathological examination of the surgical specimen revealed a gastrointestinal stromal tumor as well as aphthous ulcerations and areas of inflammation, which were characteristic of Crohn’s disease. This is the first report of small bowel intussusception due to a gastrointestinal stromal tumor coexisting with Crohn’s disease.

George E Theodoropoulos, Dimitrios Linardoutsos, Dimitrios Tsamis, Paraskevas Stamopoulos, Dimitrios Giannopoulos, Flora Zagouri, Nikolaos V Michalopoulos

2009-11-01

306

Small bowel permeability to 51Cr-EDTA in children with recurrent abdominal pain  

International Nuclear Information System (INIS)

Small bowel permeability was investigated in 87 children with recurrent abdominal pain by measuring the 24-h urinary excretion of orally administered 51Cr-EDTA. The mean excreation was 3.64% ± 1.49% per 24 h. The difference between the mean urinary excretion in children with recurrent abdominal pain and control children (2.51% ± 0.70%), was significant (p<0.01, two sample t-test). The increased small permeability in children with recurrent abdominal pain might indicate an intestinal etiology for the patients complaints

1990-01-01

307

Small bowel permeability to sup 51 Cr-EDTA in children with recurrent abdominal pain  

Energy Technology Data Exchange (ETDEWEB)

Small bowel permeability was investigated in 87 children with recurrent abdominal pain by measuring the 24-h urinary excretion of orally administered {sup 51}Cr-EDTA. The mean excreation was 3.64% {plus minus} 1.49% per 24 h. The difference between the mean urinary excretion in children with recurrent abdominal pain and control children (2.51% {plus minus} 0.70%), was significant (p<0.01, two sample t-test). The increased small permeability in children with recurrent abdominal pain might indicate an intestinal etiology for the patients complaints.

Meer, S.B. van der.; Forget, P.P. (State Univ. of Limburg (Netherlands). Dept. of Paediatrics); Heidendal, A.K. (State Univ. of Limburg (Netherlands))

1990-01-01

308

Epidemiology and Pathophysiology of Diverticular Disease  

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Diverticular disease is common and thought to result from structural abnormalities of the colonic wall, disordered intestinal motility, or deficiencies of dietary fiber. Signs and symptoms of inflammation include fever, abdominal pain, and leukocytosis.

Matrana, Marc R.; Margolin, David A.

2009-01-01

309

Treatment Options for Perforated Colonic Diverticular Disease  

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Diverticular disease is one of the most common diseases of the gastrointestinal (GI) tract requiring in-hospital treatment in Western countries. Despite its high incidence, controversies remain about the optimal treatment of the different stages of this disease. Most people with diverticular disease remain asymptomatic; however, approximately 15% develop symptoms, and of these, 15% will develop significant complications such as perforation [1]. Although the...

Mulder, I. M.; Vermeulen, J.

2011-01-01

310

Diverticular disease of the right colon  

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Abstract Background The incidence of colonic diverticular disease varies with national origin, cultural background and diet. The frequency of this disease increases with advancing age. Right-sided diverticular disease is uncommon and reported to occur in 1-2% of surgical specimens in European and American series. In contrast the disease is more prevalent and reported in 43-50% of specimens in Asian series. Various lines of evidence suggest this variation may represent heredit...

Radhi Jasim M; Ramsay Jennifer A; Boutross-Tadross Odette

2011-01-01

311

Occult small bowel perforation in a patient with Ehlers Danlos syndrome: a case report and review of the literature  

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Patients who present with a co-existing connective tissue disorder add a degree of complexity to operative intervention. We present an unusual case of a 53-year-old Caucasian female patient with Ehlers Danlos syndrome who presented with an occult perforation of the distal ileum. The patient had known small bowel diverticulae yet the perforation occurred within the normal bowel wall. The pre-operative CT only showed malrotation of the large bowel and did not correlate with the intra-operative ...

Leake, Tessa Frances; Singhal, Tarun; Chandra, Aninda; Ashcroft, Alexandra; Doddi, Sudeendra; Hussain, Abdulzahra; Smedley, Frank

2010-01-01

312

Novel specific microRNA biomarkers in idiopathic inflammatory bowel disease unrelated to disease activity.  

Science.gov (United States)

The diagnosis of idiopathic inflammatory bowel disease can be challenging. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate protein synthesis through post-transcriptional suppression. This study is to identify new miRNA markers in inflammatory bowel disease, and to examine whether miRNA biomarkers might assist in the diagnosis of inflammatory bowel disease. Illumina small RNA sequencing was performed on non-dysplastic fresh-frozen colonic mucosa samples of the distalmost colectomy tissue from 19 patients with inflammatory bowel disease (10 ulcerative colitis and 9 Crohn disease) and 18 patients with diverticular disease serving as controls. To determine differentially expressed miRNAs, the USeq software package identified 44 miRNAs with altered expression (fold change ?2 and false discovery rate ?0.10) compared with the controls. Among them, a panel of nine miRNAs was aberrantly expressed in both ulcerative colitis and Crohn disease. Validation assays performed using quantitative reverse transcription PCR (qRT-PCR) on additional frozen tissue from ulcerative colitis, Crohn disease, and control groups confirmed specific differential expression in inflammatory bowel disease for miR-31, miR-206, miR-424, and miR-146a (PmiR-146a are novel specific biomarkers of inflammatory bowel disease. Furthermore, miR-31 is universally expressed in both ulcerative colitis and Crohn disease not only in fresh-frozen but also in formalin-fixed, paraffin-embedded tissues. PMID:24051693

Lin, Jingmei; Welker, Noah C; Zhao, Zijin; Li, Yong; Zhang, Jianjun; Reuss, Sarah A; Zhang, Xinjun; Lee, Hwajeong; Liu, Yunlong; Bronner, Mary P

2014-04-01

313

Enhanced Diagnostic Yield with Prolonged Small Bowel Transit Time during Capsule Endoscopy  

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Full Text Available Background: The effect of small bowel transit time (SBTT on diagnostic yield during capsule endoscopy (CE has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE. Methods: We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and presence of blood. In patients with diarrhea or abdominal pain, ulcers, erosions, and blood were considered relevant. Age, gender, study indication, hospital status, and quality of bowel preparation were identified as candidate risk factors affecting SBTT. Univariate logistic and linear regression analyses were performed to study the effect of SBTT on diagnostic yield. Results: Total of 212 CE studies were analyzed; most were in outpatients (n=175, 82.9% and with excellent bowel preparation (n=177, 83.5%. Mean SBTT was 237.0min (3.9hrs. Age, gender, bowel prep, hospital status, and study indication did not significantly affect SBTT. However, increased SBTT was independently associated with increased diagnostic yield; OR=1.7 in SBTT=2-4hr (p=0.41, OR=1.8 in SBTT=4-6hrs (p=0.30, OR=9.6 in SBTT=6-8hrs (p=0.05. Conclusion: Prolonged SBTT during CE (>6 hr is associated with an increased diagnostic yield. This may be due to a positive effect on image quality during a “slower” study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.

Jonathan M. Buscaglia, Sumit Kapoor, John O. Clarke, Juan Carlos Bucobo, Samuel A. Giday, Priscilla Magno, Elaine Yong, Gerard E. Mullin

2008-01-01

314

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

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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

315

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

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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

316

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

317

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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 secreti [...] on, 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; S., De Martini-Costa; M.Z., Pedroso; I.C.A., Scaletsky.

318

Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center  

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Full Text Available AIM: To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization (WGO Endoscopy Training Center in Thailand. METHODS: Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed. The patients’ characteristics, pre-anesthetic problems, anesthetic techniques, anesthetic agents, anesthetic time, type and route of procedure and anesthesia-related complications were assessed. RESULTS: One hundred and forty-four patients underwent this procedure during the study period. The mean age of the patients was 57.6 ± 17.2 years, and most were American Society of Anesthesiologists (ASA class II (53.2%. Indications for this procedure were gastrointestinal bleeding (59.7%, chronic diarrhea (14.3%, protein losing enteropathy (2.6% and others (23.4%. Hematologic disease, hypertension, heart disease and electrolyte imbalance were the most common pre-anesthetic problems. General anesthesia with endotracheal tube was the anesthetic technique mainly employed (50.6%. The main anesthetic agents administered were fentanyl, propofol and midazolam. The mean anesthetic time was 94.0 ± 50.5 min. Single balloon and oral (antegrade intubation was the most common type and route of enteroscopy. The anesthesia-related complication rate was relatively high. The overall and cardiovascular-related complication rates including hypotension in the older patient group (aged ? 60 years old were significantly higher than those in the younger group. CONCLUSION: During anesthetic management for small bowel enteroscopy, special techniques and drugs are not routinely required. However, for safety reasons anesthetic personnel need to optimize the patient’s condition.

Somchai Amornyotin

2012-01-01

319

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

Ospina Nieto, John.

320

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

 
 
 
 
321

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

322

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

Science.gov (United States)

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

323

A rare complication of small bowel intussusception: report of a case and review of literature.  

Science.gov (United States)

Volvulus and intussusception are rare conditions in children. We describe an unusual case of intussusception due to a solitary Peutz-Jeghers type hamartomatous polyp complicated by volvulus, which occurred in an 11-year-old girl. A laparotomy allows to successfully treat the pathology. The postoperative course was favourable. We discuss the clinical findings and the values of the preoperative instrumental diagnosis. The literature is reviewed. Identifying a midgut volvulus, as complication of a small bowel intussusception, during the diagnostic phase could help in choosing the most appropriate surgical approach. PMID:24469494

Pietro, Impellizzeri; Astra, Borruto Francesca; Simona, Montalto Angela; Carmelo, Romeo

2013-01-01

324

Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy.  

Science.gov (United States)

Intestinal hematoma, once considered a rare complication of anticoagulation, has recently been increasingly reported. Spontaneous small bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum. They occur in patients who receive excessive anticoagulation with vitamin K antagonists or who have additional risk factors for bleeding. Diagnosis can be readily identified with sonography and confirmed with computed tomography. Early diagnosis is crucial as most patients can be treated successfully without surgery. Conservative treatment is recommended for intramural intestinal hematomas, when other associated complications needing laparotomy have been excluded. PMID:23061706

Abdel Samie, Ahmed; Theilmann, Lorenz

2012-09-01

325

Can we improve the diagnostic yield of small bowel video-capsule endoscopy?  

Directory of Open Access Journals (Sweden)

Full Text Available Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination’s diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy’s diagnostic yield sometime in the near future.

Konstantinos Triantafyllou

2010-05-01

326

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

327

Intraoperative localization of vascular malformation of small bowel by selective intra-arterial dye injection  

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Full Text Available Angiomatous malformation is the most common vascular abnormality, accounting for 30-40% cases of obscure GI bleeding from small bowel. Surgical resection is the treatment of choice in severe or recurrent hemorrhage requiring multiple blood transfusions. However, the diffuse nature of the lesions poses a challenge to localize them accurately preoperatively, for exact resection. We present a case in which we have used selective mesenteric angiography with selective cannulation and exact localization of the lesion by injecting dye such as methylene blue, indigo carmine, and fluorescein, to localize the angiomatous malformation before surgical resection and also to determine the exact resection to be done.

Eshpuniyani Priya

2010-01-01

328

Preliminary mechanical characterization of the small bowel for in vivo robotic mobility.  

Science.gov (United States)

In this work we present test methods, devices, and preliminary results for the mechanical characterization of the small bowel for intra luminal robotic mobility. Both active and passive forces that affect mobility are investigated. Four investigative devices and testing methods to characterize the active and passive forces are presented in this work: (1) a novel manometer and a force sensor array that measure force per cm of axial length generated by the migrating motor complex, (2) a biaxial test apparatus and method for characterizing the biomechanical properties of the duodenum, jejunum, and ileum, (3) a novel in vitro device and protocol designed to measure the energy required to overcome the self-adhesivity of the mucosa, and (4) a novel tribometer that measures the in vivo coefficient of friction between the mucus membrane and the robot surface. The four devices are tested on a single porcine model to validate the approach and protocols. Mean force readings per cm of axial length of intestine that occurred over a 15?min interval in vivo were 1.34?±?0.14 and 1.18?±?0.22?N cm(-1) in the middle and distal regions, respectively. Based on the biaxial stress/stretch tests, the tissue behaves anisotropically with the circumferential direction being more compliant than the axial direction. The mean work per unit area for mucoseparation of the small bowel is 0.08?±?0.03 mJ cm(-2). The total energy to overcome mucoadhesion over the entire length of the porcine small bowel is approximately 0.55?J. The mean in vivo coefficient of friction (COF) of a curved 6.97 cm(2) polycarbonate sled on live mucosa traveling at 1?mm s(-1) is 0.016?±?0.002. This is slightly lower than the COF on excised tissue, given the same input parameters. We have initiated a comprehensive program and suite of test devices and protocols for mechanically characterizing the small bowel for in vivo mobility. Results show that each of the four protocols and associated test devices has successfully gathered preliminary data to confirm the validity of our test approach. PMID:22010745

Terry, Benjamin S; Lyle, Allison B; Schoen, Jonathan A; Rentschler, Mark E

2011-09-01

329

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

330

Xanthomatosis of the gastrointestinal tract with focus on small bowel involvement  

DEFF Research Database (Denmark)

Accumulation of foamy lipid-laden histiocytic cells is most often seen in the skin and tendons, usually associated with congenital or acquired hyperlipidaemia, as seen in patients with diabetes mellitus, obstructive jaundice, and familial hypercholesterolaemia. The pathogenesis of xanthomatous lesions in other sites, including the urinary bladder, prostate, and gastrointestinal tract seems to be less consistent. Within the gastrointestinal tract the gastric mucosa is the most frequently cited location. Involvement of the oesophagus and bowel has rarely been described. Only three such cases largely confined to the small bowel have previously been documented. We here present an additional small bowel example accompanied by a short review of the existing literature in English on gastrointestinal xanthomatous lesions, including a discussion on its possible pathogenesis. Histologically, the lesion is unique and a correct diagnosis does not pose significant difficulties. Identification of diverse phagocytosed cytoplasmic deposits in other histiocytic lesions may require ancillary studies. More importantly, malignant lesions composed of clear cells or signet ring cells, primary or metastatic, need consideration. With a high index of suspicion coupled with appropriate histochemical and immunohistochemical reactions, the correct diagnosis will easily be accomplished. The process is characterised by aggregates of foamy histiocytes, unaccompanied by fibrosis or giant cells as seen in xanthogranulomatous lesions.  Well-defined clusters of such foamy histiocytes have been labelled xanthoma. The diffusely infiltrating counterpart has been termed xanthomatosis. When forming a bulky mass lesion, the label xanthomatous pseudotumour has been applied 11 12 and the subtle collection of xanthoma cells is often referred to as xanthelasma. 13 In this letter we collectively refer to these lesions, which may be related, as xanthomatous lesions (XAN).

Nielsen, S.L.; Ingeholm, P.

2007-01-01

331

Surgery for small bowel Crohn?s disease: Experience of a tertiary referral center  

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Full Text Available The aim: The study aims to evaluate the clinical presentation and surgical management of small bowel Crohn?s disease (CD at a tertiary referral center in the Kingdom of Saudi Arabia (KSA. Patients and methods: A retrospective review of the medical records of all patients with the diagnosis of small bowel CD from March 1999 up to December 2003. The records of 28 patients were reviewed for demographic data, clinical presentation, preoperative investigations, indications of surgery, surgical procedures, postoperative complications and follow-up. The final diagnosis of CD was based on paraffin section histopathology reports. Results: The mean age was 34 years, female to male ratio was 1:2.1. The medical treatment was offered to 22 patients in whom the diagnosis of CD was established after investigations or they were known to have CD before admission. Thirteen patients (46.4% responded to medical treatment, whereas 15 patients (53.6% required surgery. The indications for surgery were intestinal obstruction (seven patients, right iliac fossa mass lesion of uncertain nature (three patients, enterocutaneous fistula and pelvic collection (one patient, failure of medical treatment (two patients, and acute abdomen (two patients. The surgical procedures carried out were limited right hemicolectomy in ten patients, segmental bowel resection (two patients and stricturoplasty of the stenosed segment (three patients. Conclusion: Crohn?s disease is not uncommon in KSA. It is a disease of young patients, half of patients needed surgery at some stage. Intestinal obstruction remains the most common indication of surgery. The surgery of CD needs a good cooperation between the surgeon, radiologist and gastroenterologist

Al Salamah Saleh

2005-01-01

332

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

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

Amanda D. Rice

2013-02-01

333

Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype  

Science.gov (United States)

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

Ghoshal, Uday C; Srivastava, Deepakshi

2014-01-01

334

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

International Nuclear Information System (INIS)

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)

1978-01-01

335

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

International Nuclear Information System (INIS)

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

1986-03-05

336

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

International Nuclear Information System (INIS)

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)

2010-01-01

337

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

338

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

339

Small bowel polypectomy by double balloon enteroscopy: Correlation with prior capsule endoscopy  

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Full Text Available AIM: To investigate the feasibility of small bowel polypectomy using double balloon enteroscopy and to evaluate the correlation with capsule endoscopy (CE. METHODS: This is a retrospective review of a single tertiary hospital. Twenty-five patients treated by enteroscopy for small bowel polyps diagnosed by CE or other imaging techniques were included. The correlation between CE and enteroscopy (correlation coefficient of Kendall for the number of polyps, intra-class coefficient for the size and coefficient of correlation kappa for the location was evaluated. RESULTS: There were 31 polypectomies and 12 endoscopic mucosal resections with limited morbidity and no mortality. Histological analysis revealed 27 hamartomas, 6 adenomas and 3 lipomas. Strong agreement between CE and optical enteroscopy was observed for both location (Kappa value: 0.90 and polyp size (Kappa value: 0.76, but only moderate agreement was found for the number of polyps (Kendall value: 0.47. CONCLUSION: Double balloon enteroscopy is safe for performing polypectomy. Previous CE is useful in selecting the endoscopic approach and to predicting the difficulty of the procedure.

Gabriel Rahmi

2013-01-01

340

Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems  

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Full Text Available Transmission of oesophageal images may vary between different small-bowel capsule endoscopy models. A retrospective review of 100 examinations performed with 2 different Small-bowel capsule endoscopy (SBCE systems (PillCam® and MiroCam® was performed. The oral cavity/aero-digestive tract (i.e., tongue, uvula and/or epiglottis was captured/identified in almost all (99% of PillCam® videos but in none of MiroCam® cases, P < 0.0001. Furthermore, oesophageal images (i.e., from the upper oesophageal sphincter to the Z-line were captured in 99% of PillCam® videos (mean ± SD, 60.5 ± 334.1 frames, range: 0-3329 frames and in 66% of MiroCam® cases (mean ± SD, 11.1 ± 46.5 frames, range: 0-382 frames, P < 0.0001. The Z-line was identified in 42% of PillCam® videos and 17% of MiroCam®, P = 0.0002. This information might be useful when performing SBCE in patients with high risks for aspiration.

Anastasios Koulaouzidis

2012-01-01

 
 
 
 
341

Small bowel obstruction - the water-soluble follow-through revisited  

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AIMS: The aim of the present study to examine the use of a modified water-soluble follow-through in the diagnosis and management of small bowel obstruction (SBO). MATERIALS AND METHODS: Sixty-two patients were recruited to the study: 33 into the control group and 29 into the study group. A modified small bowel follow-through (SBFT) was performed in the study group patients. The control group was managed conventionally. Assessment was made by questionnaire documenting initial surgical diagnosis and likelihood of operative intervention, final diagnosis and surgical outcome (operative versus non-operative). RESULTS: SBFT changed the diagnosis in 12/24 of the study group (p<0.01). In the study group 8/24 proceeded to surgery whereas 19/33 underwent laparotomy in the control group, representing a relative risk reduction of 52%, but this was not statistically significant (0.10>p>0.05, chi-squared test). CONCLUSION: SBFT remains a valid and useful tool in surgical management of SBO. In particular it aids diagnostic confidence in planning surgical intervention, particularly in uncomplicated patients.

Brochwicz-Lewinski, M.J.; Paterson-Brown, S.; Murchison, J.T. E-mail: john.murchison@luht.scot.nhs.uk

2003-05-01

342

Small bowel ischaemia and perforation as a complication of Henoch-Schönlein Purpura in a previously healthy adult  

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Henoch-Schönlein purpura is a small vessel vasculitis with multi-system manifestations that commonly affects children. We describe a case of new onset Henoch-Schönlein purpura in a previously healthy 42-year-old female who required an emergency laparotomy for small bowel perforation.

Locke, T. E.; Stewart, D.; Patel, K.; Takou, A.

2012-01-01

343

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

Science.gov (United States)

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. PMID:17021699

Wyss, Michael; Froehlich, Johannes M; Patak, Michael A; Juli, Christoph F; Scheidegger, Markus B; Zollikofer, Christoph L; Wentz, Klaus U

2007-04-01

344

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-contrast enteroclysis. Segmental display without overlay is possible. (orig.)

2007-04-01

345

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

Energy Technology Data Exchange (ETDEWEB)

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

346

Efficacy of a 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 for both chemotherapy and radiotherapy 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. Methods and Materials: Twelve consecutive patients referred to our department with rectal cancer were included in this study. Patients were given oral contrast 1.5 h prior to scanning and instructed not to empty their bladder during the procedure. The initial CT scan without BBD was taken in the prone position with an immobilization cast. A second CT study was performed with a commercially available BBD consisting of an 18-cm thick hard sponge with an adjustable opening (maximum 42 x 42 cm2). All patients were positioned prone over the BBD so that the opening was above the treatment volume and usually extended from the diaphragm to the bottom of the fourth lumbar spine. Image fusion between both sets of CT scans (with and without BBD) was performed using common bony landmarks to maintain the same target volume. The critical structures including small bowel and bladder were delineated on each slice for DVH analysis. 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 median age and body weight of 12 patients (4 females and 8 males) were 57.5 years and 82.7 kg, respectively. The changes in posterior-anterior (PA) and lateral separation with and without BBD at central axis slices were analyzed. The changes in lateral separation were minimal (<0.8 cm); however, the PA separation was reduced by 11.3 ± 3.3% when BBD was used. The reduction in PA separation was directly related to the reduction is small bowel volume. The small bowel volume was significantly reduced with a median reduction of 70% (range 10-100%) compared to the small bowel volume without BBD. The small bowel volume reduction did not correlate either with body weight, age, gender, or sequence of radiation treatment with surgery (pre-op vs. post-op). The DVH analysis of small bowel with BBD showed significant volume reduction at each dose level. For 50% patients, the DVH analysis demonstrated an increase in bladder volume with BBD. All patients treated with the BBD completed their treatment without any break and without significant acute gastrointestinal or genitourinary toxicity. Conclusions: For rectal cancers, small bowel is the dose-limiting structure for acute and chronic toxicity. The use of the BBD should improve the tolerance of aggressive combined modality treatment by reducing the small bowel volume within the pelvis compared to the prone position alone. The BBD provides an easy, economical, comfortable, and noninvasive technique to displace small bowel from pelvic treatment fields. The small bowel volume is dramatically reduced at each dose level. The volume reduction does not correlate with gender, age, weight, pelvic separation, and sequence of radiation treatment vs. surgery

1997-08-01

347

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.)

2001-08-01

348

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

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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.

Chaudhary Amit

2006-06-01

349

[A case of primary leiomyosarcoma of the small bowel with hepatic portal venous gas].  

Science.gov (United States)

A 92-year-old woman was admitted with speech disturbance. She had severe anemia (hemoglobin, 6.3g/dl), and abdominal ultrasonography revealed hepatic portal venous gas and an intra-abdominal tumor. Abdominal computed tomography also revealed an irregularly enhanced intra-abdominal tumor, 32x35mm in diameter, which was surgically resected. The tumor was located in the small intestine. Histopathological examination revealed spindle-shaped atypical cells. Immunological evaluation showed the tumor to be SMA (+), c-kit (-), CD34 (-), S100 (-). The Ki-67/MIB1 labeling index was 2.3%. The tumor was diagnosed as leiomyosarcoma of the small bowel. The patient recovered after surgery and was discharged. PMID:20616484

Hashimoto, Akira; Oda, Yasuhiro; Inagaki, Yuji; Iguchi, Masashi; Wakita, Yoshihiro; Shimizu, Atsuya; Murata, Yasuhiro; Tanaka, Jo; Naganuma, Tatsushi; Nakano, Hiroshi

2010-07-01

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.)

1997-10-01

351

Radiation-associated angiosarcoma of the small bowel. A case of multiploidy and a fulminant clinical course. Case report.  

Science.gov (United States)

Angiosarcoma developing in unusual sites such as the gastrointestinal tract is not uncommonly associated with a known eliciting factor. Thus, among hitherto reported cases of angiosarcoma of the small bowel, five were radiation-associated. One additional example of ileal angiosarcoma induced by therapeutic irradiation of endometrial carcinoma is herein reported as a reminder of this causal association. DNA analyses of the primary growth as well as the metastatic deposits showed at least four aneuploid cell clones indicating genetic instability. This observation corresponds to the consistently poor prognosis of radiation-associated angiosarcoma of the small bowel. PMID:9048867

Hansen, S H; Holck, S; Flyger, H; Tange, U B

1996-12-01

352

MALT lymphoma of the small bowel with protein-losing enteropathy.  

Science.gov (United States)

Mucosa-associated lymphoid tissue (MALT) lymphoma usually arises from chronic inflammation. We herein report a case of small intestinal MALT lymphoma with protein-losing enteropathy (PLE). A 73-year-old woman presented with lower leg edema and severe hypoalbuminemia. She had a medical history of pylorus-preserving pancreaticoduodenectomy with Billroth II reconstruction. Oral and anal route double-balloon enteroscopies revealed irregular nodular mucosal lesions with erosion extending from the jejunum to terminal ileum. Histopathological evaluation of the biopsied mucosa showed proliferation of small-to-medium-sized lambda light chain-restricted B cells. Plasmacytic differentiation and lymphoepithelial lesions were present, leading to the diagnosis of MALT lymphoma. Tc-99m albumin scintigraphy indicated tracer exudation in the small bowel, suggesting the presence of PLE. Combination immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen improved both MALT lymphoma and PLE, whereas rituximab monotherapy was not successful. This case is considered to be common type of MALT lymphoma at an uncommon site and is distinct from immunoproliferative small intestinal disease (IPSID). To our knowledge, this is the first case of non-IPSID-type small intestinal MALT lymphoma complicated by PLE. Gastrointestinal reconstruction may be responsible for underlying chronic inflammation via small intestinal bacterial overgrowth. PMID:24395281

Tsukamoto, Ayato; Nakamura, Fumihiko; Nannya, Yasuhito; Kobayashi, Yuka; Shibahara, Junji; Ichikawa, Motoshi; Fukayama, Masashi; Koike, Kazuhiko; Kurokawa, Mineo

2014-02-01

353

Capsule Endoscopy: A Cause of Late Small Bowel Obstruction and Perforation  

Science.gov (United States)

Case Report. A 71-year-old man was admitted to the department of gastroenterology with diffuse abdominal pain. Through the previous 12 months, the patient had experienced episodes of vomiting and watery diarrhea of increasing intensity as well as weight loss. The patient was evaluated with ultrasound, MRI, and subsequently a capsule endoscopy. Six months later, the patient presented, and an abdominal CT-scan showed mechanical small bowel obstruction with suspicion of metallic foreign body and perforation. Laparotomy showed perforation, stenosis, and foreign body, approximately 5?cm from the ileocecal valve. A right hemicolectomy and distal ileectomy (60?cm) with an ileostomy were performed. On further inspection of resection, a capsule endoscope was found impacted in a stenosis. The ileostomy was later reversed without complications. Conclusion. It is important to be aware of the possibility of capsule retention, especially in patients with known or suspected Crohn's disease, due to the propensity of Crohn's disease to form stenosis of the bowel. In cases where a stenosis is suspected, it is warranted to perform a patency capsule swallow before subjecting the patient to a capsule endoscopy.

Burgdorf, Stefan Kobbelgaard

2013-01-01

354

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

355

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

Science.gov (United States)

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

Dogan, Sait Murat; K?l?nc, Selcuk; Kebapc?, Eyup; Tugmen, Cem; Gurkan, Alp; Baran, Masallah; Kurtulmus, Yusuf; Olmez, Mustafa; Karaca, Cezmi

2014-01-01

356

MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis  

Energy Technology Data Exchange (ETDEWEB)

The aim of the study was to evaluate the additional findings of MRI following small bowel enteroclysis and to compare the efficacy of negative and positive intraluminal contrast agents. Fifty patients with inflammatory or tumorous small bowel disease were investigated by small bowel enteroclysis and consecutive MRI using breathhold protocol (T1-weighted fast low-angle shot, T2-weighted turbo spin echo). Patients were randomly assigned to either receiving a positive oral (Magnevist, Schering, Berlin, Germany) or a negative oral MR contrast media (Abdoscan, Nycomed, Oslo, Norway). The pattern of contrast distribution, the contrast effect, presence of artifacts, as well as bowel wall and extraluminal changes, were determined and compared between the contrast type using Fischer's exact test. Sensitivity, specificity, and diagnostic accuracy for MRI and enteroclysis were calculated. Twenty-seven patients had clinically proven Crohn's disease and two patients surgically proven small bowel tumours. Magnetic resonance imaging had important additional findings as abscesses and fistulae in 20 patients. Surgically compared sensitivities were 100 and 0 % for MRI and enteroclysis, for the detection of abscesses, and 83.3 and 17 % for the diagnosis of fistulae, respectively. Bowel wall thickening was more reliably detected with use of positive oral contrast media without intravenous enhancement (p < 0.001), whereas postcontrast negative oral contrast media allow for a superior detection (p < 0.001). T2-weighted sequences were necessary with use of negative oral contrast media, because loop abscesses may be masked. Magnetic resonance imaging should be performed in all patients with suspicion of extraintestinal complications, because the complications are more reliably detected by MRI. Negative oral contrast media show advantages with the use of intravenous contrast but can mask loop abscesses using only T1-weighted imaging. (orig.)

Rieber, A.; Aschoff, A.; Nuessle, K.; Wruk, D.; Tomczak, R.; Brambs, H.J. [Ulm Univ. (DE). Abt. Radiologie 1 (Roentgendiagnostik); Reinshagen, M.; Adler, G. [Univ. of Ulm (Germany). Dept. of Gastroenterology

2000-09-01

357

MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis  

International Nuclear Information System (INIS)

The aim of the study was to evaluate the additional findings of MRI following small bowel enteroclysis and to compare the efficacy of negative and positive intraluminal contrast agents. Fifty patients with inflammatory or tumorous small bowel disease were investigated by small bowel enteroclysis and consecutive MRI using breathhold protocol (T1-weighted fast low-angle shot, T2-weighted turbo spin echo). Patients were randomly assigned to either receiving a positive oral (Magnevist, Schering, Berlin, Germany) or a negative oral MR contrast media (Abdoscan, Nycomed, Oslo, Norway). The pattern of contrast distribution, the contrast effect, presence of artifacts, as well as bowel wall and extraluminal changes, were determined and compared between the contrast type using Fischer's exact test. Sensitivity, specificity, and diagnostic accuracy for MRI and enteroclysis were calculated. Twenty-seven patients had clinically proven Crohn's disease and two patients surgically proven small bowel tumours. Magnetic resonance imaging had important additional findings as abscesses and fistulae in 20 patients. Surgically compared sensitivities were 100 and 0 % for MRI and enteroclysis, for the detection of abscesses, and 83.3 and 17 % for the diagnosis of fistulae, respectively. Bowel wall thickening was more reliably detected with use of positive oral contrast media without intravenous enhancement (p < 0.001), whereas postcontrast negative oral contrast media allow for a superior detection (p < 0.001). T2-weighted sequences were necessary with use of negative oral contrast media, because loop abscesses may be masked. Magnetic resonance imaging should be performed in all patients with suspicion of extraintestinal complications, because the complications are more reliably detected by MRI. Negative oral contrast media show advantages with the use of intravenous contrast but can mask loop abscesses using only T1-weighted imaging. (orig.)

2000-09-01

358

Massive retroperitoneal ganglioneuroma presenting with small bowel obstruction 18 years following initial diagnosis.  

LENUS (Irish Health Repository)

BACKGROUND: Ganglioneuroma is a rare tumour of neural crest origin, which arises from maturation of a neuroblastoma. While previously considered to be non-functioning, they are now known to be frequently endocrinologically active. AIMS AND METHODS: We report a case of a massive retroperitoneal ganglioneuroma presenting with small bowel obstruction in an adult, 18 years after initial diagnosis. Urinary dopamine levels were elevated, but other catecholamines were within normal limits. This is the first report in the English-language literature of a retroperitoneal ganglioneuroma presenting with or causing intestinal obstruction. We also review the metabolic, radiological, and histological features of these tumours. Relevant publications were identified from a Medline search using the MeSH headings \\'ganglioneuroma\\

Cronin, E M P

2012-02-03

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

Tumor estromal gastrointestinal de intestino delgado Gastrointestinal stromal tumor of small bowel  

Directory of Open Access Journals (Sweden)

Full Text Available Stromal tumors of the gastrointestinal tract (gists represent relatively rare lesions that arise from connective tissue elements located along the entire length of the gut. They were initially identified by immunohistochemical investigation, proving their origin from nondifferentiated mesenchymal cells. Only a minority of this lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma. The majority of gists corresponds to a heterogeneous group of lesions that have as their common denominator an immature proliferation of epithelioid or spindle cells arising from its muscle layers, or between them, showing partial or incomplete myoide, neural, ganglionic, or mixed features of differentiation. This case report intends to show a gist of small bowel in a male, 46 years old, with a two-year of evolution.

Francisco Marivaldo Benício da Silva

2001-02-01

 
 
 
 
361

A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.  

Science.gov (United States)

Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use. PMID:19505417

Liverani, A; Pezzatini, M; Conte, S; Mari, F; Milillo, A; Gasparrini, M; Marino, G; Catracchia, V; -Favi, F

2009-05-01

362

Capsule endoscopy in suspected small bowel Crohns disease: Economic impact of disease diagnosis and treatment  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To model clinical and economic benefits of capsule endoscopy (CE compared to ileo-colonoscopy and small bowel follow-through (SBFT for evaluation of suspected Crohn’s disease (CD.METHODS: Using decision analytic modeling, total and yearly costs of diagnostic work-up for suspected CD were calculated, including procedure-related adverse events, hospitalizations, office visits, and medications. The model compared CE to SBFT following ileo-colonoscopy and secondarily compared CE to SBFT for initial evaluation.RESULTS: Aggregate charges for newly diagnosed, medically managed patients are approximately $8295. Patients requiring aggressive medical management costs are $29?508; requiring hospitalization, $49?074. At sensitivity > 98.7% and specificity of > 86.4%, CE is less costly than SBFT.CONCLUSION: Costs of CE for diagnostic evaluation of suspected CD is comparable to SBFT and may be used immediately following ileo-colonoscopy.

Jonathan A Leighton, Ian M Gralnek, Randel E Richner, Michael J Lacey, Frank J Papatheofanis

2009-12-01

363

Tumor estromal gastrointestinal de intestino delgado / Gastrointestinal stromal tumor of small bowel  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese [...] Abstract in english Stromal tumors of the gastrointestinal tract (gists) represent relatively rare lesions that arise from connective tissue elements located along the entire length of the gut. They were initially identified by immunohistochemical investigation, proving their origin from nondifferentiated mesenchymal c [...] ells. Only a minority of this lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma. The majority of gists corresponds to a heterogeneous group of lesions that have as their common denominator an immature proliferation of epithelioid or spindle cells arising from its muscle layers, or between them, showing partial or incomplete myoide, neural, ganglionic, or mixed features of differentiation. This case report intends to show a gist of small bowel in a male, 46 years old, with a two-year of evolution.

Francisco Marivaldo Benício da, Silva; Jefferson Soares, Lemos; Marcos Gonçalves Nunes de, Moraes.

364

Small Intestinal Bacterial Overgrowth: Novel Insight in the Pathogenesis and Treatment of Irritable Bowel Syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available A total of 65-84% of patients with irritable bowel syndrome (IBS presents with small intestinal bacterial overgrowth (SIBO. SIBO is defined as the presence of more than 105 cfu/ml of colonic type bacteria in the lumen of the small bowel. It is more common in patients with IBS and predominant bloating and diarrhea. Based on the implication of SIBO in the pathogenesis of IBS, six trials have been conducted and analyzed in this review aiming to define a role of rifaximin for the management of IBS. Rifaximin is an orally administered antimicrobial with limited systemic absorption and considerable potency against bacteria implicated in SIBO. In two trials patients with SIBO irrespective of the presence of IBS were enrolled. A positive effect of rifaximin was denoted in the eradication of SIBO in both.One double-blind, prospective randomized trial over placebo in patients with IBS denoted a substantial improvement of the global assessment of patients after treatment with rifaximin. Benefit remained for 10 weeks after stop of treatment. A major benefit was disclosed for bloating. Another three prospective randomized trials have been conducted in patients with both IBS and SIBO. Rifaximin significantly eradicated SIBO and improved bloating.These findings led the Task Force for IBS of the American College of Gastroenterology to appoint a grade of evidence of 1B for the administration of rifaximin in the management of IBS. The proposed oral regimen is 400 mg three times daily for 10 days. However, results of large Phase III trials are mandatory.

Evangelos J. Giamarellos Bourboulis

2009-05-01

365

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

366

Usefulness of Intestinal Fatty Acid-Binding Protein in Predicting Strangulated Small Bowel Obstruction  

Science.gov (United States)

Background The level of intestinal fatty acid-binding protein (I-FABP) is considered to be useful diagnostic markers of small bowel ischemia. The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO). Methods A total of 37 patients diagnosed with SBO were included in this study. The serum I-FABP levels were retrospectively compared between the patients with strangulation and those with simple obstruction, and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Twenty-one patients were diagnosed with strangulated SBO. The serum I-FABP levels were significantly higher in the patients with strangulation compared with those observed in the patients with simple obstruction (18.5 vs. 1.6 ng/ml p<0.001). Using a cut-off value of 6.5 ng/ml, the sensitivity, specificity, PPV and NPV were 71.4%, 93.8%, 93.8% and 71.4%, respectively. An I-FABP level greater than 6.5 ng/ml was found to be the only independent significant factor for a higher likelihood of strangulated SBO (P?=? 0.02; odds ratio: 19.826; 95% confidence interval: 2.1560 – 488.300). Conclusions The I-FABP level is a useful marker for discriminating between strangulated SBO and simple SBO in patients with SBO.

Kittaka, Hirotada; Akimoto, Hiroshi; Takeshita, Hitoshi; Funaoka, Hiroyuki; Hazui, Hiroshi; Okamoto, Masao; Kobata, Hitoshi; Ohishi, Yasuo

2014-01-01

367

Effect of chemical sympathectomy on scintigraphic gastric and small bowel transit in the rat.  

Science.gov (United States)

Our aims were to measure gastric and small bowel transit of radiolabeled chow or liquids in rats and to assess the effect of pharmacologically induced chronic sympathectomy of at least 5 weeks duration. Three series of experiments were performed. In series I, four rats in each group underwent i.p. chloral hydrate anesthesia, tracheostomy with intubation and mechanical ventilation: they received by gavage 1.0 g rat chow dissolved in 1.5 ml saline labeled with 1.0 mCi 99mTc-DTPA In series II, four rats in each group were anesthetized with only i.p. chloral hydrate and received 1.5 ml labeled saline. Rats were placed on a gamma camera for dynamic acquisition of 1-min images for 7 h in series I, and 4 h in series II. Activity was quantitated in stomach and cecum; gastric emptying was analyzed by the power exponential model. In series III, four rats in each group were studied for 1 h on gamma camera and sacrificed after 5 h. At the end of each study, the stomach, small bowel, cecum and colon were removed and radioactivity counted in each organ in a dose calibrator. Quantitation of radioactivity by gamma camera was highly accurate: labeled chow in the stomach at 7 h was identical by external camera and counting of the excised organ (linear regression slope = 1.01, r = 0.97, P less than 0.0001). Similar precision was observed with labeled liquids (slope = 0.93, r = 0.93, P = 0.001). Chow emptied slower than liquid in both groups (P = 0.048). Ileocecal movement of isotope occurred by bolus transfers.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1430794

Ruytjens, I; Thomforde, G M; Camilleri, M; Chapman, N J

1992-06-15

368

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 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

2000-09-01

369

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

370

Late liver metastases of small bowel leiomyoma. The difficulty in assessing malignancy in gastro-intestinal smooth muscle tumours.  

Science.gov (United States)

Two cases of small bowel tumour, resected and considered as benign leiomyomas, are reported. Both developed late hepatic metastases, 6 and 8 years after surgery respectively, diagnosed as leiomyosarcoma. Emphasizing the difficulties in assessing malignancy of these tumours and considering local and far dissemination, a long-term follow-up is recommended after surgical resection. PMID:9689967

Salari, G R; Peny, M O; Van de Stadt, J; Donckier, V; Zalcman, M; Gelin, M

1998-06-01

371

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

372

Changing incidence of diverticular disease of the colon in Korea : a serial radiologic study (report III)  

Energy Technology Data Exchange (ETDEWEB)

Diverticular disease of the colon (DDC), the most common affliction in developed countries, increases in incidence. It is an acquired disease where overactivity of smooth muscle of the colon causes mucosa and sub mucosa to herniate through the muscle layer of the bowel. Starting from 1964, we have periodically carried out radiologic survey to acertain the tendency of DDC to gradually increase in the Koreans. Initially Kim reported the incidence to be 0.2% in 1964 but the incidence in 1979 increased to 2.5% as reported by Chung et al. As the third survey on the series of the study on DDC, we have recently reviewed 1,859 consecutive new cases of double contrast barium enemas performed at the department of radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the 5 year's period from Feb. 1983 to May 1987. The results were as follows. 1. The present study revealed an incidence 6.0% of DDC, 7.2% in male and 5.0% in female. 2. The distribution of diverticular was 37.0% in cecum, 39.0% in ascending colon, 13.6% in transverse colon, 6.2% in descending colon, 3.7% in sigmoid colon. 3. The mean number of diverticular was 5. 4. The average age of patients with DDC was 50.5 years. From the present study, it has emerged that the diverticular disease of the colon in the Koreans is definitely on gradual increase with a significant change in the site of predominant involvement from the right to the left colon.

Kwoen, Young Teck; Han, Sung Il; Chung, Soo Kyo; Bahk, Yong Whee [Catholic University Medical College, Seoul (Korea, Republic of)

1988-10-15

373

Changing incidence of diverticular disease of the colon in Korea : a serial radiologic study (report III)  

International Nuclear Information System (INIS)

Diverticular disease of the colon (DDC), the most common affliction in developed countries, increases in incidence. It is an acquired disease where overactivity of smooth muscle of the colon causes mucosa and sub mucosa to herniate through the muscle layer of the bowel. Starting from 1964, we have periodically carried out radiologic survey to acertain the tendency of DDC to gradually increase in the Koreans. Initially Kim reported the incidence to be 0.2% in 1964 but the incidence in 1979 increased to 2.5% as reported by Chung et al. As the third survey on the series of the study on DDC, we have recently reviewed 1,859 consecutive new cases of double contrast barium enemas performed at the department of radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the 5 year's period from Feb. 1983 to May 1987. The results were as follows. 1. The present study revealed an incidence 6.0% of DDC, 7.2% in male and 5.0% in female. 2. The distribution of diverticular was 37.0% in cecum, 39.0% in ascending colon, 13.6% in transverse colon, 6.2% in descending colon, 3.7% in sigmoid colon. 3. The mean number of diverticular was 5. 4. The average age of patients with DDC was 50.5 years. From the present study, it has emerged that the diverticular disease of the colon in the Koreans is definitely on gradual increase with a significant change in the site of predominant involvement from the right to the left colon.

1988-10-01

374

Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis.  

Science.gov (United States)

Lower gastrointestinal bleeding is a frequent cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Colonic diverticular bleeding is the most common form of lower gastrointestinal bleeding and is responsible for 30-40 % of bleeding episodes. Risk factors associated with diverticular bleeding include obesity, hypertension, anticoagulants, diabetes mellitus, and ischemic heart disease. Recent studies have suggested a relationship between usage of non-steroidal anti-inflammatory drugs (NSAIDs) and colonic diverticular bleeding; however, most studies were small with wide confidence intervals. We identified studies by searching the PubMed and Scopus databases (from inception through 31 December 2012) and by searching bibliographies of relevant articles. Summary relative risks (RRs) with 95 % confidence intervals (CIs) were calculated with fixed-effects and random-effects models. A total of six studies (five case-control studies and one cohort study) met inclusion criteria for analysis. Non-aspirin NSAIDs (NANSAIDs) and aspirin were associated with an increased risk of colonic diverticular bleeding (summary RR = 2.48, 95 % CI 1.86-3.31), with moderate heterogeneity among these studies (P heterogeneity = 0.11, I (2) = 44.4 %). Stratification to evaluate the heterogeneity found that both NANSAIDs (summary RR = 2.24, 95 % CI 1.63-3.09; 5 studies) and aspirin (summary RR = 1.73; 95 % CI 1.31-2.30; 3 studies) were associated with the risk of diverticular bleeding. Aspirin/NANSAIDs use was strongly and consistently associated with an increased risk of colonic diverticular bleeding. Further studies are needed to stratify individuals at risk of diverticular bleeding associated with the use of these agents. PMID:24221694

Yuhara, Hiroki; Corley, Douglas A; Nakahara, Fumio; Nakajima, Takayuki; Koike, Jun; Igarashi, Muneki; Suauki, Takayoshi; Mine, Tetsuya

2014-06-01

375

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

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Full Text Available 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 glucose breath test (GBT to determine the presence of SIBO. Breath samples were obtained at baseline and at 30, 45, 60, 75 and 90 minutes after ingestion of 50 g of glucose dissolved in 150 mL of water. Results of the glucose breath test, which measures hydrogen and methane levels in the breath, were considered positive for SIBO if 1 the hydrogen or methane peak was >20 ppm when the baseline was Results Ninety-eight patients were identified who underwent a GBT (mean age, 49 y; 78% female. Thirty-five patients (36% had a positive GBT result suggestive of SIBO. A positive GBT result was more likely in patients >55 years of age (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4-9.0 and in females (OR, 4.0; 95% CI, 1.1-14.5. Hydrogen was detected more frequently in patients with diarrhea-predominant IBS (OR, 8; 95% CI, 1.4-45, and methane was the main gas detected in patients with constipation-predominant IBS (OR, 8; 95% CI, 1.3-44. There was no significant correlation between the presence of SIBO and the predominant bowel pattern or concurrent use of tegaserod, proton pump inhibitors, or opiate analgesics. Conclusions Small intestinal bacterial overgrowth was present in a sizeable percentage of patients with IBS with predominance of bloating and flatulence. Older age and female sex were predictors of SIBO in patients with IBS. Identification of possible predictors of SIBO in patients with IBS could aid in the development of successful treatment plans.

McCallum Richard W

2010-02-01

376

Recurrent wound dehiscence and small bowel herniation following Caesarean section in a woman with hidradenitis suppurativa.  

Science.gov (United States)

Caesarean wound dehiscence that is severe enough to result in bowel herniation is exceptionally rare. This case describes a woman who experienced wound dehiscence following each of her two Caesarean sections, with bowel herniation present in the second case. The contribution of her comorbid hidradenitis suppurativa will be discussed. PMID:24876503

Fernando, Magage; Schultz, Meleesa J

2014-01-01

377

Recurrent wound dehiscence and small bowel herniation following Caesarean section in a woman with hidradenitis suppurativa  

Science.gov (United States)

Caesarean wound dehiscence that is severe enough to result in bowel herniation is exceptionally rare. This case describes a woman who experienced wound dehiscence following each of her two Caesarean sections, with bowel herniation present in the second case. The contribution of her comorbid hidradenitis suppurativa will be discussed.

Fernando, Magage; Schultz, Meleesa J.

2014-01-01

378

Contrast-enhanced ultrasonography of the small bowel in healthy cats.  

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We characterized the pattern of ultrasonographic contrast enhancement of the small intestinal wall using a commercial contrast medium (Sonovue(®) ) in 10 healthy awake cats. Subjectively, a rapid intense enhancement of the serosal and submucosal layers was followed by gradual enhancement of the entire wall section during the early phase. At peak enhancement, there was a subjective loss of demarcation between intestinal wall layers. In the late phase, there was a gradual wash out of signal from the intestinal wall. Submucosal wash out occurred last. Time-intensity curves were generated for selected regions in the intestinal wall and multiple perfusion parameters were calculated for each cat. Perfusion parameters included arrival time (7.64 ± 2.23 s), baseline intensity (1.04 ± 0.04 a.u.), time to peak from injection (10.74 ± 2.08 s), time to peak from initial rise (3.1 ± 1.15), peak intensity (8.92 ± 3.72 a.u.), wash-in rate (2.06 ± 0.70 a.u./s) and wash-out rate (-1.07 ± 0.91 a.u./s). The perfusion pattern of normal feline small bowel may be useful for characterizing feline gastrointestinal disorders that involve the intestinal wall. PMID:21689198

Diana, Alessia; Specchi, Swan; Baron Toaldo, Marco; Chiocchetti, Roberto; Laghi, Andrea; Cipone, Mario

2011-01-01

379

Wireless capsule endoscopy and proximal small bowel lesions in Crohn’s disease  

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Full Text Available AIM: To investigate the prevalence of proximal small bowel (SB lesions detected by wireless capsule endoscopy (WCE in Crohn’s disease (CD.METHODS: WCE was performed in 64 patients: 32 with CD of the distal ileum, and 32 controls with iron-deficiency anemia (IDA or diarrhea. WCE was performed using the Given SB-WCE, followed by small intestine contrast ultrasonography (SICUS. Findings compatible with CD by using WCE included erosions, aphthoid or deep ulcers, and strictures/stenosis.RESULTS: WCE detected proximal SB lesions in 16/32 (50% patients (14 aphthoid ulcers, 2 deep ulcers, one stricture, which appeared not to be related to clinical parameters [epigastric pain, age, smoking, non-steroidal anti-inflammatory drugs (NSAIDs, IDA]. Among patients with proximal SB lesions, 6 (37% were smokers, 3 (19% NSAID users, 3 (19% had epigastric pain and 4 (25% had IDA. SICUS detected proximal SB lesions in 3/32 patients (19% also showing lesions with WCE. No correlations were observed between proximal SB lesions assessed by WCE or by SICUS (?2 = 1.5, P = 0.2.CONCLUSION: The use of WCE allows the detection of previously unknown upper SB lesions in a high proportion of patients with a previous diagnosis of CD involving the distal ileum.

Carmelina Petruzziello, Sara Onali, Emma Calabrese, Francesca Zorzi, Marta Ascolani, Giovanna Condino, Elisabetta Lolli, Paola Naccarato, Francesco Pallone, Livia Biancone

2010-07-01

380

Combined transplantation of small and large bowel. FK506 versus cyclosporine A in a porcine model.  

Science.gov (United States)

Clinically, FK506 is superior to CsA after solitary small bowel transplantation (SBTx). Development of diarrhea after SBTx has been the rationale for adding the colon to small bowel grafts. However, the additional lymphoid and bacterial content transferred with total small plus large bowel transplants (TBTx) might aggravate the alloimmune response-rejection and graft-versus-host disease (GVHD)-and increase the risk of infection. We studied the incidence of rejection, GVHD, and infection after TBTx and the impact of CsA versus FK506. We performed orthotopic TBTx with portal drainage after total enterectomy in outbred Yorkshire Landrace pigs, divided into 3 groups: control pigs (n=6) received no immunosuppression; CsA pigs (n= 14) received CsA (5 mg/kg), antilymphocyte globulin (10 mg/kg for 10 days), prednisone (2 mg/kg), and AZA (2.5 mgtkg); and FK506 pigs (n=9) received FK506 (0.2 mg/kg) and prednisone (2 mg/kg). Trough CsA whole blood levels were >400 ng/ml for the first 7 days and >200 ng/ml thereafter. FK506 levels were > 15 ng/ml. We excluded from further analysis 5 early deaths (<3 days) due to anesthesiologic (n=2) or technical reasons (n=3). Median survival of control pigs was 9.5 days (range, 4-13). Cyclosporine did not extend survival: median, 9 days (range, 5-31) (P=0.6). FK506 prolonged survival: median, 37 days (range, 21-49) (P<0.001 vs. control and CsA pigs). Of FK506 pigs, 60% gained weight (+75 g/day), whereas 100% of controls and 75% of CsA pigs lost weight (-550 g/day and -300 g/day, respectively). All control pigs died of rejection within 2 weeks versus none of the FK506 pigs. However, 36% of CsA pigs died of rejection. Groupwise comparison showed less rejection in FK506 versus control pigs (P<0.001) and in FK506 versus CsA pigs (P<0.03), but no difference between CsA and control pigs. None of the control pigs died of GVHD versus 18% of CsA pigs (by day 31) and 37% of FK506 pigs (by day 49). Groupwise comparison showed increased GVHD in FK506 versus control pigs (P<0.001) and a tendency toward increased GVHD in FK506 versus CsA pigs (P=0.08). None of the control pigs died of infection alone versus 22% of CsA pigs (by day 31) and 67% of FK506 pigs (by day 49). Groupwise comparison showed increased infection in FK506 versus control pigs (P<0.001). We detected significant endotoxemia early and late postoperatively. But we saw no specific correlation between endotoxemia, rejection, GVHD, or infection. Based on this study, we have drawn several conclusions: (1) In untreated pigs, TBTx provokes a severe rejection response, but no lethal GVHD. (2) Cyclosporine and particularly FK506 pigs have a high incidence of infection and lethal GVHD, a complication that we had not seen after solitary SBTx. (3) FK506 is superior to CsA in controlling rejection and in prolonging graft and recipient survival; FK506, however, does not reduce GVHD, but rather tends to augment it. (4) TBTx causes endotoxemia. As with solitary SBTx, FK506 is superior to CsA after TBTx. However, longterm survival is difficult to achieve on FK506 recipients because of the development of GVHD and infection. PMID:8685944

Pirenne, J; Benedetti, E; Gruessner, A; Moon, C; Hakim, N; Fryer, J P; Troppmann, C; Nakhleh, R E; Gruessner, R W

1996-06-27

 
 
 
 
381

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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. Abstract in english 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 com [...] e 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; Carlos, Guzmán; Sergio, Hoyos; Álvaro, Mena; Carolina, Echeverri; Mario, Ruiz; Hernán, Franco; Sandra, Alzate.

2008-06-30

382

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

Directory of Open Access Journals (Sweden)

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