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1

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

UK PubMed Central (United Kingdom)

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

Arabadzhieva E; Boney S; Dimitrova V

2013-01-01

2

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

Science.gov (United States)

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

Arabadzhieva, E; Boney, S; Dimitrova, V

2013-01-01

3

Small bowel radiology  

International Nuclear Information System (INIS)

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

1987-01-01

4

Small bowel endoscopy in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.

Yamagami H; Watanabe K; Kamata N; Sogawa M; Arakawa T

2013-07-01

5

Small bowel tissue smear  

Science.gov (United States)

Small bowel tissue smear is a laboratory test that checks for disease in a sample of tissue from the small intestine. ... A laboratory smear poses no risks to the patient. For risks related to obtaining a sample of intestinal tissue, see EGD .

6

Updates in diverticular disease.  

UK PubMed Central (United Kingdom)

Diverticulosis and its major complications, diverticulitis and diverticular bleeding, are increasingly common indications for hospitalization and outpatient visits. Recent publications in the field of diverticular disease have challenged long-standing disease concepts and management strategies. This article will highlight studies which have helped to clarify the contribution of genetic factors, fiber consumption and medication use to the development of diverticular disease, the role of antibiotics in the treatment of acute diverticulitis, and the association between diverticulitis, irritable bowel syndrome, and colon cancer.

Templeton AW; Strate LL

2013-08-01

7

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

Energy Technology Data Exchange (ETDEWEB)

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

8

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

2002-01-01

9

Small bowel tumors  

Directory of Open Access Journals (Sweden)

Full Text Available SUMMARY Small intestinal neoplasms are uncommonly encountered in clinical practice. Small intestinal neoplasms may occur sporadically, or in association with genetic diseases such as familial adenomatous polyposis coli or Peutz-Jeghers syndrome, or in association with chronic intestinal inflammatory disorders such as Crohn?s disease or celiac sprue. Benign small intestinal tumors such as leiomyoma, lipoma, hamartoma or desmoid tumor, are usually asymptomatic but may present with intussception. Primary malignancies of the small intestine, including adenocarcinoma, leiomyosarcoma, carcinoid, and lymphoma, may present with intestinal obstruction, jaundice, bleeding, or pain. Extraintestinal neoplasms may involve the intestine via contiguous spread or peritoneal metastasis. Hematogenous metastases to the intestine from an extraintestinal primary are unusual and are most typical of melanoma. Because the small intestine is relatively inaccessible to routine endoscopy, diagnosis of small intestinal neoplasms is often delayed for months after onset of symptoms. When the diagnosis is suspected, enteroclysis is the most useful imaging study. Small bowel endoscopy (enteroscopy) is increasingly widely available and may permit earlier, non-operative diagnosis.

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

2007-01-01

10

Adenocarcinoma of the small bowel  

International Nuclear Information System (INIS)

[en] 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)

2007-01-01

11

Primary malignant small bowel tumor  

International Nuclear Information System (INIS)

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

1990-01-01

12

Small bowel endoscopy in inflammatory bowel disease.  

UK PubMed Central (United Kingdom)

The last decade has witnessed a revolution in small bowel (SB) endoscopy technologies. Endoscopists are no longer confined to the use of push enteroscopy or the significantly more invasive intra-operative enteroscopy: SB capsule endoscopy (SBCE) and device assisted enteroscopy (DAE) have rapidly enabled endoscopic visualisation of the entire SB without the need for surgery. DAE goes a step further by allowing tissue sampling and the application of endotherapy. These developments have also been parallelled by rapid advances in dedicated radiological SB imaging technologies. Although it is clear that SBCE and DAE may have a significant role in the diagnosis and management of IBD patients, their respective place in relation to other technologies within the clinical paradigm of IBD is as yet unclear. This review outlines the current evidence base relating to these endoscopic technologies and their impact in the diagnosis and management of IBD and highlights current international recommendations.

Despott EJ; Fraser C

2012-06-01

13

Small bowel protection with 'STEP'  

International Nuclear Information System (INIS)

This is a case report of a patient presenting with rectal carcinoma and Crohn's disease. Adjuvant treatment was considered to be mandatory on the basis of local extention. Therefore a Silastic Tissue Expander Prosthesis (STEP), connected with a subcutaneously located self-sealing valve system, was introduced surgically to push small bowel up of the treatment portals. Patient received 55 Gy without any acute or late complication. This easy technique allows radiotherpay in conditions where complete elimination of small bowel outside the treatment volume is required. (orig.).

1992-01-01

14

Analysis of small bowel tumors.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Small bowel tumors are remarkably rare. The colon is affected 40 times than the small bowel. Even though the small intestine accounts for 80% of the length and 90% of the mucosal surface of the gastrointestinal tract, only 3-6% of the gastrointestinal malignancies arise from the small bowel. The aim of the study is to enlighten the subject in our community including: therapeutic intervention, the histopathologic types, the risk factors and outcome. METHODS: Between January 1997 and January 2002, 40 patients with primary small bowel tumors were followed in Baghdad Hospital, Gastroenterology and Hepatology Hospital, Al-Mansour Hospital for Pediatrics at Medical City Teaching Centre and the Al-Zahraa Private Hospital, for presentations, preoperative investigations, operative procedures and outcome. Chi-square test or where appropriate Fishers exact test was used to assess for the statistical significance of the site of the tumor and outcome. The relative risk (RR) and odds ratio (OR) where possible, were used to measure the magnitude of developing a certain outcome (like death) in the presence of risk factor compared to its absence. P value less than the 0.05 level of significance is considered statistically significant. The 95% confidence interval was used to express the expected range of incidence rate of certain outcomes in the target population. RESULTS: The most frequent age group affected is 46-60. The most frequent symptoms in decreasing order were abdominal pain (75%), vomiting (72.5%), and weight loss (52.5%). The most sensitive diagnostic procedure was barium study (84.6%). Lymph nodes were the most common site of metastases 15 (37.5%). The duration of follow up was from 2-60-months. The site: duodenum has the highest case fatality rate (62.5 %) with an RR=9.9 which was statistically significant (p=0.006) as compared to the jejunum (25%) that has an RR=3.9 (p=0.16 NS)], then the ileum (6.3%). CONCLUSION: Overall, the prognosis for patients with small intestinal tumors is poor. The duodenum as a site of the small bowel tumors was the only significant risk factor with regard to case fatality rate. Despite current advanced diagnostic modalities, the small intestine remains a difficult area to image with both radiographs and the endoscope.

Abdul-Rahman MM; Al-Waali MM; Al-Naaimi AS

2004-12-01

15

Evaluation of small bowel bleeding.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: The review focuses on the latest techniques that are evolving in the management of small bowel bleeding. RECENT FINDINGS: Video capsule endoscopy has the highest yield of diagnosis when it is performed within 48?h of the bleeding event (78 versus 48%). The pooled detection rate of double balloon endoscopy was noted to be 68.1% for obscure gastrointestinal bleeding according to a systematic review of 66 studies in the last 10 years. Also a recent review, which focused on analysis of 68 studies found that the procedural characteristics were comparable for double balloon, single balloon and spiral enteroscopy though the procedure time was fastest for the spiral enteroscopy group. Medical therapy for vascular lesions is in its infancy but shows promise. SUMMARY: Advanced diagnostic and therapeutic endoscopic techniques are changing the paradigm of care for patients with small bowel bleeding.

Singh A; Baptista V; Stoicov C; Cave DR

2013-03-01

16

CT enteroclysis in small bowel Crohn's disease  

International Nuclear Information System (INIS)

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

2009-01-01

17

Small bowel obstruction: the art of management.  

UK PubMed Central (United Kingdom)

Strategies for the management of small bowel obstructions have changed significantly over the years. Nonoperative medical management has become the mainstay of treatment of many small bowel obstructions. However, the key to the management of small bowel obstructions is identifying those patients who need surgical intervention. Identification of those at risk for bowel ischemia and bowel death is an art as much as it is a science. Using the current literature and the past knowledge regarding small bowel obstructions, the clinician must carefully identify the signs and symptoms that suggest the need for operative intervention. Classification of the obstruction, history and physical examination, imaging, response to decompression and resuscitation, and resolution or progression of symptoms are the key factors influencing the management of small bowel obstructions.

Trevino C

2010-04-01

18

Small bowel intubation using guide wire: use in decompression of small bowel obstruction  

Energy Technology Data Exchange (ETDEWEB)

Small bowel intubation is a useful method in the non-operative decompression of small bowel obstruction and enteral hyperalimentation in malnourished patients. We have tried small bowel intubation with Ventrol tube guided by small bowel enteroclysis guide wire (Bilbao-Dotter wire) in 12 patients. Ten cases were successfully intubated. In 11 cases of bowel obstruction, 9 cases were intubated and 8 cases were effectively drained. One malnourished patient was improved in nutritional state after enteral hyperalimentation through the intubated tube. We believe this method is an easy and time-saving method in the small bowel decompression.

Kim, Kyo Yeoun; Kim, Ki Whang [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

1987-06-15

19

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.)

2004-01-01

20

Radiopathological review of small bowel carcinoid tumours  

International Nuclear Information System (INIS)

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

2009-01-01

 
 
 
 
21

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; John Choi; Xiang Da Dong

2010-01-01

22

Diverticulosis of the small bowel with Diverticulitis  

International Nuclear Information System (INIS)

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

1980-01-01

23

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.

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

2011-01-01

24

CT findings of small bowel trichobezoar.  

UK PubMed Central (United Kingdom)

A 14-year-old girl presented to our emergency room with abdominal pain and persistent vomiting. A plain radiograph of the abdomen showed features of small bowel obstruction, with dilated loops of small bowel and a mottled gas and debris pattern in the stomach and right lower quadrant. A CT scan of the abdomen and pelvis obtained to exclude appendicitis showed the distinctive appearance of a trichobezoar. A preoperative diagnosis of gastric and intestinal trichobezoar was made.

Naran AD; Naran D; Haller JO

2002-07-01

25

The small bowel enema - a general survey  

International Nuclear Information System (INIS)

[en] General thoughts about small bowel radiology are followed by a description of the technique of the small bowel enema with methyl cellulose for achieving double contrast. Parameters for the normal finding are stated. For the following situations, a small bowel enema is recommended for clinical application: clarification of an ileus of the small bowel, special aspects of inflammatory diseases of the small bowel, malabsorption, clarification of a carcinomatosis or a radiation damage, clarification of occult intestinal blood loss, and in cases of irresolute conventional gastrointestinal passage. Small bowel enema is also suitable for use in diagnosing diseases of severely handicapped patients. (orig.)[de] An allgemeine Ueberlegungen ueber die Duenndarmradiologie schliesst sich eine Beschreibung der Technik fuer den Duenndarmeinlauf mit Methylzellulose zur Erreichung eines Doppelkontrastes an. Parameter fuer den Normalbefund werden angegeben. Fuer folgende Situation wird der Duenndarmeinlauf zur klinischen Anwendung empfohlen: Abklaerung eines Duenndarmileus, besondere Aspekte bei entzuendlichen Duenndarmerkrankungen, Malabsorptionszustaende, Abklaerung einer Karzinomatose oder eines Strahlenschadens, Abklaerung von okkultem intestinalem Blutverlust und bei unschluessiger konventioneller Magen-Darm-Passage. Ebenso eignet sich der Duenndarmeinlauf bei der Diagnostik schwer behinderter Patienten. (orig.)

1984-01-01

26

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

2008-01-01

27

SMALL BOWEL GANGRENE SECONDARY TO PERITONEAL ENCAPSULATION  

Directory of Open Access Journals (Sweden)

Full Text Available Containment of small bowel in a separate peritoneal sac is a rare condition, previously described asperitoneal encapsulation. Small bowel at a variable distance from duodeno-jejunal flexure entersthrough a small opening into the sac which often extends down to pelvis Malrotation of gut is usuallynot associated with the condition. Exact anatomy in detail has been described before . Etiology has 1'2been attributed to a defect occurring during return of physiological hernia in embryonic life. Eight caseshave been reported so far in literature mostly asymptomatic, some with few abdominal symptoms andone with acute intestinal obstruction, but none with gangrene of small bowe .

Irfan Akhtar

1998-01-01

28

Recurrent malignant schwannoma of the small bowel.  

UK PubMed Central (United Kingdom)

Primary malignant schwannoma of the small bowel is an extremely rare disease. Only 24 malignant schwannomas of the small bowel have been reported in the medical English literature. We report a primary malignant schwannoma of the distal ileum in a 53-year-old woman, who was admitted to the hospital because of abdominal pain. CT scan revealed a semisolid mass in the small intestine of the serosa. The tumour measuring 14 x 13 x 8 cm and 100 cm of the distal ileum were resected. We observed a recurrence after seventeen months and the recurrent tumour measured 6 x 2.5 x 1 cm was excised.

Yilmaz F; Uzunlar AK; Bükte Y

2004-05-01

29

Recurrent malignant schwannoma of the small bowel.  

Science.gov (United States)

Primary malignant schwannoma of the small bowel is an extremely rare disease. Only 24 malignant schwannomas of the small bowel have been reported in the medical English literature. We report a primary malignant schwannoma of the distal ileum in a 53-year-old woman, who was admitted to the hospital because of abdominal pain. CT scan revealed a semisolid mass in the small intestine of the serosa. The tumour measuring 14 x 13 x 8 cm and 100 cm of the distal ileum were resected. We observed a recurrence after seventeen months and the recurrent tumour measured 6 x 2.5 x 1 cm was excised. PMID:15359985

Yilmaz, Fahri; Uzunlar, Ali Kemal; Bükte, Ya?ar

2004-05-01

30

Dynamic double contrast small bowel enema  

International Nuclear Information System (INIS)

[en] A modification of the double contrast technique for examining the small bowel is described. This employs an infusion system with variable infusion pressure, which makes it possible to adjust the flow of contrast medium, methyl cellulose and water separately, permitting continuous double contrast demonstration of the entire small bowel. The ileum, which was poorly demonstrated by conventional double contrast methods, can be shown satisfactorily in a high percentage of cases (70%). Side effects and failures, which were frequent at first, have become less common with increasing experience. (orig.)

1980-01-01

31

Small-bowel endoscopy core curriculum.  

Science.gov (United States)

This is one of a series of documents prepared by the ASGE Training Committee. This curriculum document contains recommendations for training, intended for use by endoscopy training directors, endoscopists involved in teaching endoscopy, and trainees in endoscopy. It was developed as an overview of techniques currently favored for the performance and training of small-bowel endoscopy and to serve as a guide to published references, videotapes, and other resources available to the trainer. By providing information to endoscopy trainers about the common practices used by experts in performing the technical aspects of the procedure, the ASGE hopes to improve the teaching and performance of small-bowel endoscopy. PMID:23261090

Rajan, Elizabeth A; Pais, Shireen A; Degregorio, Barry T; Adler, Douglas G; Al-Haddad, Mohammad; Bakis, Gennadiy; Coyle, Walter J; Davila, Raquel E; Dimaio, Christopher J; Enestvedt, Brintha K; Jorgensen, Jennifer; Lee, Linda S; Mullady, Daniel K; Obstein, Keith L; Sedlack, Robert E; Tierney, William M; Faulx, Ashley L

2013-01-01

32

[Seminoma metastasis in the small bowel].  

UK PubMed Central (United Kingdom)

Approximately 95% of testicular cancers are germ-cell tumours and these are divided into non-seminoma and pure seminoma. They rarely metastasize to the gastrointestinal tract (< 5%) and pure seminoma are the least likely to do so with an incidence of < 1%. We describe an unusual case of a 67-year-old man, who presented with gastrointestinal complaints, the first symptoms of testicular seminoma being a small bowel metastasis. The patient had a palpable testicular mass which was not detected until after the tumour in the small bowel had been resected and histology revealed metastasis from a seminoma.

Lund DM; Fode M; Balslev I; Sønksen J

2013-03-01

33

Small bowel endoscopy and coeliac disease.  

UK PubMed Central (United Kingdom)

Coeliac disease (CD) is a gluten-responsive, chronic inflammatory enteropathy that shares many features with classical autoimmune diseases. Coeliac disease affects about 1-2% of Caucasians, North Africans and Asians who possess the necessary susceptibility genes encoding HLA DQ2 or HLA DQ8. It is not only unique among the autoimmune diseases in that the precise trigger (gluten from wheat, rye and barley) has been identified, but also in that it has lent itself well to advancements in endoscopic imaging. Since its introduction, flexible endoscopy has allowed tissue to be collected from the small bowel with relative ease and safety, and recently has facilitated direct imaging and sampling of the entire small intestine. It is now fifty years since the Crosby capsule first allowed clinicians the ability to non-surgically biopsy the small bowel leading to an enhanced diagnosis of coeliac disease. The introduction of wireless video capsule endoscopy (VCE), small bowel enteroscopy and in particular double balloon enteroscopy (DBE), have expedited the accurate diagnosis of coeliac disease and its more serious complications such as small bowel adenocarcinoma, refractory coeliac disease type II (RCDII) and enteropathy associated T cell lymphoma (EATL).

Daveson AJ; Anderson RP

2012-06-01

34

Small bowel endoscopy and coeliac disease.  

Science.gov (United States)

Coeliac disease (CD) is a gluten-responsive, chronic inflammatory enteropathy that shares many features with classical autoimmune diseases. Coeliac disease affects about 1-2% of Caucasians, North Africans and Asians who possess the necessary susceptibility genes encoding HLA DQ2 or HLA DQ8. It is not only unique among the autoimmune diseases in that the precise trigger (gluten from wheat, rye and barley) has been identified, but also in that it has lent itself well to advancements in endoscopic imaging. Since its introduction, flexible endoscopy has allowed tissue to be collected from the small bowel with relative ease and safety, and recently has facilitated direct imaging and sampling of the entire small intestine. It is now fifty years since the Crosby capsule first allowed clinicians the ability to non-surgically biopsy the small bowel leading to an enhanced diagnosis of coeliac disease. The introduction of wireless video capsule endoscopy (VCE), small bowel enteroscopy and in particular double balloon enteroscopy (DBE), have expedited the accurate diagnosis of coeliac disease and its more serious complications such as small bowel adenocarcinoma, refractory coeliac disease type II (RCDII) and enteropathy associated T cell lymphoma (EATL). PMID:22704573

Daveson, A James M; Anderson, Robert P

2012-06-01

35

Spontaneous perforation of rectum with evisceration of small bowel small bowel simulating intussusception  

Directory of Open Access Journals (Sweden)

Full Text Available Context: Spontaneous perforation of rectum is a rare event; however evisceration of the small bowel through the perforated site without predisposing factors is extremely rare, complex and worth reporting. Case report: A 14 years old presented to us apparently as a case of intussception. The operative findings revealed it to be a case of spontaneous perforation of rectum with evisceration of the small bowel through the perforation. Conclusion: Sudden increase in the intra-abdominal pressure leads to the perforation in the chronically deranged rectal wall and pushes the small bowel loops into the pelvis and through the perforated rectum to appear transanally.

Sandeep Bhat; Tariq P Azad; Manmeet Kaur

2010-01-01

36

Changes of smooth muscle contractile filaments in small bowel atresia  

Directory of Open Access Journals (Sweden)

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

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

2012-01-01

37

Effect of small bowel preparation with simethicone on capsule endoscopy*  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 pr...

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

38

Metoclopramide-ceruletide-assisted small bowel examination  

International Nuclear Information System (INIS)

We investigated the feasibility of performing a combined upper gastrointestinal and small bowel examination. Metoclopramide was given at the start of the examination and ceruletide was injected to hasten small bowel transit. The quality and duration of fifty examinations (group I) was compared to that of fifty patients receiving metoclopramide alone (group II) and fifty patients undergoing unaided examinations (group III). The mean duration of the entire study was 29.3 minutes for group I patients, 37.6 minutes for patients in group II and 69.1 minutes for group III subjects. The combination of agents produced contracted fold patterns in the jejunum and ileum that rendered individual loops more accessible to individual study under fluoroscopy in approximately 50% of subjects. (orig.)

1988-01-01

39

Metoclopramide-ceruletide-assisted small bowel examination  

Energy Technology Data Exchange (ETDEWEB)

We investigated the feasibility of performing a combined upper gastrointestinal and small bowel examination. Metoclopramide was given at the start of the examination and ceruletide was injected to hasten small bowel transit. The quality and duration of fifty examinations (group I) was compared to that of fifty patients receiving metoclopramide alone (group II) and fifty patients undergoing unaided examinations (group III). The mean duration of the entire study was 29.3 minutes for group I patients, 37.6 minutes for patients in group II and 69.1 minutes for group III subjects. The combination of agents produced contracted fold patterns in the jejunum and ileum that rendered individual loops more accessible to individual study under fluoroscopy in approximately 50% of subjects.

Grumbach, K.; Herlinger, H.; Laufer, I.; Levine, M.S.

1988-07-01

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

Does all small bowel intussusception need exploration?  

Directory of Open Access Journals (Sweden)

Full Text Available Small bowel intussusception (SBI) in infants and children are ususally associated with a lead point. With increased use of radiological investigations, more idiopathic SBIs are identified. As reduction by hydrostatic or air enema are less successful in these cases, most of them require surgical exploration in children. However, now many cases of SBI have been found to reduce spontaneously. We report two cases of SBI with spontaneous reduction and review the literature for the management guidelines.

Parikh Mitul; Samujh Ram; Kanojia Ravi; Sodhi Kushaljit

2010-01-01

42

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

43

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

44

Surgical management of tuberculous small bowel obstruction  

International Nuclear Information System (INIS)

[en] 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

45

Primary malignant mucosal tumours of the small bowel  

Energy Technology Data Exchange (ETDEWEB)

Three cases of primary malignant tumours in the small bowel are presented. The authors discuss the clinical symptoms of these patients and describe the radiological picture. Adenocarcinoma most frequently occurs in the proximal small bowel. Radiologists should be aware of the dominant site of occurrence of these tumours when performing a small bowel investigation, because lesions in the jejunum may easily be overlooked due to superposition.

Jagt, E.J. van der; Thijn, C.J.P.; Jansen, W.

1988-07-01

46

Blunt abdominal trauma with transanal small bowel evisceration.  

UK PubMed Central (United Kingdom)

Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestinal loops through the anus following BAT and discuss the etiologies and mechanisms of injury of this rare presentation.

Medappil N; Prashanth AK; Latheef A

2013-01-01

47

Small bowel evisceration following removal of an abdominal drain.  

UK PubMed Central (United Kingdom)

Drain site small bowel evisceration represents a small but potentially serious risk following abdominal drain removal. We present the case of a patient in whom removal of an abdominal drain was complicated by small bowel evisceration requiring surgical intervention. Strategies for management, consequences and potential preventive measures are discussed.

Hemandas A; Mitchell C; Aikoye A

2012-06-01

48

Blunt abdominal trauma with transanal small bowel evisceration  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestin...

Medappil, Noushif; Prashanth, Adiga K; Latheef, Abdul

49

Blunt abdominal trauma with transanal small bowel evisceration.  

Science.gov (United States)

Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestinal loops through the anus following BAT and discuss the etiologies and mechanisms of injury of this rare presentation. PMID:23493429

Medappil, Noushif; Prashanth, Adiga K; Latheef, Abdul

2013-01-01

50

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

Science.gov (United States)

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

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

2013-01-01

51

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; Handa R; Harjai Man

2006-01-01

52

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; Ana Paula Santos de Andrade; Cléciton Braga Tavares; Kelson James Silva de Almeida

2010-01-01

53

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 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 m (more) ultiples 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

2010-02-01

54

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

55

Small bowel motility in functional chronic constipation.  

UK PubMed Central (United Kingdom)

In functional constipation, three pathophysiological subgroups have been identified: slow-transit constipation (STC); normal-transit constipation (NTC) and outlet delay (OD). Extracolonic manifestations, especially disturbed small bowel motility, are well known to occur in STC, but have rarely been studied in NTC and OD. To perform 24-h-ambulatory jejunal manometry in a large prospective series of clinical patients with chronic constipation of all subtypes. A total of 61 consecutive patients, referred to our tertiary gastroenterologic centre for chronic constipation (48 female, 13 male; mean age 57 (range 20-87) years), underwent jejunal 24-h-ambulatory manometry (standardized meal) after a transit-time study (radio-opaque markers), anorectal manometry, defecography and colonoscopy. Computerized and visual analysis by two independent observers was compared with the normal range of manometric variables, defined by data previously obtained in 50 healthy subjects (Gut 1996;38:859). Five patients were excluded from the study because of coexistence of OD and STC. No patient with OD (n = 8), but all patients with STC (n = 32) and 94% of patients with NTC (n = 16) showed small bowel motor abnormalities; both in postprandial response and fasting motility. The abnormal findings ranged from severe disturbances with complete loss of MMC to subtle changes of contraction parameters that could only be assessed by computerized analysis. No significant differences between STC- and NTC-patients were found. Most findings pointed to an underlying enteric neuropathy. Intestinal prolonged-ambulatory manometry adds valuable information to the pathophysiologic understanding of functional chronic constipation of STC- and NTC-type, however there are no distinct manometric features to differentiate between both.

Seidl H; Gundling F; Pehl C; Pfeiffer A; Schepp W; Schmidt T

2009-12-01

56

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.

2010-01-01

57

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

58

REPORT OF AN INTERESTING CASE OF SMALL BOWEL DUPLICATION  

Directory of Open Access Journals (Sweden)

Full Text Available A 13 years old boy with severe abdominal pain and history of intermittent (II bleeding since the aye of 3 months, is presented. Different diagnostic procedures were unremarkable. A Tc-99m Pertechnetate abdominal study revealed abnormal radionuclide accumulation in small bowel region. Duplication of small bowel was suspected which was confirmed by surgery and pathologic examination.    

Javad Esmaili; - Hosein Forootan

1998-01-01

59

Interposition of the demucosed colon segment into the small bowel  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The aim of this study is, could we transform demucosed colon into the small bowel? To find the answer, this study was investigated the surface changes of demucosed colon segment, interposed into the small bowel fashioned as a blind loop. This study was performed in five healthy young stray dogs. A b...

Sanal M; Sinmaz K; Sunay F; Çavusoglu I; Büyükçoban M

60

Sarcoidosis: association with small bowel disease and folate deficiency.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

A 30 year old woman with recurrent anaemia due to folate deficiency had evidence of sarcoid granuloma on small bowel biopsy but was presumed to have Crohn's disease. The diagnosis of small bowel sarcoidosis was not seriously considered until she developed systemic manifestations of sarcoidosis (cuta...

MacRury, S M; McQuaker, G; Morton, R; Hume, R

 
 
 
 
61

Perforation of the mesenteric small bowel: etiologies and CT findings.  

UK PubMed Central (United Kingdom)

The purpose of this article is to illustrate and discuss the various etiologies of perforation of the mesenteric small bowel and associated findings on abdominal CT. Perforation of the mesenteric small bowel is an uncommon cause of an acute abdomen and can be due to various etiologies. In underdeveloped countries, infection is probably the most common cause, while in industrialized nations, perforation may be due to Crohn disease, diverticulitis, foreign body, trauma, tumor, mechanical obstruction, primary ischemic event, or iatrogenic causes. CT is usually the initial imaging examination in patients with an acute abdomen and is sensitive in diagnosing small bowel perforation. CT findings in the setting of small bowel perforation are often subtle, but when present, may help the radiologist determine a specific cause of perforation. The aims of this pictorial essay are to review the various causes of mesenteric small bowel perforation and to discuss and illustrate the CT findings that can help arrive at the diagnosis.

Hines J; Rosenblat J; Duncan DR; Friedman B; Katz DS

2013-04-01

62

Metastatic seeding along the small bowel mesentery. Roentgen features.  

UK PubMed Central (United Kingdom)

1. Intra-abdominal malignant seeding along the small bowel mesentery is roentgenologically identifiable. 2. The anatomic features of the small bowel mesentery and the pathways of flow of ascitic fluid along its peritoneal recesses determine the depostion and growth of seeded metastases. 3. Seeded deposits lodge particularly within the lower recesses of the small bowel mesentery and are reflected by typical changes involving distal ileal loops or the cecum. 4. These are characterized by (a) palisading, arcuate scalloped deflections or gross mass displacement of distal small bowel loops in the right lower quadrant, or (b) extrinsic indentations upon the medial and inferior contours of the cecum. Associated desmoplastic reaction may result in tethering of mucosal folds and angulated fixation of bowel loops.

Meyers MA

1975-01-01

63

Small bowel transplantation in outbred rats.  

UK PubMed Central (United Kingdom)

PURPOSE: To investigate the clinical evolution of orthotopic small bowel transplantation in outbred rats. METHODS: Seventy-two outbred Wistar rats weighting from 250 to 300g were used as donor and recipient in 36 consecutives ortothopic small intestine transplantation without immunosuppression. The graft was transplanted into the recipient using end-to-side aortic and portacaval microvascular anastomosis. Procedure duration, animal clinical course and survival were evaluated. Survival shorter than four days was considered technical failure. Recipients were sacrificed with signs of severe graft rejection or survival longer than 120 days. Necropsies were performed in all recipients to access histopathological changes in the graft. RESULTS: Median time for the procedure was 107 minutes. Six recipients (16.7%) presented technical failure. Twenty-seven recipients were sacrificed due to rejection, being nineteen (52.7%) between 7(th) and 15(th) postoperative day and eight (22.2%) between 34(th) and 47(th) postoperative day. Graft histology confirmed severe acute cellular rejection in those recipients. Uneventful evolution and survival longer than 120 days without rejection were observed in three recipients (8.3%). CONCLUSION: Intestinal transplantation in outbred rats without immunosuppressant regiment accomplishes variable clinical evolution.

Waisberg DR; Lee AD; Santos RM; Mory EK; Costa AL; Montero EF; Chaib E; D'Albuquerque LA; Galvao FH

2011-12-01

64

Expanding applications: the potential usage of 5-aminosalicylic acid in diverticular disease.  

UK PubMed Central (United Kingdom)

Diverticular disease is a common bowel condition, the pathogenesis of which is incompletely understood. Acute exacerbations of diverticular disease usually require dietary changes, antibiotic therapy, and may necessitate urgent surgery. Approximately 25-33% of patients experience symptomatic and acute inflammatory disease recurrence, suggesting that current long-term management is inadequate. Because inflammatory complications of diverticular disease, including diverticulitis, are similarities to inflammatory bowel diseases, evidence suggests that patients may respond to anti-inflammatory therapies used in these conditions. Here, we explore the rationale and evidence for use of inflammatory bowel disease treatment, namely 5-aminosalicylic acid (5-ASA; mesalamine), in diverticular disease, and review clinical data on the efficacy of mesalamine either alone or in combination with other agents for the treatment of diverticular disease. PubMed and conference abstracts were searched for clinical studies examining the use of mesalamine in treating diverticular disease. Studies were evaluated for treatment efficacy in symptom reduction, recurrence prevention, or improving quality of life. The results of our search suggest that single-agent mesalamine can reduce diverticular disease symptoms and improve quality of life more effectively than antibiotic treatment alone. Mesalamine in combination with antibiotics can also reduce symptoms and improve quality of life with greater efficacy than either treatment alone. Combining mesalamine and probiotics treatments may reduce recurrent attacks of diverticular disease. Further randomized, well-controlled studies are required for validation; however, it seems that mesalamine is an important agent in future diverticular disease management.

Tursi A; Joseph RE; Streck P

2011-11-01

65

Early postoperative small bowel obstruction after laparoscopic myomectomy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To describe an early small bowel obstruction after robotic-assisted laparoscopic myomectomy with the Davinci system. DESIGN: Case report. SETTING: Academic medical center. PATIENT(S): Two days after a robotic-assisted laparoscopic myomectomy, a 35-year-old nulligravid African-American woman developed a small bowel obstruction due to retained myoma fragments that had implanted on and subsequently kinked loops of the small bowel. INTERVENTION(S): The patient was managed conservatively for 4 days with bowel rest and IV hydration. Due to worsening clinical symptoms and supportive radiologic findings, exploratory laparotomy was performed to lyse adhesions and remove the implanted myoma pieces. MAIN OUTCOME MEASURE(S): Clinical resolution of small bowel obstruction symptoms. RESULT(S): No bowel resection was needed for this patient. CONCLUSION(S): Prompt recognition and operative treatment of the small bowel obstruction prevented the need for intestinal resection. To reduce the risk of ectopic implantation of myoma fragments, meticulous care should be taken to remove all remnants of morcellated tissue. Immediate postoperative complications, such as bowel obstruction, and long-term complications related to recurrent myomas may then be avoided.

Erman-Akar M; Mullany S; Huffman J; Yalcinkaya TM

2010-11-01

66

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

International Nuclear Information System (INIS)

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

2008-01-01

67

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

Science.gov (United States)

Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 = very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders. PMID:18500525

Kinner, Sonja; Kuehle, Christiane A; Herbig, Sebastian; Haag, Sebastian; Ladd, Susanne C; Barkhausen, Joerg; Lauenstein, Thomas C

2008-05-24

68

Radical surgical approach to radiation injury of the small bowel  

Energy Technology Data Exchange (ETDEWEB)

During a period of 12 years, 52 patients without tumor recurrence were treated for chronic radiation injury to the small bowel. Eighteen patients also had concomitant large bowel injuries. Forty-seven patients were treated surgically, 42 of whom presented with obstruction, necrosis, or perforation of the bowel and had emergency operations. Thirty-eight patients underwent wide resection of the injured bowel, and six had bypass procedures. Anastomotic leakage occurred in 6 percent of the patients. The operative morbidity rate was 34 percent, and the mortality rate, 9 percent. Based on this experience, when surgery for small intestinal radiation injury is mandatory, the procedure should be a generous small bowel resection whenever possible, and probably should be performed only by experienced surgeons.

Harling, H.; Balslev, I.

1986-06-01

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

Transient small-bowel intussusception in children on CT  

International Nuclear Information System (INIS)

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.)

2003-01-01

71

MR enterography for the assessment of small bowel diseases.  

UK PubMed Central (United Kingdom)

This article focuses on MR enterography in the evaluation of small bowel diseases, including the protocol, enteric contrast agents, imaging timing and sequence selection. It is becoming the first-line radiological investigation to evaluate the small bowel in patients diagnosed with Crohn disease, particularly in young adults, in whom ionizing radiation is a concern. A key question in the management of such patients is the assessment of disease activity. Knowledge of the location, severity, and presence of complications may assist in providing patients with appropriate treatment options. Other small bowel diseases beyond Crohn disease will also be discussed.

Costa-Silva L; Brandão AC

2013-05-01

72

Effect of small bowel preparation with simethicone on capsule endoscopy.  

UK PubMed Central (United Kingdom)

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 a few investigators. METHODS: Sixty-four participants were randomly divided into two groups to receive a bowel preparation of polyethylene glycol (PEG) solution (Group 1) and both PEG solution and simethicone (Group 2). The PEG solution and simethicone were taken the night before and 20 min prior to capsule endoscopy, respectively. Frames taken in the small intestine were examined and scored for luminal bubbles by two professional capsule endoscopists. Gastric emptying time and small bowel transit time were also recorded. RESULTS: Simethicone significantly reduced luminal bubbles both in the proximal and distal small intestines. The mean time proportions with slight bubbles in the proximal and distal intestines in Group 2 were 97.1% and 99.0%, respectively, compared with 67.2% (P<0.001) and 68.8% (P<0.001) in Group 1. Simethicone had no effect on mean gastric emptying time, 32.08 min in Group 2 compared with 30.88 min in Group 1 (P=0.868), but it did increase mean small intestinal transit time from 227.28 to 281.84 min (P=0.003). CONCLUSION: Bowel preparation with both PEG and simethicone significantly reduced bubbles in the intestinal lumen and improved the visualization of the small bowel by capsule endoscopy without any side effects observed.

Fang YH; Chen CX; Zhang BL

2009-01-01

73

Small bowel enteroclysis using a hemodialysis blood pump  

Energy Technology Data Exchange (ETDEWEB)

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

Lee, Soon Jin; Lim, Hyo Keun; Lee, Won Jae; Kim, Kyeong Ah; Lee, Yeon Ok; Hwang, Jung Hwa; Choi, Sang Hee; Lim, Jae Hoon [Samsung Medical Center, Seoul (Korea, Republic of)

1998-04-01

74

Small bowel enteroclysis using a hemodialysis blood pump  

International Nuclear Information System (INIS)

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

1998-01-01

75

Diverticular disease: eat your fiber!  

UK PubMed Central (United Kingdom)

In industrialized nations, diverticular disease affects up to 70% of individuals by 60 years of age, with symptoms that can range from mild gastrointestinal disturbance to incapacitating pain. Diverticular disease appears to be related to increasing affluence and changed diet: Current theory holds that diverticular disease's origin is low-fiber diet. This explains why its incidence is highest and accelerating in the more prosperous countries where intake of fiber has decreased and intake of milled grains and refined sugars has increased over time. Not all patients develop symptoms, but if they do, the most frequent complaints associated with diverticulosis are cramping in the left-lower quadrant, bloating, constipation, and soiling. If diverticula perforate the gut's wall into the pericolic tissue, small and large abscesses, accompanied by bleeding, can form. Fistulization, when it occurs, most often penetrates to the bladder. Treatment addresses symptoms and may require hospitalization. During symptomatic periods, patients do best on low-fiber, bland diets. Once the acute episode or highly symptomatic period resolves or chronic disease is managed, patients should gradually increase dietary fiber to 20 to 30 grams daily or take dietary fiber in the form of bulk stimulants like psyllium.

Wick JY

2012-09-01

76

Incidence, presentation, and prognosis of small bowel adenocarcinoma in patients with small bowel Crohn's disease: a prospective observational study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Patients with Crohn's disease (CD) of the colon are at risk for colorectal cancer and should be screened for dysplasia and cancer of the colon. Small bowel adenocarcinoma (SBA) is a complication of small bowel CD and carries a poor prognosis. However, there is no screening test for SBA in patients with small bowel CD. The aim of this study was to assess the risk and incidence of SBA in a large prospective cohort of patients with small bowel CD and to compare it with the risk of colorectal cancer in patients with CD involving the colon, recruited in the same cohort. METHODS: In a nationwide French cohort, 11,759 patients with CD were enrolled by 680 gastroenterologists. The SBA risk was obtained by dividing the observed cases in our cohort to the expected cases in the general population. RESULTS: At baseline, 8222 (69.9%) patients had small bowel CD (either alone or associated with colonic CD); their median follow-up was 35 months (interquartile range, 29-40). Five new cases of SBA were diagnosed, all in patients with small bowel CD, within inflamed areas. Among the 5 patients with incident SBA, 4 died of SBA and 1 is in remission 7 years after the diagnosis of SBA. The incidence rates of SBA were 0.235 per 1000 patient-years (95% confidence interval [CI], 0.076-0.547) among patients with small bowel CD and 0.464 per 1000 patient-years (95% CI, 0.127-1.190) among those with small bowel CD for >8 years. This accounted for approximately 30% of the risk of colorectal cancer in patients with CD of the colon. Patients with small bowel CD and small bowel CD for >8 years had an SBA standardized incidence ratio of 34.9 (95% CI, 11.3-81.5) and 46.0 (95% CI, 12.5-117.8), respectively. CONCLUSIONS: SBA in patients with small bowel CD carries a poor prognosis, and its risk is approximately 30% of colorectal cancer risk in patients with CD of the colon. Further studies should determine if small bowel endoscopic screening in high-risk patients is feasible and effective.

Elriz K; Carrat F; Carbonnel F; Marthey L; Bouvier AM; Beaugerie L

2013-08-01

77

Normal small bowel wall characteristics on MR enterography  

Energy Technology Data Exchange (ETDEWEB)

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

78

Synchronous Adenocarcinomas of the small (Jejunum) and large (Transverse and Sigmoid Colon) bowel. A Case Study  

Directory of Open Access Journals (Sweden)

Full Text Available SUMMARY A case of synchronous primary adenocarcinomas of the small and large bowel in a patient, thoroughly investigated for abdominal discomfort, is presented. Primary tumors of the small bowel are rare, and the diagnosis of primary adenocarcinoma of the small bowel in the presence of primary adenocarcinomas of the large bowel requires a high degree of suspicion and may well modify the prognostic outcome if detected early. Key Words: synchronous, adenocarcinoma, large bowel , small bowel, diagnosis, treatment.

V. Penopoulos, N.Gougoulias, J. Walonga, G. Christianopoulos,; K. Pistevou-Gobaki, G. Kokozidis, G. Kitis

2007-01-01

79

Single-port laparoscopic management of adhesive small bowel obstruction.  

UK PubMed Central (United Kingdom)

Laparoscopic adhesiolysis has been the focus of much recent attention; however, the role of single-port laparoscopic surgery for adhesive small bowel obstruction remains unclear. We report our experience of performing single-port laparoscopic surgery for adhesive small bowel obstruction through a retrospective review of 15 consecutive patients who underwent single-port laparoscopic surgery for single adhesive small bowel obstruction between 2010 and 2012. We analyzed data on patient demographics, operating time, conversion, and surgical morbidity. Surgery was completed successfully without conversion to laparotomy or the need for additional intraoperative ports in 14 patients, but the remaining patient had peritoneal dissemination from colon cancer. The median operative time was 49 (25-148) min, and the estimated blood loss was 19 (2-182) ml. There were no major postoperative complications. We conclude that single-port laparoscopic surgery is a technically feasible approach for selected patients with adhesive small bowel obstruction when preoperative imaging identifies a single adhesive obstruction.

Hiro J; Inoue Y; Okugawa Y; Kawamoto A; Okita Y; Toiyama Y; Tanaka K; Uchida K; Mohri Y; Kusunoki M

2013-09-01

80

Granular small bowel mucosa: a reflection of villous abnormality  

Energy Technology Data Exchange (ETDEWEB)

Diffuse mucosal granularity was reported recently in small bowel Crohn's disease. The radiographic appearance corresponded on histopathologic examination to villous hypertrophy, fusion, or epithelial bridge formation. We have observed similar granularity in Crohn's disease but also in several other conditions, including radiation enteritis, pancreatic glucagonoma, protein-losing enteropathy, and small bowel ischemia. Histopathologic examination demonstrated various alterations in villous morphology, such as edema, hyperplasia, clubbing, or fusion. In Crohn's disease, this appearance was sometimes an indication of early inflammatory disease but was also seen following extensive small bowel resection, possibly due to villous enlargement resulting from intestinal adaptation. These findings suggest that granular mucosa in the small bowel is a nonspecific finding reflecting an alteration in villous structure.

Jones, B.; Hamilton, S.R.; Rubesin, S.E.; Bayless, T.M.; Ravich, W.J.; Hendrix, T.R.

1987-01-01

 
 
 
 
81

Salivary duct carcinoma metastasizing to the small bowel.  

UK PubMed Central (United Kingdom)

We report a case of salivary duct carcinoma in a 47-year-old woman. The patient presented with symptoms simulating acute appendicitis. Surgery revealed metastatic tumor in the wall of the small bowel. Two months later, a tumor of the right parotid gland was resected, and histologic analysis revealed a salivary duct carcinoma. To our knowledge, this is the first case of salivary duct carcinoma metastasizing to the small bowel with manifestations of metastatic disease as the prominent symptom.

Kruslin B; Scukanec-Spoljar M; Separovi? V; Manojlovi? S; Jankovi? D; Danilovi? Z

1996-09-01

82

Pylephlebitis secondary to strangulated umbilical hernia with small bowel ischemia  

Directory of Open Access Journals (Sweden)

Full Text Available Pylephlebitis is a septic thrombophlebitis of the portal venous system that infrequently complicates small bowel infarction. We present a case of pylephlebitis with portomesenteric vein gas bubbles secondary to small bowel ischemia caused by a strangulated umbilical hernia, diagnosed on computed tomography (CT) and confirmed in the operating theater. This case is an example of the usefulness of CT in early recognition of suggestive radiologic findings of pylephlebitis associated with intestinal ischemia for prompt treatment of the patient.

Ennio Bruschi; Giovanna Graziani; Maurizio Vergendo; Antonello Conte; Massimo Valentino

2013-01-01

83

Primary small bowel lymphomas: clinico-radiological correlations  

International Nuclear Information System (INIS)

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

1991-01-01

84

CT findings of small bowel metastases from primary lung cancer  

International Nuclear Information System (INIS)

[en] 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

85

Transient small bowel angioedema due to intravenous iodinated contrast media  

Directory of Open Access Journals (Sweden)

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; Xiang-Yang Gong; Peng Hu

2012-01-01

86

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.

2004-01-01

87

US features of transient small bowel intussusception in pediatric patients  

Energy Technology Data Exchange (ETDEWEB)

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.

Kim, Ji Hye [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2004-09-15

88

Diverticulite do intestino delgado, uma causa incomum de abdome agudo inflamatório =Diverticulitis of the small bowel, an unusual cause of inflamatory acute abdomen  

Directory of Open Access Journals (Sweden)

Full Text Available Objetivos: Descrever a apresentação clínica, o diagnóstico diferencial e o tratamento de um caso de diverticulite do intestino delgado. Descrição do caso: Um homem de 58 anos de idade apresentou quadro clínico de dor e distensão abdominal, com exames de imagem demonstrando espessamento de alça de intestino delgado. Foi realizado exame videolaparoscópico do abdome e diagnosticada diverticulite do intestino delgado, a qual recebeu tratamento cirúrgico. O paciente teve boa evolução no pós operatório. Conclusões: A localização da doença diverticular no intestino delgado é pouco comum, e sua apresentação com complicações como perfuração, obstrução e hemorragia a tornam de grande importância clínica, pela dificuldade de se estabelecer o diagnóstico diferencial com outras moléstias abdominais. Aims: To describe the clinical presentation, differential diagnosis and treatment of a case of diverticulitis of the small intestine. Case description: A man of fifty-eight years of age presented a clinical picture of abdominal pain and distension, with imaging demonstrating thickened loop of small intestine. Direct laparoscopic examination of the abdomen diagnosed diverticulitis of the small intestine, which received surgical treatment. The patient progressed well postoperatively. Conclusion: Small bowel is an uncommon site of diverticular disease, and its great clinical importance lies in its presentation with problems such as perforation, obstruction and bleeding, which makes it difficult to establish a differential diagnosis with other abdominal diseases.

Leão, Ari BenHur Stefani et al.

2012-01-01

89

Surgical management of irradiation-induced small bowel damage  

International Nuclear Information System (INIS)

[en] Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups

1985-01-01

90

Surgical management of irradiation-induced small bowel damage  

Energy Technology Data Exchange (ETDEWEB)

Seventy-seven patients, presenting with radiation small bowel injuries at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1962 and 1978, were analyzed retrospectively. The patients were divided into two categories: bowel bypass without resection, and resection of irradiated bowel. Each group was then analyzed for its short- and long-term complications. Ileocolectomy with end-to-end anastomosis was the surgical procedure of choice in those people undergoing resection. There was no difference in short-term complications noted between the two groups. The long-term complications of fistula formation and continued small bowel necrosis could be prevented by resection, as a primary procedure. The surgical details of ileocolectomy with end-to-end anastomosis are presented, along with an analysis of the complications encountered in both groups.

Smith, S.T.; Seski, J.C.; Copeland, L.J.; Gershenson, D.M.; Edwards, C.L.; Herson, J.

1985-04-01

91

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

Directory of Open Access Journals (Sweden)

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

Eun-Jung Cha

2011-01-01

92

Pathology Case Study: Small Bowel Malabsorption  

Science.gov (United States)

This is a case study presented by the University of Pittsburgh Department of Pathology in which a child developed bowel transplantation. Visitors are given the microscopic descriptions, including images, and have the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pediatric pathology.

Agostini, Rocco; Kapali, Malathy

2008-05-20

93

Small bowel intramural hematoma secondary to abdominal massage.  

UK PubMed Central (United Kingdom)

Oral anticoagulant therapy with warfarin is commonly used to prevent thromboembolic event in patients at risk with atrial fibrillation [1]. Spontaneous intramural hematoma of small intestine is rare complication of anticoagulant therapy and occurs in patient who receives excessive warfarin that may result in potentially serious complications. Small bowel intramural hematoma secondary to warfarin therapy is a recognized complication [2]. In the present report, we report an unusual case of small bowel intramural hemorrhage secondary to anticoagulant therapy after abdominal massage. The emergency physicians should be aware that the potential spontaneous small bowel intramural hemorrhage in the patients has a high index of suspicion because most patients are treated nonoperatively with a good outcome.

Chen HL; Wu CC; Lin AC

2013-04-01

94

ENETS TNM Staging Predicts Prognosis in Small Bowel Neuroendocrine Tumours.  

UK PubMed Central (United Kingdom)

Introduction. Small bowel neuroendocrine tumours (NETs) are the most common type of gastrointestinal neuroendocrine tumours. The incidence and prevalence of these tumours are on the rise. The aims of this study were to determine prognostic clinicopathological features and whether the ENETS TNM staging system predicts prognosis and also. Method. Clinical data was collected retrospectively from 138 patients with histologically proven small bowel NETs managed at King's College Hospital. Histology was reviewed and small bowels tumours, were staged according to the ENETS TNM staging system. Results. Median age was 65 years (range 29-87). The 5-year survival was 79.5% and the 10-year survival was 48.5%. Resection of the primary tumour was associated with improved survival (120 versus 56 months, P < 0.05). On multivariate analysis prognostic factors were primary tumour resection and not having a carcinoid heart disease. TNM staging significantly separated survival of stage 2 and stage 3 from stage 4 NETs. Conclusion. Small bowel primary tumour resection and not having carcinoid heart disease are prognostic factors. The ENETS TNM staging and grading system appears to be of prognostic relevance to small bowel NETs.

Srirajaskanthan R; Ahmed A; Prachialias A; Srinivasan P; Heaton N; Jervis N; Quaglia A; Vivian G; Ramage JK

2013-01-01

95

Small bowel barium meal with methylcellulose of different viscosity  

International Nuclear Information System (INIS)

In certain diseases originating from the small intestine the peroral application of contrast medium can complete with enteroclysis. The use of methylcellulose MH 1000 proved to be a good compromise between viscosity and stability of mucosal coating. It allowdd good image quality in all segments of the small bowel particularly in the distal ileum. Therefore, this method is clearly indicated in Crohn's disease. Good results were also obtained in delineating tumours, radiation enteritis and ischaemic enteritis. With few patients exhibiting reduced small bowel mobility and/or who are incapable of drinking adequate volumes of contrast medium the results of the oral method are rather unfavourable. (orig.)

1988-01-01

96

Noninvasive diagnosis of small bowel Crohn's disease: direct comparison of bowel sonography and magnetic resonance enterography.  

UK PubMed Central (United Kingdom)

BACKGROUND: The diagnosis of small bowel Crohn's disease (CD) is performed by ileocolonoscopy, whereas the assessment of its extension can be achieved by radiologic studies or, noninvasively, by magnetic resonance (MR) enterography and bowel sonography (BS). However, few comparative studies exist directly comparing the diagnostic accuracy of BS and MRI. The aim of this study was to evaluate the diagnostic accuracy of BS and MRI for the diagnosis of small bowel CD. METHODS: We prospectively performed a noninferiority diagnostic study including 234 consecutive subjects with suspected small bowel CD. All patients underwent IC (used as gold standard for diagnosis), BS, and MR enterography performed in random order by physicians who were blinded about the results. RESULTS: The diagnosis of small bowel CD was made in 120 of 249 subjects (48%). Sensitivity, specificity, positive predictive value, and negative predictive value for CD diagnosis were 94%, 97%, 97%, and 94% for BS and 96%, 94%, 94%, and 96% for MR enterography, respectively. BS was less accurate than MR enterography in defining CD extension (r = 0.69), whereas the concordance in terms of CD location between the 2 procedures was high (k = 0.81). Also, MRI showed a fair concordance with BS about strictures (k = 0.82) and abscesses (k = 0.88), with better detection of enteroenteric fistulas (k = 0.67). CONCLUSIONS: BS and MR enterography are 2 accurate procedures for the diagnosis of small bowel CD, although MR seems to be more sensitive in defining its extension. BS could be used to select the patients for subsequent MRI examination.

Castiglione F; Mainenti PP; De Palma GD; Testa A; Bucci L; Pesce G; Camera L; Diaferia M; Rea M; Caporaso N; Salvatore M; Rispo A

2013-04-01

97

Diagnostic performance of 64-MDCT for blunt small bowel perforation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The objective was to assess the diagnostic performance of 64-multidetector computed tomography (CT) for blunt small bowel perforation (BSBP). MATERIALS AND METHODS: The study included 106 CT examinations of surgically proven blunt bowel and mesentery injuries (78 of BSBP and 28 of non-BSBP). CT diagnosis was based on detection of bowel wall discontinuity or extraluminal gas. RESULTS: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT diagnosis were 84.0%, 79.5%, 96.4%, 98.4%, and 62.8%, respectively. Bowel wall discontinuity and extraluminal gas were detected on 19.2% and 74.4% examination, respectively. CONCLUSION: CT diagnosis of BSBP is highly specific but not sensitive.

Park MH; Shin BS; Namgung H

2013-09-01

98

X-ray differential diagnosis in small bowel disease  

Energy Technology Data Exchange (ETDEWEB)

This book is a compendium of the author's experience with contrast fluid irrigation techniques of the small intestine. This book contains 300 radiographs, X-rays and detailed figures. It presents an overview of differential diagnosis of abnormal conditions of the small bowel.

Sellink, S.L. (University Hospital, Leiden (NL))

1988-01-01

99

X-ray differential diagnosis in small bowel disease  

International Nuclear Information System (INIS)

This book is a compendium of the author's experience with contrast fluid irrigation techniques of the small intestine. This book contains 300 radiographs, X-rays and detailed figures. It presents an overview of differential diagnosis of abnormal conditions of the small bowel

1988-01-01

100

Small bowel review: diseases of the small intestine.  

Science.gov (United States)

In the past year there have been many advances in the area of small bowel physiology and pathology and therapy. In preparation for this review, over 1500 papers were assessed. The focus is on presenting clinically useful information for the practicing gastroenterologist. Selected important clinical learning points include the following: (1) glutamine may restore the AIDs-associated increased intestinal permeability to normal; (2) substance P is a major mediator of diarrhea caused by Costridium difficile toxin A, acting by binding to a G-protein-coupled receptor, and represents a possible 2therapeutic target; (3) the serological diagnosis of celiac disease has been greatly enhanced with the use of anti-endomysial antibody testing, and the recent antitransglutaminase; (4) a quarter of patients with celiac disease may have secondary pancreatic insufficiency and require enzyme replacement therapy; (5) in the patient with unexplained elevation in the serum transaminase concentration, consider celiac disease as an obscure possibility; (6) bosentan and endothelin receptor agonist may prove to be useful in reducing gut ischemia in patients with septic shock; and (7) the administration of recombinant human fibroblast growth factor-2 may prove to be useful to prevent radiation damage to the gastrointestinal tract. PMID:11768246

Thomson, A B; Keelan, M; Thiesen, A; Clandinin, M T; Ropeleski, M; Wild, G E

2001-12-01

 
 
 
 
101

Small bowel review: diseases of the small intestine.  

UK PubMed Central (United Kingdom)

In the past year there have been many advances in the area of small bowel physiology and pathology and therapy. In preparation for this review, over 1500 papers were assessed. The focus is on presenting clinically useful information for the practicing gastroenterologist. Selected important clinical learning points include the following: (1) glutamine may restore the AIDs-associated increased intestinal permeability to normal; (2) substance P is a major mediator of diarrhea caused by Costridium difficile toxin A, acting by binding to a G-protein-coupled receptor, and represents a possible 2therapeutic target; (3) the serological diagnosis of celiac disease has been greatly enhanced with the use of anti-endomysial antibody testing, and the recent antitransglutaminase; (4) a quarter of patients with celiac disease may have secondary pancreatic insufficiency and require enzyme replacement therapy; (5) in the patient with unexplained elevation in the serum transaminase concentration, consider celiac disease as an obscure possibility; (6) bosentan and endothelin receptor agonist may prove to be useful in reducing gut ischemia in patients with septic shock; and (7) the administration of recombinant human fibroblast growth factor-2 may prove to be useful to prevent radiation damage to the gastrointestinal tract.

Thomson AB; Keelan M; Thiesen A; Clandinin MT; Ropeleski M; Wild GE

2001-12-01

102

Small bowel adenocarcinoma: Epidemiology, risk factors, diagnosis and treatment.  

UK PubMed Central (United Kingdom)

Small bowel adenocarcinomas are rare tumours, but their incidence is increasing. Their most common primary location is the duodenum. The few studies that have collected data regarding small bowel adenocarcinoma are not homogeneous and are widely spread over time. Even though these tumours are most often sporadic, some predisposing diseases have been identified, among which Crohn's disease and genetic syndromes. Early diagnosis of small bowel adenocarcinoma remains difficult despite significant radiological and endoscopic progress. After surgical resection the main prognostic factor is node invasion; in this case, adjuvant chemotherapy can be expected to be beneficial, although this has not been established by randomised trials. For metastatic disease, platinum-based chemotherapy seems to be the most effective treatment. Targeted therapies have not yet been evaluated in this type of cancer.

Aparicio T; Zaanan A; Svrcek M; Laurent-Puig P; Carrere N; Manfredi S; Locher C; Afchain P

2013-06-01

103

[Technical aspects, indications and results of small bowel videocapsule endoscopy].  

UK PubMed Central (United Kingdom)

BACKGROUND: Videocapsule endoscopy is a new non-invasive endoscopic tool useful for small bowel examination. Aim: The aims of this review are to precise the technical aspects of videocapsule endoscopy, indications and results of this technique in clinical practice. METHODS: Literature review. RESULTS: The main indication of vidéocapsule endoscopy is obscure gastrointestinal bleeding. Videocapsule endoscopy can precise the aetiology of the bleeding and guide the therapeutic approach. The second indication is Crohn's disease, in establishment of the diagnosis, evaluation of small bowel extension or in differential diagnosis of indeterminate colitis. Videocapsule endoscopy is also useful in patients with small bowel neoplasia, polyposis and some patients with celiac sprue. CONCLUSION: Videocapsule endoscopy is an important endoscopic technique which is must be quickly part of endoscopic diagnosis tools.

Karoui S; Ouerdiane S; Serghini M; Boubaker J; Filali A

2010-08-01

104

Diospyrobezoar as a cause of small bowel obstruction.  

UK PubMed Central (United Kingdom)

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 AP; Rodrigues FH; Rodrigues MR; Sato DT; Nonose R; Nascimento EF; Martinez CA

2012-09-01

105

Cell stress response in rat chronic small bowel allograft rejection.  

UK PubMed Central (United Kingdom)

BACKGROUND: We sought to assess the expression of five cell stress molecules: Heat shock protein (HSP)-60, HSP-70, interferon (IFN)-?, rat retinoic acid early induible-1 like transcript (RRLT), and vasoactive intestinal peptide (VIP) during rat chronic small bowel allograft rejection. METHODS: A rat model of small bowel allograft rejection was induced on postoperative day 90 using F344 rat as donor and Lewis rat as recipient. RESULTS: We demonstrated increased expression of lamina propria HSP-60 (mean rank grade 8.3 and 3.2, respectively), graft RRLT (relative mRNA amount 5.1 ± 1.8 and 3.0 ± 1.3, respectively) and IFN-? (relative mRNA amount 108.3 ± 49.2 and 59.2 ± 22.0, respectively) in allograft group compared with the isograft group. CONCLUSION: These data suggest the presence of cell stress during chronic small bowel allograft rejection.

Wang J; Li Y; Li J

2013-07-01

106

Small bowel protection with 'STEP'  

Energy Technology Data Exchange (ETDEWEB)

This is a case report of a patient presenting with rectal carcinoma and Crohn's disease. Adjuvant treatment was considered to be mandatory on the basis of local extention. Therefore a Silastic Tissue Expander Prosthesis (STEP), connected with a subcutaneously located self-sealing valve system, was introduced surgically to push small bowel up of the treatment portals. Patient received 55 Gy without any acute or late complication. This easy technique allows radiotherpay in conditions where complete elimination of small bowel outside the treatment volume is required. (orig.).

Coucke, P.A.; Mirimanoff, R.O. (Centre Hospitalier Universitaire Vandois, Lausanne (Switzerland). Dept. of Radiotherapy); Cuttat, J.F. (Centre Hospitalier Universitaire Vandois, Lausanne (Switzerland). Dept. of Surgery)

1992-04-01

107

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; Hester Y. S. Cheung; Cliff C. C. Chung; Michael K. W. Li

2013-01-01

108

Normal tissue tolerance to external beam radiation therapy: Small bowel  

International Nuclear Information System (INIS)

The small bowel is a hollow organ involved in the transit and absorption of food. In relation to its anatomical location, a significant amount of this organ is exposed in whole or in part to ionizing radiation in external radiotherapy during abdominal or pelvic irradiation either for primary cancers or metastasis. The acute functional changes during external beam radiation are mainly leading to diarrhea, abdominal pain and bloating. The main late side effects of irradiation of the small intestine are chronic diarrhea, malabsorption with steatorrhoea, abdominal spasms, intestinal obstruction, bleeding and fistulas. The architecture of the small intestine may be considered as parallel with a significant correlation between the irradiated volume of small bowel and the likelihood of acute toxicity, whatever the dose. The literature analysis recommends to consider the volume of small bowel receiving 15 Gy (threshold of 100 to 200 cm3) but also 30 and 50 Gy (thresholds of 35 to 300 cm3, depending on the level of dose considered). Modern techniques of conformal radiotherapy with modulated intensity will probably have beneficial impact on small bowel toxicity. (authors)

2010-01-01

109

Development of a new method for small bowel transit study  

International Nuclear Information System (INIS)

Currently, most studies combine the small bowel transit examination with gastric emptying time examination. There are significant drawbacks to this method. The radiotracer does not enter the small intestine in a bolus and the starting time for transit in the duodenum is difficult to define. This makes the result unreliable. In this study, we used a commercial enteric capsule containing radioactive charcoal to solve these problems. Activated charcoal powder was mixed with Tc-99m pertechnetate and loaded to the enteric capsule which can resist gastric acid and dissolve only in the small intestine, in-vitro stability experiment was performed by immersing these capsules in a colorless phosphate buffer of variable pH which mimicked the condition in stomach and small intestine. In addition, ten healthy Chinese volunteers were included for in-vivo experiment. Anterior and posterior views of abdomen were obtained at regular 30-minute intervals until the eighth hour after administration of the radioactive enteric capsule. Small bowel transit time was calculated. The enteric capsule remained intact for at least 480 minutes in the solution mimicking gastric content (pH=3.0) and disrupted at a mean duration of 227.2 minutes at a pH of 6.8 and at a mean duration of 212.4 minutes at a pH of 7.4 in the solution mimicking pancreaticobiliary secretions. In nine of ten volunteers, the small bowel transit time was between 30 to 270 minutes with a mean transit time of 140 min. In one volunteer, we failed to detect the exact time of small bowel transit because the capsule remained in the stomach throughout the study for up to 8 hours. We consider activated charcoal labeled with Tc-99m pertechnetate using an enteric capsule as the carrier to be a potential radioactive marker for small bowel transit study. (author)

2006-01-01

110

MR enterography in the evaluation of small bowel dilation  

Energy Technology Data Exchange (ETDEWEB)

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

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

2009-10-15

111

Small bowel adenocarcinoma mimicking a large adrenal tumor  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 admitte...

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

112

Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma.  

UK PubMed Central (United Kingdom)

Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis.

Naidoo K; Mewa Kinoo S; Singh B

2013-01-01

113

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

2007-01-01

114

Small bowel ultrasound in patients with celiac disease  

Energy Technology Data Exchange (ETDEWEB)

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

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

2007-08-15

115

Clinical and immunohistochemical studies of small bowel carcinoid tumours  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Small bowel carcinoid tumours arising from enterochromaffin cells in the jejunum and ileum are neuroendocrine tumours (NETs) characterized by secretion of serotonin, tachykinins and other bioactive substances. These substances may lead to the typical carcinoid syndrome as well as pronounced fibrosis...

Landerholm, Kalle

116

Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma  

Science.gov (United States)

Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis.

Naidoo, K.; Mewa Kinoo, S.; Singh, B.

2013-01-01

117

Oral purgative and simethicone before small bowel capsule endoscopy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 liqu...

Bruno Joel Ferreira Rosa; Mara Barbosa; Joana Magalhães; Ana Rebelo; Maria João Moreira; José Cotter

118

MR enterographic manifestations of small bowel Crohn disease.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Magnetic resonance (MR) enterography is a clinically useful technique for the evaluation of both intraluminal and extraluminal small bowel disease, particularly in younger patients with Crohn disease. MR enterography offers the advantages of multiplanar capability and lack of ionizing radiation. It ...

Tolan, DJ; Greenhalgh, R; Zealley, IA; Halligan, S; Taylor, SA

119

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; Andy Culver

2012-01-01

120

Small bowel obstruction due to incarcerated sciatic hernia: ultrasound diagnosis.  

UK PubMed Central (United Kingdom)

A 71-year-old woman presented with vomiting, abdominal pain and vague right gluteal discomfort. Abdominal ultrasound showed ascites and dilated small bowel loops with peristaltic movement, while transgluteal ultrasound revealed entrapped ascites beneath gluteal muscles and an oedematous, immobile bowel loop trapped between the sacrum and iliac bone with barely visible colour Doppler flow suggestive of an incarcerated sciatic hernia. CT demonstrated similar findings and subsequent surgery confirmed the diagnosis. To our knowledge, this is the first report of a pre-operative diagnosis of incarcerated sciatic hernia on ultrasound.

Yu PC; Ko SF; Lee TY; Ng SH; Huang CC; Wan YL

2002-04-01

 
 
 
 
121

Evisceration of small bowel after cauterization of an umbilical mass.  

UK PubMed Central (United Kingdom)

The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient required resection of the incarcerated bowel but had an otherwise uneventful and complete recovery.

Kondrich J; Woo T; Ginsburg HB; Levine DA

2012-12-01

122

Evisceration of small bowel after cauterization of an umbilical mass.  

Science.gov (United States)

The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient required resection of the incarcerated bowel but had an otherwise uneventful and complete recovery. PMID:23166332

Kondrich, Janienne; Woo, Theodore; Ginsburg, Howard B; Levine, Deborah A

2012-11-19

123

[The first Danish child with small bowel transplantation].  

UK PubMed Central (United Kingdom)

A girl with extensive Hirschsprung's disease was operated, leaving her with a 35 cm short bowel. She received long-term parenteral nutrition through a central catheter. Progressive liver failure and intravenous access problems developed and at the age of 5.5 years she was transplanted in Birmingham with 270 cm small bowel, a reduced liver and pancreas. After the transplantation she received immunosuppressive medication, ursodeoxycholic acid and antibiotic prophylaxis. She is now well and on enteral nutrition, 32 months after the transplantation.

Thøstesen LM; Lassen LB; Qvist N; Gupte G; Husby S

2010-03-01

124

Transrectal small bowel evisceration after abdominal crush injury.  

UK PubMed Central (United Kingdom)

Transrectal small bowel evisceration (TSBE) is a rare entity that can occur after traumatic injuries. It has been described after impalement, sexual assault, blunt abdominal trauma, and swimming pool drain suction. The authors encountered such a case in a 4-year-old by following a crush abdominal injury. A laparotomy was performed. The eviscerated bowel was pulled inside the abdominal cavity, revealing the rectal perforation. A portion of devascularized ileum was resected, a primary bowel anastomosis was performed, and the longitudinal rectal laceration was repaired with a two-layered closure. There was no fecal soilage, and no protective colostomy was performed. The mortality and morbidity of TSBE are usually related with the severity and type of trauma. The mesenteric laceration and concomitant injuries can cause significant bleeding leading to a hemorrhagic shock and multiorgan failure.

Gelas T; Combet S; Perinel J; Javouhey E; Mure PY

2012-11-01

125

[Value of small bowel double contrast enema in clinical interventions].  

Science.gov (United States)

The double contrast enema is the most effective morphological screening method for the evaluation of the whole small bowel. Its sensitivity is 85%, its specifity 96.7%. In specific clinical problems the number of pathological roentgen findings rises: from 34.4% when all indications are taken into consideration to 58% in indications specific to the small intestine such as Morbus Crohn or the malabsorption syndrome. Search for tumours and the double contrast of the small bowel in unclear gastro-intestinal bleeding are unproductive. The weak point of this screening method is the lower part of the small intestine. Therefore, the selective peroral or retrograde analysis of the terminal ileum supplement the contrast method. A precondition for good results is an adequate technical standard. Besides the clinical results some technical results are therefore discussed such as contrast medium quantities, examination and X-ray time, radiation exposure and influences on the image quality. PMID:3083480

Rödl, W; Possel, H M; Prull, A; Wunderlich, L

1986-02-01

126

Diffuse small bowel thickening in aids patient - a case report  

Directory of Open Access Journals (Sweden)

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

Singla Rohit; Hari Samriti; Sharma Surendra K

2010-01-01

127

Abnormalities of small bowel and colon in systemic sclerosis  

International Nuclear Information System (INIS)

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

1990-01-01

128

Mesenteric cysts associated with recurrent small-bowel volvulus: cause or effect?  

UK PubMed Central (United Kingdom)

Recurrent small-bowel volvulus is a state of recurrent intermittent or long-standing persistent twisting of small-bowel loops around its mesentery. The association of mesenteric cysts with recurrent small-bowel volvulus as the cause or effect is a much debated issue in the literature. We report two cases of mesenteric lymphangioma and one case of enteric duplication cyst seen in association with recurrent small-bowel volvulus of long duration in absence of malrotation.

Prabhu SM; Anand R; Narula MK; Shetty GS; Udiya AK; Chauhan U; Shukla S; Grover JK

2012-12-01

129

Oral purgative and simethicone before small bowel capsule endoscopy  

Directory of Open Access Journals (Sweden)

Full Text Available 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 followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. RESULTS: There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). CONCLUSION: Preparation with 2 L of PEG before small bowel capsule endoscopy (SBCE) may improve small bowel cleansing and the quality of visualization. Simethicone may further reduce intraluminal bubbles. No significant differences were found regarding GET, SBTT and the proportion of complete exploration or diagnostic yield among the three different cleansing protocols.

Bruno Joel Ferreira Rosa; Mara Barbosa; Joana Magalhães; Ana Rebelo; Maria João Moreira; José Cotter

2013-01-01

130

Oral purgative and simethicone before small bowel capsule endoscopy.  

UK PubMed Central (United Kingdom)

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 followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. RESULTS: There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). CONCLUSION: Preparation with 2 L of PEG before small bowel capsule endoscopy (SBCE) may improve small bowel cleansing and the quality of visualization. Simethicone may further reduce intraluminal bubbles. No significant differences were found regarding GET, SBTT and the proportion of complete exploration or diagnostic yield among the three different cleansing protocols.

Rosa BJ; Barbosa M; Magalhães J; Rebelo A; Moreira MJ; Cotter J

2013-02-01

131

MR imaging of the small bowel in Crohn's disease  

International Nuclear Information System (INIS)

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

2009-01-01

132

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 ...

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

133

Small-bowel obstruction associated with Crohn's enterolith.  

UK PubMed Central (United Kingdom)

One of the lesser known clinical manifestations of Crohn's disease is the formation of small-bowel enteroliths. These concretions precipitate in the setting of small-bowel stasis within the alimentary tract and are associated with a variety of disease states causing strictures or diverticula. In the acute setting, patients typically present with signs of intestinal obstruction due to stone impaction. The case we report involves a 67-year-old female with long-standing Crohn's disease who presented with a 6-day history of worsening abdominal pain. Plain abdominal radiographs demonstrated dilated bowel loops consistent with intestinal obstruction. Computed tomography revealed a 2.5-cm calcified density at the transition point in the distal ileum, and two additional stones were present in the proximal ileum. At surgery, multiple ileal strictures were found, and ileocolic resection with primary anastomoses was performed. The accurate diagnosis of enterolithiasis in the setting of Crohn's disease has significant clinical implications for management and is a harbinger of underlying bowel stenosis.

Tewari A; Weiden J; Johnson JO

2013-08-01

134

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

Science.gov (United States)

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, pain control and surgery for selected cases. This review discusses recent advances in the medical treatment of diverticular disease such as the use of mesalamine, rifaximin and probiotics as our understanding of the disease evolves. PMID:23634185

Boynton, Wen; Floch, Martin

2013-05-01

135

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

UK PubMed Central (United Kingdom)

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, pain control and surgery for selected cases. This review discusses recent advances in the medical treatment of diverticular disease such as the use of mesalamine, rifaximin and probiotics as our understanding of the disease evolves.

Boynton W; Floch M

2013-05-01

136

[Bleeding small bowel angiodysplasia: unusual form of conservative treatment].  

UK PubMed Central (United Kingdom)

The authors report a case of gastrointestinal bleeding caused by angiodysplasia of the small bowel. They stress the rarity of the lesion and consider the difficulties involved in obtaining a preoperative diagnosis. Intra- or pre-operative enteroscopy seems to be the most suitable method for identifying the source of occult small-bowel bleeding. The optimal management is uncertain and depends on the severity and rate of the bleeding. A conservative medical approach is indicated for many patients, while surgery constitutes definitive treatment in cases of massive haemorrhage or recurrent bleeding. The authors describe a case in which the diagnosis was reached only at intra-operative enteroscopy and an unusual conservative surgical treatment was performed based on ligation of the vascular elements of the angiodysplasia. This method makes it possible to avoid an intestinal resection and yields good results.

Biandrate F; Piccolini M; Francia L; Rosa C; Battaglia A; Pandolfi U

2003-05-01

137

Multifocal small bowel lymphoma and latent celiac sprue.  

UK PubMed Central (United Kingdom)

Malignant small intestinal lymphoma may complicate or antedate clinical recognition of celiac sprue, a disorder becoming increasingly diagnosed as a subclinical or occult disease. A 73-yr-old woman with previously resected jejunoileal lymphoma and normal proximal small bowel biopsy specimens was given a high-gluten diet containing 40 g of added gluten daily for 4 wk. This caused small intestinal biopsy abnormalities typical of celiac sprue; the abnormalities resolved 6 wk later with a gluten-free diet. This indicates that latent celiac sprue may be present in some patients with lymphoma and suggests that the association of celiac sprue and lymphoma may be more frequent than is currently appreciated.

Freeman HJ; Chiu BK

1986-06-01

138

Metachronous small-bowel adenocarcinoma in celiac sprue.  

UK PubMed Central (United Kingdom)

Celiac sprue, or nontropical sprue, is associated with an increased incidence of digestive tract malignancy. We report a patient with celiac sprue who developed two primary adenocarcinomas of the jejunum > 2 years apart. The second cancer was asymptomatic and detected by surveillance computed tomography. Small-bowel cancers are unusual, and frequency of follow-up has not been established, so that it is important to have a high index of suspicion for these malignancies in celiac patients with vague gastrointestinal symptoms.

Begos DG; Kuan S; Dobbins J; Ravikumar TS

1995-04-01

139

Efficacy of small bowel follow-through with oral administration of methylcellulose in the diagnosis of small bowel disease  

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To evaluate the usefulness of modified Small Bowel Follow Through (SBFT) with oral administration of methylcellulose in patients with small bowel diseases. Mean transit time was 142 minutes, and the maximum diameter of the jejunum and ileum was 2.9 cm and 2.1 cm respectively: in 45 patients (63%) the examination was concluded within 2 hours. The quality of images was excellent in 29 cases (41%), good in 30 (42%), fair in 8 (11%), and poor in 3 (4%). Images related to the inflammatory and vascular disease were graded as 'good' or 'excellent' in 92% and 89% of cases, respectively, and the image quality of lesions of the jejunum and ileum were graded, respectively, as 'good' or 'excellent' in 96 % and 63% of cases. Using this modified technique, sensitivity and specificity were 90% and 99%, respectively. Modified SBFT with the oral administration of methylcellulose is a simple but highly sensitive method of evaluating small bowel diseases. It is especially valuable in cases of inflammatory and vascular disease of the small intestine and lesions in the jejunum. (author). 15 refs., 4 tabs., 5 figs.

1998-01-01

140

Efficacy of small bowel follow-through with oral administration of methylcellulose in the diagnosis of small bowel disease  

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To evaluate the usefulness of modified Small Bowel Follow Through (SBFT) with oral administration of methylcellulose in patients with small bowel diseases. Mean transit time was 142 minutes, and the maximum diameter of the jejunum and ileum was 2.9 cm and 2.1 cm respectively: in 45 patients (63%) the examination was concluded within 2 hours. The quality of images was excellent in 29 cases (41%), good in 30 (42%), fair in 8 (11%), and poor in 3 (4%). Images related to the inflammatory and vascular disease were graded as `good` or `excellent` in 92% and 89% of cases, respectively, and the image quality of lesions of the jejunum and ileum were graded, respectively, as `good` or `excellent` in 96 % and 63% of cases. Using this modified technique, sensitivity and specificity were 90% and 99%, respectively. Modified SBFT with the oral administration of methylcellulose is a simple but highly sensitive method of evaluating small bowel diseases. It is especially valuable in cases of inflammatory and vascular disease of the small intestine and lesions in the jejunum. (author). 15 refs., 4 tabs., 5 figs.

Park, K. B.; Ha, H. K.; Kim, J. H.; Lee, S. H.; Jeong, A. K.; Lee, Y. S.; Yuh, H. S.; Kim, P. N.; Lee, M. G.; Auh, Y. H. [Univ. of Ulsan, Ulsan (Korea, Republic of). Coll. of Medicine

1998-01-01

 
 
 
 
141

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

International Nuclear Information System (INIS)

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.)

2009-01-01

142

Transmucosal myotomy of the small bowel after ileoanal anastomosis.  

UK PubMed Central (United Kingdom)

Posterior transmucosal myotomy of the small bowel distal to the pelvic pouch was carried out in two patients who underwent restorative proctocolectomy for ulcerative colitis. Painful spasms of the efferent limb and outlet obstruction of the reservoir were the main indications for surgery. Laparotomy was unnecessary, as the operation could be performed either through a transanal route or by means of a rigid sigmoidoscope. Both patients showed marked clinical improvement after myotomy; therefore, it may be considered an effective and safe procedure in the treatment of functional and mechanical disorders of the small intestine above an ileoanal anastomosis.

Pescatori M; Parks AG

1984-05-01

143

Transmucosal myotomy of the small bowel after ileoanal anastomosis.  

Science.gov (United States)

Posterior transmucosal myotomy of the small bowel distal to the pelvic pouch was carried out in two patients who underwent restorative proctocolectomy for ulcerative colitis. Painful spasms of the efferent limb and outlet obstruction of the reservoir were the main indications for surgery. Laparotomy was unnecessary, as the operation could be performed either through a transanal route or by means of a rigid sigmoidoscope. Both patients showed marked clinical improvement after myotomy; therefore, it may be considered an effective and safe procedure in the treatment of functional and mechanical disorders of the small intestine above an ileoanal anastomosis. PMID:6714049

Pescatori, M; Parks, A G

1984-05-01

144

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; Sarkar Rupa; Smith Andrew M

2008-01-01

145

An unusual cause of small bowel perforation: apricot pit.  

UK PubMed Central (United Kingdom)

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

Atila K; Güler S; Bora S; Gülay H

2011-05-01

146

Small bowel adenocarcinoma mimicking a large adrenal tumor  

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

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

2013-01-01

147

Small bowel adenocarcinoma mimicking a large adrenal tumor.  

UK PubMed Central (United Kingdom)

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

Ivovi? M; Zivaljevi? V; Vujovi? S; Marina L; Gaji? MT; Dundjerovi? D; Bara? M; Mici? D

2013-03-01

148

Intestinal anisakiasis as a rare cause of small bowel obstruction.  

UK PubMed Central (United Kingdom)

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

Kojima G; Usuki S; Mizokami K; Tanabe M; Machi J

2013-09-01

149

Intestinal anisakiasis as a rare cause of small bowel obstruction.  

Science.gov (United States)

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

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

2013-06-18

150

Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Capsule endoscopy (CE) is limited by incomplete small-bowel transit and poor view quality in the distal bowel. Currently, there is no consensus regarding the use of bowel purgatives or prokinetics in CE. OBJECTIVE: To evaluate the usefulness of bowel purgatives and prokinetics in small-bowel CE. DESIGN: Prospective single-blind randomized controlled study. SETTING: Academic endoscopy unit. PATIENTS: A total of 150 patients prospectively recruited. INTERVENTION: Patients were randomized to 1 of 4 preparations: "standard" (fluid restriction then nothing by mouth 12 hours before the procedure, water and simethicone at capsule ingestion [S]); "standard" + 10 mg oral metoclopramide before the procedure (M); Citramag + senna bowel-purgative regimen the evening before CE (CS); Citramag + senna + 10 mg metoclopramide before the procedure (CSM). MAIN OUTCOME MEASUREMENTS: Gastric transit time (GTT) and small-bowel transit time (SBTT), completion rates (CR), view quality, and patient acceptability. Secondary outcome measures: positive findings, diagnostic yield. RESULTS: No significant difference was noted among groups for GTT (median [minutes] M, CS, and CSM vs S: 17.3, 24.7, and 15.1 minutes vs 16.8 minutes, respectively; P = .62, .18, and .30, respectively), SBTT (median [minutes] M, CS, and CSM vs S: 260, 241, and 201 vs 278, respectively; P = .91, .81, and .32, respectively), or CRs (85%, 85%, and 88% vs 89% for M, CS, and CSM vs S, respectively; P = .74, .74, and 1.00, respectively). There was no significant difference in view quality among groups (of 44: 38, 37, and 40 vs 37 for M, CS, and CSM, vs S, respectively; P = .18, .62, and .12, respectively). Diagnostic yield was similar among the groups. CS and CSM regimens were significantly less convenient (P < .001), and CS was significantly less comfortable (P = .001) than standard preparation. CONCLUSIONS: Bowel purgatives and prokinetics do not improve CRs or view quality at CE, and bowel purgatives reduce patient acceptability.

Postgate A; Tekkis P; Patterson N; Fitzpatrick A; Bassett P; Fraser C

2009-05-01

151

Mesenteric Vasculature-guided Small Bowel Segmentation on 3D CT.  

UK PubMed Central (United Kingdom)

Due to its importance and possible applications in visualization, tumor detection and pre-operative planning, automatic small bowel segmentation is essential for computeraided diagnosis of small bowel pathology. However, segmenting the small bowel directly on CT scans is very difficult because of the low image contrast on CT scans and high tortuosity of the small bowel and its close proximity to other abdominal organs. Motivated by the intensity characteristics of abdominal CT images, the anatomic relationship between the mesenteric vasculature and the small bowel, and potential usefulness of the mesenteric vasculature for establishing the path of the small bowel, we propose a novel mesenteric vasculature map-guided method for small bowel segmentation on high-resolution CT angiography scans. The major mesenteric arteries are first segmented using a vessel tracing method based on multi-linear subspace vessel model and Bayesian inference. Second, multiview, multi-scale vesselness enhancement filters are used to segment small vessels, and vessels directly or indirectly connecting to the superior mesenteric artery are classified as mesenteric vessels. Third, a mesenteric vasculature map is built by linking vessel bifurcation points, and the small bowel is segmented by employing the mesenteric vessel map and fuzzy connectness. The method was evaluated on 11 abdominal CT scans of patients suspected of having carcinoid tumors with manually labeled reference standard. The result, 82.5% volume overlap accuracy compared with the reference standard, shows it is feasible to segment the small bowel on CT scans using the mesenteric vasculature as a roadmap.

Zhang W; Liu J; Yao J; Louie A; Nguyen T; Wank S; Nowinski WL; Summers R

2013-06-01

152

Staged abdominal closure after small bowel or multivisceral transplantation.  

UK PubMed Central (United Kingdom)

Following paediatric SBMT, size discrepancy between the recipient's abdomen and the graft may lead to ACS, graft dysfunction, and death. We report our experience with SAC in these patients. Between 04/1993 and 03/2009, 57 children underwent 62 SBMTs. When abdominal wall tension seemed excessive for safe PAC, SAC was performed, using a Silastic® sheet and a vacuum occlusive dressing. Transplantations with SAC (23 combined liver and small bowel [CLB]) were compared with those with PAC [14 ISB and 25 CLB]. Indications for transplantation, preoperative status (after stratification for ISB/CLB transplants), age at transplantation, donor-to-recipient weight ratio, reduction in bowel and/or liver, and incidence of wound complications were not different in both groups. Post-operative intubation, stay in intensive care unit, and hospital stay were prolonged after SAC. Two deaths were related to ACS after PAC, none after SAC. Since 2000, one-yr patient survival is 73% after ISB transplantation and 57% vs. 75% after CLB transplantation with PAC vs. SAC, respectively (NS). SAC safely reduces severe ACS after paediatric SBMT and can be combined with graft reduction for transplantation of small recipients.

Sheth J; Sharif K; Lloyd C; Gupte G; Kelly D; de Ville de Goyet J; Millar AJ; Mirza DF; Chardot C

2012-02-01

153

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

Directory of Open Access Journals (Sweden)

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

Tayeb Mohammad; Khan Faiz; Rauf Fozia; Khan M Mumtaz

2011-01-01

154

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

155

Diverticular disease as a chronic illness: evolving epidemiologic and clinical insights.  

UK PubMed Central (United Kingdom)

Diverticular disease imposes a significant burden on Western and industrialized societies. The traditional pathogenesis model posits that low dietary fiber predisposes to diverticulosis, and fecalith obstruction prompts acute diverticulitis that is managed with broad-spectrum antibiotics or surgery. However, a growing body of knowledge is shifting the paradigm of diverticular disease from an acute surgical illness to a chronic bowel disorder composed of recurrent abdominal symptoms and considerable psychosocial impact. New research implicates a role for low-grade inflammation, sensory-motor nerve damage, and dysbiosis in a clinical picture that mimics irritable bowel syndrome (IBS) and even inflammatory bowel disease (IBD). Far from being an isolated event, acute diverticulitis may be the catalyst for chronic symptoms including abdominal pain, cramping, bloating, diarrhea, constipation, and "post-diverticulitis IBS." In addition, studies reveal lower health-related quality of life in patients with chronic diverticular disease vs. controls. Health-care providers should maintain a high index of suspicion for the multifaceted presentations of diverticular disease, and remain aware that it might contribute to long-term emotional distress beyond traditional diverticulitis attacks. These developments are prompting a shift in therapeutic approaches from widespread antimicrobials and supportive care to the use of probiotics, mesalamine, and gut-directed antibiotics. This review addresses the emerging literature regarding epidemiology, pathophysiology, and management of chronic, symptomatic diverticular disease, and provides current answers to common clinical questions.

Strate LL; Modi R; Cohen E; Spiegel BM

2012-10-01

156

[Inflammatory bowel diseases: diagnosis (including new procedures for small intestine examination)].  

Science.gov (United States)

Medical history, clinical examination, general laboratory data and microbial stool examinations are basic diagnostics in inflammatory bowel diseases. Specific immunologic parameters can make classification easier in indefinite disease, their use is still in an experimental state. Ultrasound and endoscopic examinations have largely replaced conventional radiological procedures. For the experienced examiner, ultrasound allows assessment of small bowel and colon as well as other organs. Ileo-colonoscopy with biopsies remains the gold standard in the diagnosis of inflammatory bowel diseases. For small bowel examination, modern methods like push-enteroscopy, capsule endoscopy or the Hydro-MRI can be employed. At the moment, their usage is limited to specialized centers. Because of its broad availability small bowel follow through is still the standard in small bowel examination. After 8 years of colitis ulcerosa, ileo-colonoscopy with biopsy should be performed every year according to the guidelines. If these recommendations also apply to Crohn's disease is not sure yet. PMID:12501497

Hahne, M; Riemann, J F

2002-11-20

157

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.

1979-01-01

158

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

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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; Andrew Barleben; Brian S Buchberg; et al

2010-01-01

159

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

Science.gov (United States)

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

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

2013-06-24

160

Small bowel obstruction secondary to transport aircraft: Coincidence or reality?  

UK PubMed Central (United Kingdom)

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

Massalou D; Fournier M; Salucki B; Baqué P

2013-09-01

 
 
 
 
161

Colonic carcinoma with multiple small bowel perforations mimicking intestinal obstruction  

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

Tiwary Satyendra K; Singh Manish K; Khanna Rahul; Khanna Ajay K

2006-01-01

162

The management of patients with suspected early postoperative small bowel obstruction.  

UK PubMed Central (United Kingdom)

A 10-year review of 101 patients sustaining an early postoperative small bowel obstruction within 30 days of celiotomy was carried out. Signs, symptoms, lab tests, and x-rays did not indicate which patients required operation. Twenty-three patients were operated on for either failure to resolve their obstruction or because it was feared that ischemic bowel was present. In none of these patients, nor the 78 patients who resolved without reoperation, did dead bowel occur. Early postoperative small bowel obstruction was most often due to adhesions and inflammatory processes. Seven patients died (6.9%), three in the operated and four in the nonoperated group. Because ischemic bowel is very unlikely in patients with early postoperative small bowel obstruction, we advise 10 to 14 days of nasogastric suction initially; after this, improvement is unlikely without reoperation.

Pickleman J; Lee RM

1989-08-01

163

The management of patients with suspected early postoperative small bowel obstruction.  

Science.gov (United States)

A 10-year review of 101 patients sustaining an early postoperative small bowel obstruction within 30 days of celiotomy was carried out. Signs, symptoms, lab tests, and x-rays did not indicate which patients required operation. Twenty-three patients were operated on for either failure to resolve their obstruction or because it was feared that ischemic bowel was present. In none of these patients, nor the 78 patients who resolved without reoperation, did dead bowel occur. Early postoperative small bowel obstruction was most often due to adhesions and inflammatory processes. Seven patients died (6.9%), three in the operated and four in the nonoperated group. Because ischemic bowel is very unlikely in patients with early postoperative small bowel obstruction, we advise 10 to 14 days of nasogastric suction initially; after this, improvement is unlikely without reoperation. PMID:2757422

Pickleman, J; Lee, R M

1989-08-01

164

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

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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.

Gencosmanoglu Rasim; Inceoglu Resit

2003-01-01

165

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

Science.gov (United States)

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.

Gencosmanoglu, Rasim; Inceoglu, Resit

2003-01-01

166

The nectarine pit as a cause for small bowel obstruction and perforation: a case report.  

UK PubMed Central (United Kingdom)

Ingestion of a foreign body is a rare cause of small bowel obstruction. Ingested foreign bodies will usually pass without clinical sequelae, however on occasion can contribute to significant morbidity. Here we present an unusual case of small bowel obstruction and perforation as a result of accidental ingestion of a nectarine pit.

Al-Najjar M; Arthur T

2013-01-01

167

A Case of Small Bowel Obstruction Due to a Paracecal Hernia  

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Internal hernias are rare causes of small bowel obstruction, and one such internal hernia is the paracecal hernia. We report a case of a small bowel obstruction related to a paracecal hernia in which a preoperative diagnosis was made on computed tomography. A laparotomy was performed for definitive ...

Jang, Eun-Jung; Cho, Seung Hyun; Kim, Dae-Dong

168

Reproductive history and risk of small bowel cancer by histologic type: a population-based study.  

UK PubMed Central (United Kingdom)

PURPOSE: The male predominance of the two main histologic malignancies of the small bowel cancer may reflect a role of sex hormones which will be examined in this study. METHODS: This was a nationwide population-based nested case-control study, based on a cohort of subjects born between 1932 and 2008, as identified in the Swedish Multi-Generation Register. For each case of small bowel cancer, 10 age- and sex-matched controls were randomly selected. Number of children and age at having the first child were analyzed in relation to the risk of small bowel cancer using conditional logistic regression, providing odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS: A total of 632 female cases and 894 male cases of small bowel cancer were included. No overall increased risk of small bowel cancer was found in parous compared to non-parous women (OR = 1.02, 95 % CI 0.67-1.54). There was no association between age at first birth and small bowel cancer (>30 years of age vs <20 years; OR = 1.04, 95 % CI 0.72-1.50). No associations were detected in separate analyses of adenocarcinoma or carcinoid of the small bowel. No distinct risk patterns were discerned in men compared to women. CONCLUSIONS: Reproductive history does not seem to be associated with the risk of small bowel cancer, independent of histologic type.

Lu Y; Lambe M; Martling A; Lagergren J

2012-12-01

169

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

170

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

171

Cisapride or metoclopramide to accelerate small bowel transit during barium follow-through examination?  

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Metoclopramide is commonly used to accelerate small bowel transit during barium follow-through (BaFT) examinations, but its action is unpredictable. Cisapride, commonly used to treat gastroesophageal reflux disease, also accelerates small bowel transit and may be a viable alternative. The two were c...

Hare, C; Halligan, S; Bartram, CI; Platt, K; Raleigh, G

172

Bowel sounds analysis: a novel noninvasive method for diagnosis of small-volume ascites.  

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Ascites is more difficult to detect when only a small quantity is present. The aim of this pilot study was to determine the optimal bowel sound characteristics in order to distinguish no ascites from small-volume ascites by advanced processing of bowel sound wave patterns. This analysis results in t...

Liatsos, C; Hadjileontiadis, LJ; Mavrogiannis, C; Patch, D; Panas, SM; Burroughs, AK

173

Incarcerated Trocar Site Herniation of the Small Bowel following Laparoscopic Myomectomy  

Science.gov (United States)

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

Zomer, Monica Tessmann; de Azevedo, Rafael Menezes

2013-01-01

174

The effect of drugs on fractionated double contrast examinations of the small bowel  

International Nuclear Information System (INIS)

The intravenous use of metoclopramid (paspertin) and ceruletid (Takus) reduces the time required for fractionated double contrast examinations of the small bowel. It also improves visualisation of individual sections of the small bowel, particularly the terminal ileum. The value of these drugs has been assessed in a prospective study in 48 patients with suspected Crohn's disease. (orig.)

1990-01-01

175

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

Science.gov (United States)

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

Kondo, William; Zomer, Monica Tessmann; Braga-Baiak, Andresa; de Azevedo, Rafael Menezes

2013-07-14

176

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...

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

177

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

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AIM: To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction. METHODS: A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized contr...

Xiao-Li Chen; Feng Ji; Qi Lin; Yi-Peng Chen; Jian-Jiang Lin; Feng Ye; Ji-Ren Yu; Yi-Jun Wu

178

Metastatic melanoma causing small bowel intussusception: diagnosis by 18F-FDG PET/CT  

International Nuclear Information System (INIS)

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 18F-FDG PET/CT in a 48-year-old woman who had this examination for restaging purposes. (author)

2009-01-01

179

Consensus guidelines for the use of bowel preparation prior to colonic diagnostic procedures: colonoscopy and small bowel video capsule endoscopy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Adequate bowel preparation prior to colonic diagnostic procedures is essential to ensure adequate visualisation. SCOPE: This consensus aims to provide guidance as to the appropriate use of bowel preparation for a range of defined clinical circumstances. A consensus group from across Europe was convened and met to discuss appropriate bowel preparation. The use of polyethylene glycol (PEG), sodium picosulphate and sodium phosphate (NaP), together with other agents, prokinetics and simethicone, in colonoscopy and small bowel video capsule endoscopy were considered. A systematic review of the literature was carried out and additional unpublished data was obtained from the members of the consensus group where required. Recommendations were graded according to the level of evidence. FINDINGS: PEG-based regimens are recommended first line for both procedures, since their use is supported by good efficacy and safety data. Sodium-picosulphate-based regimens are recommended second line as their cleansing efficacy appears less than PEG-based regimens. NaP is not recommended for bowel cleansing due to the potential for renal damage and other adverse events. However, the use of NaP is acceptable in patients in whom PEG or sodium picosulphate is ineffective or not tolerated. NaP should not be used in patients with chronic kidney disease, pre-existing electrolyte disturbances, congestive heart failure, cirrhosis or a history of hypertension. The timing of the dose, dietary restrictions, use in special patient groups and recording of the quality of bowel preparation are also considered for patients undergoing colonoscopy. During the development of the guidelines the European Society of Gastrointestinal Endoscopy (ESGE) issued guidance on bowel preparation for colonoscopy. The ESGE guidelines and these consensus guidelines share many recommendations; differences between the guidelines are reviewed. CONCLUSION: The use of bowel preparation should be tailored to the individual patient and their specific clinical circumstances.

Mathus-Vliegen E; Pellisé M; Heresbach D; Fischbach W; Dixon T; Belsey J; Parente F; Rio-Tinto R; Brown A; Toth E; Crosta C; Layer P; Epstein O; Boustiere C

2013-08-01

180

Small bowel hemangioma diagnosed with laparoscopy: Report of two pediatric cases  

Directory of Open Access Journals (Sweden)

Full Text Available Hemangiomas of the small bowel are rare tumors that often present with gastrointestinal bleeding. Diagnosis can be difficult and exploratory laparotomy has often proved to be the only method with which to determine the presence and location of these tumors. We report two cases of small bowel hemangioma in children aged 10 and 7 years, in which the diagnosis was made by laparoscopy. Laparoscopy identifies the affected segment of bowel and allows delivery to a minimally extended umbilical port site. The avoidance of an open laparotomy helps to reduce post-operative analgesic requirement and achieves an early return of bowel function.

Jones A; Ainsworth B; Desai A; Tsang T

2007-01-01

 
 
 
 
181

Lubiprostone neither decreases gastric and small-bowel transit time nor improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Lubiprostone, a selective activator of type 2 chloride channels, is approved for treatment of chronic idiopathic constipation and recently constipation-predominant irritable bowel syndrome. It has been suggested that lubiprostone has a prokinetic effect. OBJECTIVE: This investigation was designed to evaluate lubiprostone as a preparation and propulsive agent for small-bowel capsule endoscopy. The PillCam Small Bowel capsule endoscopy system with the PillCam SB1 capsule and Rapid 5 software platform were used. DESIGN: The study was designed as a double-blind, placebo-controlled trial. PATIENTS: Forty healthy adults. MAIN OUTCOME MEASURES: Gastric transit time (GTT), small-bowel transit time (SBTT), and adequacy of small-bowel cleansing preparation. INTERVENTIONS: The study subjects received 24 mug lubiprostone or placebo 30 minutes before PillCam capsule ingestion. METHODS: Capsule endoscopy studies were read by 2 independent investigators unaware of the study medication received, and differences in interpretation were resolved by consensus. Anatomical landmarks were identified, and GTT and SBTT were calculated. Overall preparation quality assessment of the proximal, mid, and distal small bowel was determined by using a 4-step scale. The percentage of visualized bowel was determined by review of 10-minute video segments at 1-hour intervals after the capsule passed through the pylorus. RESULTS: In the lubiprostone group (n = 20), 2 subjects did not pass the capsule through the pylorus in the 8-hour battery life of the capsule. An additional 3 capsules did not pass into the colon. In the placebo group (n = 20), all capsules passed into the small bowel, but 1 did not pass into the colon. The subjects in whom the capsule did not pass into the small bowel were excluded from the small-bowel analysis. In the subjects in whom the capsule did reach the colon, the SBTT could not be calculated and they were excluded from SBTT analysis. The mean GTT in the lubiprostone group was 126 minutes and 43 minutes in the placebo group (P = .0095). The mean SBTT in the lubiprostone group was 188 minutes and 219 minutes in the placebo group (P = .130). The overall preparation assessment of the small bowel was not statistically significant between the 2 groups in the proximal, mid, or distal small bowel (proximal, P = .119; mid, P = .118; distal, P = .121). There was no significant difference in lubiprostone compared with placebo in the percentage of visualized small bowel. LIMITATIONS: Some capsules did not leave the stomach or reach the cecum. CONCLUSION: Lubiprostone produced a significant increase in GTT but did not result in a significant decrease in SBTT compared with placebo. The administration of lubiprostone before capsule ingestion did not result in improved overall preparation of the small bowel for capsule endoscopy or increase the percentage of visualized small bowel. (The trial was registered at www.clinicaltrials.gov, identifier NCT00746395.).

Hooks SB 3rd; Rutland TJ; Di Palma JA

2009-11-01

182

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2004-06-15

183

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

International Nuclear Information System (INIS)

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

1986-01-01

184

Interobserver and intermodality agreement for detection of small bowel Crohn's disease with MR enterography and CT enterography  

DEFF Research Database (Denmark)

Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) visualizes small bowel Crohn's disease (CD) and its complications with high accuracy. The aim of this study was to determine the interobserver and intermodality agreement for detection of small bowel CD.

Jensen, Michael D; Ormstrup, Tina

2011-01-01

185

Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults.  

UK PubMed Central (United Kingdom)

Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. In this paper, we aim to describe a patient with small bowel intussusception caused by an isolated small bowel metastasis of the sarcomatoid carcinoma of the lung by reviewing the literature.

Guner A; Karyagar S; Livaoglu A; Kece C; Kucuktulu U

2012-01-01

186

Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults.  

Science.gov (United States)

Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. In this paper, we aim to describe a patient with small bowel intussusception caused by an isolated small bowel metastasis of the sarcomatoid carcinoma of the lung by reviewing the literature. PMID:23346451

Guner, Ali; Karyagar, Sava?; Livaoglu, Ayten; Kece, Can; Kucuktulu, Uzer

2012-12-30

187

Small bowel evisceration through the anus in rectal prolapse in an Indian male patient.  

Science.gov (United States)

Evisceration of small intestine through anus is a rare presentation in emergency. We reported a case with long history of recurrent complete rectal prolapse presenting in emergency as small bowel protruding out through anal orifice. The small bowel herniated out from a spontaneous perforation in rectosigmoid. After resuscitation, emergency exploratory laparotomy was carried out and small bowel was reposited in the peritoneal cavity through the site of perforation by pulling and pushing maneuvere and the perforated segment of rectosigmoid was exteriorised as double barrel colostomy. PMID:24014329

Kumar, Sanjeev; Mishra, Anand; Gautam, Shefali; Tiwari, Sandeep

2013-09-06

188

Small bowel evisceration through the anus in rectal prolapse in an Indian male patient.  

UK PubMed Central (United Kingdom)

Evisceration of small intestine through anus is a rare presentation in emergency. We reported a case with long history of recurrent complete rectal prolapse presenting in emergency as small bowel protruding out through anal orifice. The small bowel herniated out from a spontaneous perforation in rectosigmoid. After resuscitation, emergency exploratory laparotomy was carried out and small bowel was reposited in the peritoneal cavity through the site of perforation by pulling and pushing maneuvere and the perforated segment of rectosigmoid was exteriorised as double barrel colostomy.

Kumar S; Mishra A; Gautam S; Tiwari S

2013-01-01

189

An unusual cause of small bowel obstruction in a child: ingested rhubarb.  

Science.gov (United States)

Small bowel obstruction is rarely caused by bezoars concretions formed from undigested foreign material in the gastrointestinal tract. An important cause of bezoars is phytobezoars, formed from vegetables or fruits. A four-year-old boy presented to our emergency department with symptoms of acute intestinal obstruction. Upright plain abdominal radiography revealed multiple air fluid levels. Ultrasound showed no abnormalities, and because of worsening symptoms computed tomography of abdomen was performed. It showed intraluminal obstruction of the terminal ileum. Exploratory laparotomy revealed a phytobezoar consisting of undigested rhubarb. The mass was milked through the large bowel and out the anus. Although rare in humans, bezoars are a well-documented cause of small bowel obstruction and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction may require surgical treatment. PMID:23878756

Glatstein, Miguel; Danino, Dana; Rimon, Ayelet; Keidar, Sergei; Scolnik, Dennis

2013-06-25

190

Small bowel exploration and resection using single-port surgery: a safe and feasible approach.  

UK PubMed Central (United Kingdom)

AIM: The aim of this study is to demonstrate the efficacy of wireless capsule endoscopy for preoperative identification of bleeding sources and/or small bowel tumours in surgical patients and to evaluate the feasibility of single-port surgery in the treatment of such pathologies. METHOD: Five patients presenting with obscure gastrointestinal bleeding or/and mild small bowel obstruction were investigated to diagnose and localize the bleeding source or tumour using capsule endoscopy imaging, and, if necessary, with other investigative modalities. All patients were operated on using single-port surgery for small bowel exploration, lesion confirmation, small bowel resection and anastomosis. RESULTS: Small bowel pathology was successfully detected by video capsule endoscopy in three of four patients, and was further substantiated by contrast CT, double-balloon endoscopy or enteroclysis. Complete small bowel exploration, intra-operative identification and oncological resection of the involved segment and anastomosis (intracorporeal and extracorporeal) was successfully performed in all five patients using single-port access without any complication, morbidity or mortality. CONCLUSION: This study demonstrates the feasibility and safety of single-port small bowel resection performed after a high-quality preoperative localization of the tumour.

Dhumane P; Mutter D; D'Agostino J; Mavrogenis G; Leroy J; Marescaux J

2013-01-01

191

CT and MR enterography in evaluating small bowel diseases: when to use which modality?  

UK PubMed Central (United Kingdom)

MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantages of these techniques over traditional barium fluoroscopic examinations due to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility. MRI has many properties that make it well suited to imaging of the small bowel: the lack of ionizing radiation, the improved tissue contrast that can be obtained by using a variety of pulse sequences, and the ability to perform real time functional imaging. Moreover, MR modalities allow visualization of the entire bowel, without overlapping bowel loops, as well as the detection of both intra- and extraluminal abnormalities.The intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel diseases.

Masselli G; Gualdi G

2013-04-01

192

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

Directory of Open Access Journals (Sweden)

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

Jagannath Mala Sherigar; Archana Darshit Dalal; Jitu R. Patel

2005-01-01

193

Increased Unenhanced Bowel-Wall Attenuation at Multidetector CT Is Highly Specific of Ischemia Complicating Small-Bowel Obstruction.  

UK PubMed Central (United Kingdom)

Purpose:To evaluate performance of increased bowel-wall attenuation on unenhanced 64-section multidetector computed tomographic (CT) images for diagnosing bowel-wall ischemia in patients with mechanical small-bowel obstruction (SBO) and to evaluate the diagnostic accuracy of multidetector CT in detecting small-bowel ischemia complicating SBO, with surgical and histopathologic findings as reference standard.Materials and Methods:The local institutional review board approved this retrospective study; informed consent requirement was waived. In 44 patients (10 men, 34 women; age range, 30-100 years) who were admitted because they were suspected of having SBO and treated surgically within the next 7 days, 45 multidetector CT scans were retrospectively reviewed. Two gastrointestinal radiologists performed independent blinded reviews of images to identify specific signs of ischemia; disagreements were resolved in consensus with a third gastrointestinal radiologist. Results were compared with both findings in prospective radiology reports and surgical and histopathologic findings. Fisher exact and ?(2) tests were used to assess associations between CT signs and ischemia, and the ? statistic was used to assess interobserver agreement.Results:In 19 of 45 (42%) multidetector CT scans, ischemia was confirmed at surgery and/or histopathologic examination. Increased bowel-wall attenuation on unenhanced images was significantly associated with ischemia (P < .0001); in this highly selected population, this sign had a 100% (24 of 24) specificity and a 56% (10 of 18) sensitivity. Sensitivity and specificity of multidetector CT for ischemia were 63% (12 of 19) and 92% (24 of 26), respectively, for the prospective reports and 84% (16 of 19) and 96% (25 of 26), respectively, for the consensus review. Decreased segmental bowel-wall enhancement was the most accurate 64-section multidetector CT sign for diagnosing ischemia (sensitivity, 78% [14 of 18]; specificity, 96% [24 of 25]; P < .0001). The small-bowel feces sign was significantly associated with ischemia (P = .0308).Conclusion:Increased bowel-wall attenuation on unenhanced 64-section multidetector CT images is a specific sign for ischemia complicating SBO. Diagnostic accuracy of 64-section multidetector CT for ischemia associated with SBO was excellent.© RSNA, 2013.

Geffroy Y; Boulay-Coletta I; Jullès MC; Nakache S; Taourel P; Zins M

2013-09-01

194

Small bowel obstruction in patients with familial adenomatous polyposis-related desmoid disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: Intra-abdominal desmoid disease is one of the most common extra-intestinal manifestations of familial adenomatous polyposis (FAP). Small bowel obstruction occurs frequently in affected patients, and is notoriously difficult to treat. The aim of this study was to review the management and outcome of desmoid-related small bowel obstruction. METHOD: This was a retrospective, descriptive study of patients with familial adenomatous polyposis and intra-abdominal desmoid disease who developed small bowel obstruction. Demographic data and data concerning the presentation, diagnosis and treatment of the bowel obstructions were abstracted from the polyposis database or patients' records. Patients with obstruction unrelated to desmoid disease were excluded. RESULTS: There were 47 patients (30 women and 17 men). Median age at first bowel obstruction was 24.2 (IQR 19.2-34.2) years. The median time from index surgery to first bowel obstruction was 4.1 (IQR 1.5-9.0) years. Twenty two patients had a colectomy and ileorectal anastomosis and 21 a proctocolectomy and ileoanal pouch (IPAA). Obstruction was treated medically in 29% of cases and surgically in 69%. Thirteen patients had total parental nutrition. Thirty (63.8%) had a second episode of small bowel obstruction at a mean of 5.3 years after the first, 50% of which were treated medically. Eighteen (37.5%) patients had more than two episodes of bowel obstruction. There were 118 operations, including lysis of adhesions (29), small bowel resection (14), bypass (12), ileostomy (12), desmoid excision (9) and stricturoplasty (2). CONCLUSION: Desmoid-related small bowel obstruction in FAP patients requires multiple surgical strategies to restore a patent gastrointestinal tract. This article is protected by copyright. All rights reserved.

Xhaja X; Church J

2013-09-01

195

Small bowel carcinoid: Location isn't everything!  

Science.gov (United States)

AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid (SBC) using a population-based analysis. METHODS: The Surveillance, Epidemiology and End Results (SEER) database was queried for histologically confirmed SBC between the years 1988 and 2009. Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method and compared using Log rank testing. Log rank and multivariate Cox regression analyses were used to identify predictors of survival using age, year of diagnosis, race, gender, tumor histology/size/location, tumor-node-metastasis stage, number of lymph nodes (LNs) examined and percent of LNs with metastases. RESULTS: Of the 3763 patients, 51.2% were male with a mean age of 62.13 years. Median follow-up was 50 mo. The 10-year OS and DSS for duodenal primaries were significantly better when compared to jejunal and ileal primaries (P = 0.02 and DSS) while age, number of primaries, number of LNs examined, T-stage and M-stage were independent predictors of survival. CONCLUSION: This 21-year, population-based study of SBC challenges the concept that location of the primary lesion alone is a significant predictor of survival.

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

2013-01-01

196

Postoperative enteral nutrition improves survival after orthotopic small bowel transplantation in mice.  

UK PubMed Central (United Kingdom)

BACKGROUND: The aim of this study was to assess the effect postoperative enteral nutrition support on the survival after orthotopic small bowel transplantation in mice. METHODS: A model of orthotopic small bowel transplantation used C57BL/6 mice as both donors and recipients. RESULTS: We demonstrated that postoperative ileus was the deciding complication after transplantation. Postoperative enteral nutritional support resolved this problem and significantly improved survival and growth rates after transplantation. CONCLUSION: These data suggest the importance of routine nutritional support after orthotopic small bowel transplantation in mice.

Wang J; Li Y; Li J

2013-07-01

197

Noninvasive detection of small bowel electrical activity from SQUID magnetometer measurements using SOBI.  

UK PubMed Central (United Kingdom)

We report a robust method for noninvasive biomagnetic detection of small bowel electrical activity. Simultaneous Superconducting QUantum Interference Device (SQUID) magnetometer (MENG) and serosal electrode recordings were made on pig small bowel. The SOBI blind-source separation algorithm was used to separate the underlying source signals of the MENG. Comparison of identified SOBI components to the serosal recordings validated the underlying MENG sources as being enteric in origin. Non-invasive detection of small bowel electrical activity could have significant implications in a clinical setting.

Erickson J; Obioha C; Goodale A; Bradshaw A; Richards W

2008-01-01

198

Spontaneous perforation of rectum with evisceration of small bowel simulating intussusception.  

UK PubMed Central (United Kingdom)

CONTEXT: Spontaneous perforation of rectum is a rare event; however evisceration of the small bowel through the perforated site without predisposing factors is extremely rare, complex and worth reporting. CASE REPORT: A 14 years old presented to us apparently as a case of intussception. The operative findings revealed it to be a case of spontaneous perforation of rectum with evisceration of the small bowel through the perforation. CONCLUSION: Sudden increase in the intra-abdominal pressure leads to the perforation in the chronically deranged rectal wall and pushes the small bowel loops into the pelvis and through the perforated rectum to appear transanally.

Bhat S; Azad TP; Kaur M

2010-12-01

199

Small bowel preparations for capsule endoscopy with mannitol and simethicone: a prospective, randomized, clinical trial.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVE: There is no consensus concerning small bowel preparation before capsule endoscopy (CE). This study evaluated the effects of 4 regimens on small bowel cleansing and diagnostic yield. METHODS: Patients were randomly divided into 4 groups. Group A consumed a clear liquid diet after lunch on the day before CE, followed by overnight fasting. Group B took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In group C, the same regimen was taken at 20:00 hours on the day before and at 05:00 hours on the day of CE. In group D, in addition to the group C regimen, 20 mL oral simethicone was taken 30 minutes before CE. RESULTS: Two hundred patients were prospectively enrolled, and 7 were excluded from the final analysis because of incomplete small bowel transit. No significant difference was noted among the 4 groups for small bowel transit time. Bowel preparation in group D was significantly better than for the other regimens for overall cleansing of the proximal small bowel, and showed improved overall cleansing of the distal small bowel when compared with 10-hours overnight fasting. Pathological lesions of the proximal and distal small bowel were, respectively, achieved in 82 and 74 patients, mostly distributed in group D. CONCLUSIONS: Small bowel preparation that involves split-dose oral mannitol plus single-dose simethicone for CE can improve mucosal visualization and subsequent diagnostic yield when compared with 10-hours overnight fasting.

Chen HB; Huang Y; Chen SY; Song HW; Li XL; Dai DL; Xie JT; He S; Zhao YY; Huang C; Zhang SJ; Yang LN

2011-04-01

200

Ultrasound in Crohn's disease of the small bowel  

International Nuclear Information System (INIS)

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

2000-01-01

 
 
 
 
201

A patient presenting with acute abdomen due to metastatic small bowel melanoma: a case report  

Science.gov (United States)

Introduction Malignant tumors of the small bowel are rare. Melanoma of the small intestine is in most cases metastatic from a primary skin lesion. Perforation of small bowel melanoma is an extremely rare entity. To the best of our knowledge this is the fifth case published to date. Case presentation We report a rare case of acute abdomen due to perforated metastatic small bowel melanoma in a 38-year-old Caucasian man. Conclusions In the majority of cases small bowel melanoma represents metastasis from cutaneous sites. Although rare, the possibility of abdominal metastatic melanoma presenting with the clinical picture of acute abdomen must be always considered by the operating surgeon in patients with a history of primary cutaneous malignant lesion.

2013-01-01

202

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

Directory of Open Access Journals (Sweden)

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

Lior Drukker; Yair Edden; Petachia Reissman

2012-01-01

203

[Study of the small bowel and mesentery in Crohn's disease: comparison of ultrasonics, x-ray computed tomography and small bowel transit in 18 patients  

UK PubMed Central (United Kingdom)

The advantages of tomodensitometry and ultrasonography were compared with those of small bowel series in Crohn's disease of the small bowel in 18 patients. These two examinations give results which are inferior to those of small bowel series, for the positive diagnosis and the evaluation of the intraluminal extension of the disease, since their sensitivity was only 60 p. cent in identifying the pathological loop. On the contrary, their advantage lies in the evaluation of the intraluminal extension of the disease, which was correctly demonstrated with ultrasonography in 22 p. cent of cases, and tomodensitometry in 45 p. cent. This confirms the supplementary value of these two examinations in the study of the mesenteric involvement of the disease, screening of abscesses, and makes desirable a prospective evaluation of the influence of mesenteric abnormalities on the prognosis and surgical indications.

Wilhelm JP; Bresson A; Claudon M; Regent D; Champigneulle B; Bigard MA; Gaucher P

1988-03-01

204

Small bowel obstruction from potato and broccoli phytobezoar mimicking mesenteric ischemia.  

UK PubMed Central (United Kingdom)

BACKGROUND: Bezoars are concretions of undigested foreign material that form in the gastrointestinal tract. Rare in humans, they are nonetheless a well-documented cause of intraluminal bowel obstruction. OBJECTIVES: The objectives of this case report include describing an unusual presentation of small bowel obstruction due to phytobezoar, which mimicked mesenteric ischemia, and highlighting the risk factors, presentation, and management of bezoars, in addition to covering historical beliefs regarding bezoars. CASE REPORT: Here we report a 64-year-old man who presented to the Emergency Department with chest pain, vomiting, and hypotension. Initial work-up was directed at ruling out cardiac causes and aortic catastrophe such as aortic dissection or ruptured abdominal aortic aneurysm. Computed tomography angiography of the chest and abdomen showed findings suggestive of mesenteric ischemia and small bowel obstruction. However, exploratory laparotomy revealed intraluminal small bowel obstruction from a phytobezoar consisting of undigested chunks of potato, brussels sprouts, and broccoli. CONCLUSIONS: Although rare in humans, bezoars are a documented cause of small bowel obstruction, and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction require surgical treatment.

Serrano KD; Tupesis JP

2013-01-01

205

Small bowel obstruction in patients with familial adenomatous polyposis-related desmoid disease.  

UK PubMed Central (United Kingdom)

CONCLUSION: Desmoid-related small bowel obstruction in FAP patients requires multiple surgical strategies to restore a patent gastrointestinal tract. This article is protected by copyright. All rights reserved.

Xhaja X; Church J

2013-09-01

206

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

UK PubMed Central (United Kingdom)

An 84-year-old lady with a history of chronic recurrent rectal prolapse, presented to accident and emergency with a significant portion of small bowel and mesentery protruding out of her anus. The small bowel was not contained within peritoneum, nor was this a pararectal herniation. On examination of the rectum, a longitudinal tear was found in the anterior rectal wall, through which the small bowel had prolapsed. Hours after reducing the small bowel back into the anus, it prolapsed a second time. Due to multiple co-morbidities, this patient was not fit for surgery. The defect was temporarily repaired on the ward and the patient treated with aggressive antibiotic therapy. The patient continued to deteriorate, became septic, acidotic, hypotensive and died a day later.

Berwin JT; Ho TK; D'Souza R

2012-01-01

207

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

UK PubMed Central (United Kingdom)

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

Ghosh SC; Nolan GJ; Simpson RR

2013-05-01

208

Subtle vaginal evisceration resulting in small bowel evisceration: a case report.  

UK PubMed Central (United Kingdom)

BACKGROUND: Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction. OBJECTIVE: We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence. CASE REPORT: A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room. CONCLUSION: Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.

Woo KM; Linden JA; Lowenstein RA; Varghese JC; Burch MA

2012-08-01

209

Barium/air double contrast examination of the small bowel in Crohn's disease  

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In patients with Crohn's disease the radiological demonstration of small bowel lesions requires an elaborate and meticulous technique. The barium/air double contrast technique is a method for accurate delineation of normal and abnormal small bowel morphology. By distending the bowel transmural lesions are accurately evaluated. A precise assessment of the axial extension of disease is possible due to an 'en face' presentation which is more sensitive than a 'profile' presentation for detection of superficial lesions. 10 figs.

Ekberg, O.

1984-04-01

210

Minimally invasive surgery using intraoperative real-time capsule endoscopy for small bowel lesions.  

UK PubMed Central (United Kingdom)

BACKGROUND: The small bowel has been considered the "black box" of gastroenterology. Identifying the exact site of small bowel hemorrhage is often difficult, thus complicating surgical treatment. We report two cases of small bowel bleeding lesions that were successfully managed by intraoperative real-time capsule endoscopy and minimally invasive surgery. METHODS: We developed a double-lumen tube similar to, but thinner and longer than, the Miller-Abbott tube. We insert the tube nasally, 3 or 4 days preoperatively, such that its balloon tip reaches the anus by the operative day. During surgery, the endoscopic capsule is connected to the balloon tip of the tube that protrudes from the anus. An assistant pulls on the nasal end of the tube, bringing the balloon tip and capsule back into the bowel. Capsule endoscopic images are displayed in a real-time video format. RESULTS: We employed this procedure in two patients with repeated melena. Various examinations including gastroendoscopy and total colonoscopy showed bleeding confined to the small bowel, but the exact lesion site was unknown. Minimally invasive surgery was successfully performed in both patients: open minilaparotomy in one and laparoscopy in the other. The small bowel and capsule endoscope were easily controlled during minilaparotomy, and real-time capsule endoscopic images clearly identified the bleeding lesion. Control of the small bowel was more difficult in the laparoscopic case; however, real-time capsule endoscopic images identified a small tumor that was successfully resected. CONCLUSIONS: Intraoperative capsule endoscopy combined with the tube provides surgeons real-time images indicating the exact site of lesions. The tube also helps surgeons control the position of the capsule endoscope and enables suction of intraluminal fluid or inflation of the lumen to allow clearer views during the operation. We conclude that combined use of capsule endoscopy and the tube facilitates management of bleeding lesions in the small bowel.

Yamashita K; Okumura H; Oka Y; Urakami A; Shiotani A; Nakashima H; Matsumoto H; Hirai T; Nakamura M

2013-07-01

211

Ultrasonographic findings of ascaris in the small bowel: A case report  

International Nuclear Information System (INIS)

Ascariasis is one of the most common helminthic disease worldwide and evoked variable clinical manifestations by the migration of worm in the alimentary and biliary tract. The ultrasonographic detection of ascaris in the small bowel is relatively difficult, and no report on the ultrasonographic findings have been published in Korea. On abdominal ultrasonography, ascaris is seen as an intraluminal tubular structure with 4 linear echogenic stripes and movement. We report a case of ascaris in the small bowel detected by abdominal ultrasonography.

2003-01-01

212

Malignant Peripheral Nerve Sheath Tumor of the Small Bowel: An Unusual Presentation with Fatal Outcome  

Science.gov (United States)

Malignant peripheral nerve sheath tumor of the small bowel is an extremely rare disease. Histologic distinction from other types of soft tissue sarcoma especially fibrosarcoma and leiomyosarcoma requires electron microscopy. Complete surgery remains the only curative treatment. However, late diagnosis makes curative surgery more difficult. The contribution of chemotherapy to incomplete surgery has been proved without controlled studies. We report a case of this type of lesion discovered following a small bowel perforation.

Mohtaram, Amina; Mesmoudi, Siham; M'rabti, Hind; Rami, Amal; Latib, Rachida; Bernoussi, Zakia; Aaribi, Imane; Ben Ameur El Youbi, Meryam; Errihani, Hassan

2013-01-01

213

Transstomal small bowel evisceration after colonic perforation secondary to ischemic colitis.  

UK PubMed Central (United Kingdom)

Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site.

Guner A; Kahraman I; Ozkan OF; Aktas A; Kece C

2012-01-01

214

Transstomal Small Bowel Evisceration after Colonic Perforation Secondary to Ischemic Colitis  

Science.gov (United States)

Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site.

Guner, Ali; Kahraman, Izzettin; Ozkan, Omer Faruk; Aktas, Adem; Kece, Can

2012-01-01

215

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

216

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

217

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2009-08-15

218

Fecal bile acids related to small-bowel length before and after ileal exclusion.  

Science.gov (United States)

We studied the relationship among the small-bowel length, the fecal excretion of bile acids and neutral steroids, and cholesterol synthesis in 16 patients with familial hypercholesterolemia before and 1 month after the ileal bypass operation. The mean small-bowel length measured during the operation was 6.3 +/- 0.3 (SEM) m before and 4.3 +/- 0.2 m after the bypass of the distal third of the small bowel. The preoperative fecal bile acid excretion was negatively correlated (r = 0.63, p less than 0.01) with the small-bowel length, whereas this correlation was insignificant for fecal neutral steroid excretion and cholesterol synthesis. Postoperative amounts of fecal bile acids and neutral steroids and cholesterol synthesis were negatively correlated with the length of the small bowel remaining in function (r = -0.52, -0.51, and -0.62, respectively). Our study suggests that fecal bile acid excretion and, hence, bile acid synthesis are related to the small-bowel length even under physiologic conditions. PMID:3659832

Koivisto, P; Lempinen, M; Miettinen, T A

1987-08-01

219

Fecal bile acids related to small-bowel length before and after ileal exclusion.  

UK PubMed Central (United Kingdom)

We studied the relationship among the small-bowel length, the fecal excretion of bile acids and neutral steroids, and cholesterol synthesis in 16 patients with familial hypercholesterolemia before and 1 month after the ileal bypass operation. The mean small-bowel length measured during the operation was 6.3 +/- 0.3 (SEM) m before and 4.3 +/- 0.2 m after the bypass of the distal third of the small bowel. The preoperative fecal bile acid excretion was negatively correlated (r = 0.63, p less than 0.01) with the small-bowel length, whereas this correlation was insignificant for fecal neutral steroid excretion and cholesterol synthesis. Postoperative amounts of fecal bile acids and neutral steroids and cholesterol synthesis were negatively correlated with the length of the small bowel remaining in function (r = -0.52, -0.51, and -0.62, respectively). Our study suggests that fecal bile acid excretion and, hence, bile acid synthesis are related to the small-bowel length even under physiologic conditions.

Koivisto P; Lempinen M; Miettinen TA

1987-08-01

220

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

 
 
 
 
221

Lower Gastrointestinal Bleeding due to Small Bowel Metastasis from Leiomyosarcoma in the Tibia  

Directory of Open Access Journals (Sweden)

Full Text Available Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we reporton a 50-year-old man who presented with general weakness, weight loss (six kg in twomonths) and intermittent tarry stools for two months. He had undergone an above-kneeamputation for left tibia leiomyosarcoma seven years previously. No local recurrence and/ordistant metastasis developed during a seven-year period of follow-up. Subsequent imagingstudy revealed a multilobulated mass in the ileum. He received segmental resection of thesmall bowel and a multilobulated mass was noted in the submucosal layer of the ileum withmucosa ulceration. His postoperative course was uneventful. Histopathological examinationof the resected mass revealed small bowel metastatic leiomyosarcoma. No local recurrenceor distant metastases were detected during a six-month follow-up period. To the best of ourknowledge, this is the first report of small bowel metastasis from primary bone leiomyosarcomapresenting with lower gastrointestinal bleeding.

Kun-Chun Chiang; Chun-Nan Yeh; Hsin-Nung Shih; Yi-Yin Jan; Miin-Fu Chen

2006-01-01

222

Laparoscopic management of diverticular colovesical fistula: experience in 15 cases and review of the literature.  

UK PubMed Central (United Kingdom)

Abstract Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P = 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.

Marney LA; Ho YH

2013-04-01

223

Bariatric Surgery Complications Leading to Small Bowel Transplant: A Report of 4 Cases.  

UK PubMed Central (United Kingdom)

Obesity is a major chronic disease affecting the U.S. population. Bariatric surgery has consistently shown greater weight loss and improved outcomes compared with conservative therapy. However, complications after bariatric surgery can be catastrophic, resulting in short bowel syndrome with a potential risk of intestinal failure, ultimately resulting in the need for a small bowel transplant. A total of 6 patients became dependent on home parenteral nutrition (HPN) after undergoing bariatric surgery at an outside facility. Four of the 6 patients required evaluation for small bowel transplant; 2 of the 6 patients were successfully managed with parenteral nutrition and did not require further small bowel transplant evaluation. Catheter-related bloodstream infection, a serious complication of HPN, occurred in 3 patients despite extensive patient education on catheter care and use of ethanol lock. Two patients underwent successful small bowel transplantation, 1 died before transplant could be performed, and 1 was listed for a multivisceral transplantation. Surgical procedures to treat morbid obesity are common and growing in popularity but are not without risk of serious complications, including intestinal failure and HPN dependency. Despite methods to prevent complications, failure of HPN may lead to the need for transplant evaluation. In selected cases, the best therapeutic treatment may be a small bowel transplant to resolve irreversible, post-bariatric surgery intestinal failure.

Raheem SA; Deen OJ; Corrigan ML; Parekh N; Quintini C; Steiger E; Kirby DF

2013-05-01

224

Clinical usefulness of classification by transabdominal ultrasonography for detection of small-bowel stricture.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the clinical usefulness of transabdominal ultrasonography (TUS) for detection of small-bowel stricture. PATIENTS AND METHODS: Subjects were 796 patients undergoing double-balloon endoscopy (DBE), December 2003-October 2011. All underwent TUS prior to DBE. The TUS findings were classified by type as intestinal narrowing and distension at the oral side (Type A); extensive bowel wall thickening (Type B); focal bowel wall thickening (Type C) or no abnormality detected (Type D). We compared TUS findings against DBE findings with respect to small-bowel stricture, defined as failure of the enteroscope to pass through the small bowel. RESULTS: Small-bowel stricture was detected by DBE in 11.3% (90/796) of patients. Strictures resulted from Crohn's disease (n = 36), intestinal tuberculosis (n = 24), malignant lymphoma (n = 9), ischemic enteritis (n = 6), NSAID ulcer (n = 5), radiation enteritis (n = 2), surgical anastomosis (n = 2) and other abnormalities (n = 6). Stricture was detected by TUS in 93.3% (84/90) of patients, and each such stricture fell into one of the three types of TUS abnormality. The remaining 6 strictures were detected only by DBE. DBE-identified strictures corresponded to TUS findings as follows: 100% (43/43) to Type A, 59.1% (29/49) to Type B, 14.8% (12/81) to Type C and 1% (6/623) to Type D. Correspondence between stricture and the Type A classification (vs. Types B, C and D) was significantly high, as was correspondence between stricture and Type B (vs. Types C and D). CONCLUSIONS: TUS was shown to be useful for detecting small-bowel stricture. We recommend performing TUS first when a small-bowel stricture is suspected.

Nakano M; Oka S; Tanaka S; Aoyama T; Watari I; Hayashi R; Miyaki R; Nagai K; Sanomura Y; Yoshida S; Ueno Y; Chayama K

2013-09-01

225

Diverticular Disease: Reconsidering Conventional Wisdom.  

UK PubMed Central (United Kingdom)

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 10-25% commonly 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 prior to the attack. Given these surprising findings, it is time to reconsider conventional wisdom about diverticular disease.

Peery AF; Sandler RS

2013-05-01

226

Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations  

Directory of Open Access Journals (Sweden)

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

Cemal Yazici; John Losurdo; Michael D Brown; Scott Oosterveen; Robert Rahimi; Ali Keshavarzian; Leila Bozorgnia; Ece Mutlu

2012-01-01

227

Laparoscopic treatment of early small bowel obstruction after laparoscopic ventral hernia repair.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of presenting this case is to highlight the importance of early diagnosis and laparoscopic treatment of bowel obstruction following laparoscopic ventral hernia repair. METHOD: A 45-years old patients underwent laparoscopic exploration for bowel obstruction following laparoscopic repair of ventral hernia. The early adhesions were divided and the mesh was re-fixed using different ticker. RESULTS: The patient had uneventful recovery and was discharged in good health. CONCLUSIONS: Early small bowel obstruction following laparoscopic ventral hernia repair was managed using minimal access. High index of suspicior and early laparoscopic exploration is important to avoid catastrophic complications following laparoscopic ventral hernia repair.

Hussain A; Mahmood H; Singhal T; El-Hasani S

2009-08-01

228

Radiation Dose-Volume Effects in the Stomach and Small Bowel  

International Nuclear Information System (INIS)

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

2010-03-01

229

Polyethylene glycol plus simethicone in small-bowel preparation for capsule endoscopy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Small-bowel contents can hamper the quality of video-capsule endoscopy (VCE). No standardized protocol has been proposed and overnight fasting remains the proposed preparation for VCE. AIMS: The aim was to evaluate the effects of 2 regimens of bowel preparation on small intestine cleansing, diagnostic yield and capsule transit times. METHODS: This is a prospective, randomized, blinded, and controlled study. Sixty patients referred for VCE were randomized into 2 groups. Group A ingested 2l of a polyethylene glycol and simethicone solution 16h before VCE. Group B were instructed to consume a fibre-free diet and allowed to consume clear liquids the day before VCE. The small-bowel cleansing was graded as "complete" if the entire wall was assessable, "incomplete" if more than 50% of the wall was visible, and "insufficient" if less than 50% of the wall was visible. RESULTS: In group A, a "complete", "incomplete" and "insufficient" small-bowel cleansing was achieved in 42%, 39% and 19% of cases respectively. In group B, a "complete", "incomplete" and "insufficient" small-bowel cleansing was achieved in 43%, 33% and 24% of cases respectively. No significant differences were observed between the two groups, regarding small-bowel cleansing level (p=0.65). No differences were also observed in the diagnostic yield (48.2%, 13.8% and 38% vs 65.5%, 6.9% and 27.6% of positive, suspicious and no findings respectively, in groups A and B [p=0.39]) and small-bowel transit times (mean 288min and 299 min in groups A and B respectively [p=0.70]). CONCLUSIONS: The results of the present study do not support the use of 2l of a polyethylene glycol and simethicone solution before VCE.

Spada C; Riccioni ME; Familiari P; Spera G; Pirozzi GA; Marchese M; Bizzotto A; Ingrosso M; Costamagna G

2010-05-01

230

Effect of oral purgatives on gastric and small bowel transit time in capsule endoscopy.  

UK PubMed Central (United Kingdom)

BACKGROUND: During ingestible capsule endoscopy, video images are recorded throughout the device's natural propulsion through the digestive system. Shortening the transit time of the wireless video capsule through the stomach and small bowel could reduce the time needed to read and analyze the resultant images, utilize more effectively the short life of the capsule battery (7 +/- 1 hours) and make it possible to image the entire small bowel. OBJECTIVE: To measure gastric and small bowel transit times, with and without preparation, using capsule endoscopy. METHODS: Capsule transit times through the stomach, small bowel and colon were evaluated by analysis of the videos generated during the capsule's passage. The study group included 62 patients with small and large bowel pathologies (e.g., iron deficiency anemia, Crohn's disease). The patients were divided into three groups: prepared with polyethylene glycol (Group A, n = 9), prepared with sodium phosphate (Group B, n = 13), and with no preparation (Group C, n = 40). RESULTS: The gastric emptying times were 20.4 +/- 15.2 minutes in group A, 55.7 +/- 45.1 in group B, and 48.3 +/- 28.7 in group C (P = 0.01). The capsule produced views of the cecum in only 49 of the 62 patients. The mean small bowel transit time for these 49 patients was 238.8 +/- 82.1 minutes, making the mean times for the groups (A,B,C) 148.9 +/- 32.6, 289.4 +/- 77.2 and 249.3 +/- 73.9 minutes respectively (P = 0.0001). CONCLUSION: Compared to both SP and no preparation, preparation of the colon with PEG significantly shortened the transit time of the capsule through the stomach and small bowel.

Fireman Z; Kopelman Y; Fish L; Sternberg A; Scapa E; Mahaina E

2004-09-01

231

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

International Nuclear Information System (INIS)

Purpose: To assess the potential reduction of small bowel volume receiving high-dose radiation by using kilovoltage X-ray cone beam computed tomography (CBCT) and quantized margin selection for adaptive bladder cancer treatment. Methods and Materials: Twenty bladder patients were planned conformally using a four-field, 15-mm uniform margin technique. Two additional planning target volumes (PTVs) were created using margins quantized to 5 and 10 mm in the superior direction only. CBCTs (?8 scans/patient) were acquired during treatment. CBCT volumes were registered with CT planning scans to determine setup errors and to select the appropriate PTV of the day. Margin reduction in other directions was considered. Outlining of small bowel in every fraction is required to properly quantify the volume of small bowel spared from high doses. In the case of CBCT this is not always possible owing to artifacts created by small bowel movement and the presence of gas. A simpler method was adopted by considering the volume difference between PTVs created using uniform and adapted margins, which corresponds to the potential volume of small bowel sparing. Results: The average small bowel volume that can be spared by this form of adaptive radiotherapy is 31 ± 23 cm3 (±1 SD). The bladder for 1 patient was systematically smaller than the planning scan and hence demonstrated the largest average reduction of 76 cm3. The clinical target volume to PTV margins in other directions can be safely reduced to 10 mm except in the anterior direction where, like the superior direction, the bladder showed significant variation. Conclusions: Online CBCT-assisted plan selection based on quantized margins can significantly reduce the volume of small bowel receiving high doses for some bladder patients. CBCT allows the 15-mm margins used in some directions to be safely reduced to 10 mm.

2006-11-01

232

Small bowel perforation after duodenal stent migration: An interesting case of a rare complication.  

UK PubMed Central (United Kingdom)

Duodenal stents are frequently used for palliating malignant gastric outlet obstruction. Successful stent placement relieves obstructive symptoms, is cost effective, and has a relatively low complication rate. However, enteral stents have the potential of migrating distally and rarely, even lead to bowel perforation. We present a rare case of a duodenal stent placed as a palliative measure for gastric outlet obstruction due to unresectable pancreatic cancer that migrated distally after a gastrojejunostomy resulting in small bowel perforation.

Lee PH; Moore R; Raizada A; Grotz R

2011-06-01

233

Internal hernia: computed tomography diagnosis and differentiation from adhesive small bowel obstruction.  

UK PubMed Central (United Kingdom)

BACKGROUND: The goals of this study were to evaluate the specific computed tomography (CT) features of internal hernia (IH), and to verify CT features useful for the differential diagnosis of IH from adhesive small bowel obstruction (ASBO), and for the early detection of intestinal strangulation. METHODS: CT findings for 28 patients with surgically proven IH were retrospectively reviewed and compared with those for 50 patients with surgically proven ASBO. RESULTS: CT features most suggestive of IH versus ASBO included the following: a cluster of small bowel segments (100% vs 4% of patients; p < 0.0001); crowding and convergence of mesenteric vessels (79% vs 4%; p < 0.0001); mesenteric vessel engorgement (79% vs 26%; p = 0.0002); and mass effect to the surrounding bowels (82% vs 44%; p = 0.002). In addition, intestinal strangulation, the most severe complication, occurred more in IH than ASBO (39% vs 10%; p = 0.002), whereas proximal small bowel dilation (46% vs 100%; p < 0.0001) and small-bowel feces sign (0% vs 26%; p = 0.0029) were less common in IH than ASBO. The CT features indicative of intestinal strangulation were localized mesenteric fluid (p < 0.0001), mesenteric infiltrates (p = 0.0005), bowel wall thickening (p = 0.003), intramural hemorrhage (p = 0.005), mesenteric vessel engorgement (p = 0.03), and abnormal bowel wall enhancement (p = 0.008); the first 4 of these features were noted more in patients with IH than ASBO. CONCLUSION: The most specific CT criteria for the diagnosis of IH, rather than ASBO, were engorged mesenteric vessels, mass effect to surrounding organs, and bowel wall thickening. When associated mesenteric infiltrates were found, intestinal strangulation was highly suspected.

Yen CH; Chen JD; Tui CM; Chou YH; Lee CH; Chang CY; Yu C

2005-01-01

234

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

International Nuclear Information System (INIS)

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

1979-01-01

235

Small bowel obstruction following laparoscopic ventral mesh rectopexy.  

UK PubMed Central (United Kingdom)

Laparoscopic ventral mesh rectopexy (LVMR) has been gaining wide acceptance for the treatment of rectal prolapse and rectal intussusception [1,2]. The laparoscopic approach has allowed low postoperative morbidity and shorter hospital stay including as a day procedure [3]. However, the technique brings certain challenges with regard to mesh fixation and closure of the peritoneum to avoid complications from exposure of synthetic mesh to the bowel. This article is protected by copyright. All rights reserved.

P Vasudevan S; Dworkin MJ

2013-08-01

236

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.  

UK PubMed Central (United Kingdom)

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 R; Chakraborty S; Nygren I; Sinha R

2013-04-01

237

[Laparoscopic surgery in the treatment of 12 patients with radiogenic small bowel damage].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To summarize the preliminary experience of laparoscopic surgery in the treatment of radiogenic small bowel damage. METHODS: Clinical data of 12 patients with radiogenic small bowel damage undergoing laparoscopic operation in our department from January 2012 to January 2013 were retrospectively reviewed. RESULTS: Two patients were transferred to laparotomy because of dense adhesion in the entire abdomen and uncertainty of metastatic malignancy, respectively. The laparoscopic surgery was successfully performed in other 10 patients. Three patients received enterostomy or colostomy because of intestinal obstruction or bleeding. Among the other seven patients who underwent intestinal resection and anastomosis, intestinal anastomosis was performed with an small adjunvant incision in the former two cases and performed under laparoscopy in the latter five cases. The post-operative complication included one anastomotic fistula. CONCLUSION: Laparoscopic surgery can be safely used in radiogenic small bowel damage patients, which can avoid the delayed incision healing.

Wang J; Li YS; Yao DH; Wang XD; Li JS

2013-05-01

238

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

Science.gov (United States)

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

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

2013-01-01

239

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

Directory of Open Access Journals (Sweden)

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

Steven T. Dorsey; Eric T. Harrington; W. F. Peacock; Charles L. Emerman

2011-01-01

240

Chemotherapy, radical irradiation plus salvage cystectomy for bladder cancer--severe late small bowel morbidity.  

UK PubMed Central (United Kingdom)

A proportion of patients with invasive bladder cancer are treated with radical irradiation and salvage cystectomy. The use of neo-adjuvant chemotherapy is being widely investigated. Five patients with invasive bladder cancer at Groote Schuur Hospital have undergone salvage cystectomy after neo-adjuvant chemotherapy and radical irradiation. Two of these patients had severe small bowel morbidity while clear of carcinoma and this was fatal in one patient. In our historical series of 30 patients who had salvage cystectomy after radical irradiation alone, there was only one patient with similar small bowel morbidity. There may be an increase in small bowel morbidity from neo-adjuvant chemotherapy in patients who are treated to clinical tolerance by irradiation and who then require a cystectomy.

Abratt RP; Pontin AR; Barnes RD

1993-06-01

 
 
 
 
241

Usefulness of double-balloon endoscopy in the diagnosis of malignant small-bowel tumors.  

UK PubMed Central (United Kingdom)

BACKGROUND & AIMS: Double-balloon endoscopy (DBE) enables endoscopic and histopathologic diagnosis of malignant small-bowel tumors (MSBT). This study examined the clinical features of patients with MSBT and evaluated the usefulness of DBE in the diagnosis of MSBT. METHODS: We retrospectively examined consecutive DBE studies of 358 patients who underwent DBE in our hospital between December 2003 and October 2007 because of suspected or established small-bowel disease. RESULTS: Fourteen patients with MSBT were diagnosed by DBE. The most common type was primary adenocarcinoma (8 patients), followed by metastatic carcinoma (3 patients) and malignant lymphoma (3 patients). Half of these patients presented with obscure gastrointestinal bleeding (OGIB). Histopathologic diagnosis was obtained in 11 of 14 patients. CONCLUSIONS: Of 180 patients with OGIB, MSBT accounted for only 3.9%, however, 50% of patients with MSBT presented with OGIB. OGIB is an important clinical feature of small-bowel malignancy, which can be diagnosed by DBE.

Yamagami H; Oshitani N; Hosomi S; Suekane T; Kamata N; Sogawa M; Okazaki H; Watanabe K; Tominaga K; Watanabe T; Fujiwara Y; Arakawa T

2008-11-01

242

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

UK PubMed Central (United Kingdom)

INTRODUCTION: In suspected Crohn's disease (CD), current diagnostic guidelines recommend additional small bowel imaging irrespective of the findings at ileocolonoscopy. Magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE) are regarded first line imaging techniques and should generally precede capsule endoscopy. MATERIAL AND METHODS: This article brings together results from a prospective blinded diagnostic study of MRE, CTE, capsule endoscopy and faecal calprotectin (fCal) in 93 patients undergoing their first diagnostic work-up for CD. RESULTS: In patients with suspected CD, fCal is useful for the identification patients without need for colonoscopy or small bowel imaging. Patients with an elevated fCal should undergo colonoscopy including a persistent attempt to intubate the terminal ileum. CD isolated in the upper small bowel is rare, and in patients with a normal ileocolonoscopy or non-complicated CD in the colon and/or terminal ileum, small bowel imaging provides little extra information compared to ileoscopy alone. Small bowel imaging is primarily indicated if ileoscopy is not achieved and capsule endoscopy is recommended as first line imaging technique. If small bowel stenosis is not ruled out, a preceding test with a patency capsule can be performed to avoid capsule retention. MRE and CTE are complimentary modalities preferably used in patients with stenosis detected at ileocolonoscopy or suspicion of extra-intestinal disease complications. CONCLUSION: Our results suggest that a diagnostic approach different to that described in the guidelines may be expedient. FUNDING: not relevant. TRIAL REGISTRATION: The study was approved by the Ethics Committee of Southern Denmark (S-20070072) and the Danish Data Protection Agency (journal number: 2007-41-0675). ClinicalTrials.gov identifier: NCT01019460.

Jensen MD; Nathan T; Rafaelsen SR; Kjeldsen J

2012-09-01

243

Carcinoid tumors of the small-bowel: evaluation with 64-section CT-enteroclysis.  

UK PubMed Central (United Kingdom)

PURPOSE: To describe the imaging presentation of carcinoid tumors of the small-bowel at 64-section CT-enteroclysis and determine the sensitivity of this technique for tumor detection. PATIENTS AND METHODS: The 64-section CT-enteroclysis examinations of 22 patients with histopathologically proven small-bowel carcinoid tumors and those of 6 patients with suspected recurrence after small-bowel resection for carcinoid tumor were reviewed. Images were analyzed with respect to imaging presentation. Sensitivity, specificity, and accuracy, of 64-section CT-enteroclysis for the diagnosis of carcinoid tumor of the small-bowel were estimated with 95% confidence intervals (CIs). RESULTS: Twenty-five carcinoid tumors were confirmed in 22 patients (prevalence, 22/28; 79%). Overall sensitivity for carcinoid tumor detection was 76% (19/25; 95%CI: 55-91%) on a per-lesion basis. On a per-patient basis, 64-section CT-enteroclysis had a sensitivity of 86% (19/22; 95%CI: 65-97%), a specificity of 100% (6/6; 95%CI: 54-100%) and an accuracy of 89% (25/28; 95%CI: 72-98%) for the diagnosis of carcinoid tumor. Focal small-bowel wall thickening, mesenteric stranding, and mesenteric mass were found in 20/22 (91%), 18/22 (82%) and 15/22 (68%) patients with pathologically confirmed tumors. CONCLUSION: 64-Section CT-enteroclysis shows highly suggestive features for the diagnosis of carcinoid tumor of the small-bowel and achieves high degrees of sensitivity for tumor detection.

Soyer P; Dohan A; Eveno C; Dray X; Hamzi L; Hoeffel C; Kaci R; Boudiaf M

2013-06-01

244

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

Directory of Open Access Journals (Sweden)

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; Nicolas Veyrie

2012-01-01

245

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

International Nuclear Information System (INIS)

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

1984-01-01

246

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

International Nuclear Information System (INIS)

[en] 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

247

Acute abdomen caused by a small bowel perforation due to a clinically unsuspected fish bone.  

UK PubMed Central (United Kingdom)

We report the case of a 78-year-old woman with a three-day history of abdominal pain and vomiting. An abdominal plain film showed a distended small bowel loop and no signs of free intra-abdominal gas. An abdominal ultrasound revealed a mass containing a linear, hyperechoic structure. The mass was connected through a sinus tract to an adjacent aperistaltic small bowel loop. A laparotomy revealed a jejunal perforation and an omental granuloma containing a fish bone. Accidentally ingested foreign bodies should always be suspected in cases of acute abdomen, and ultrasonography remains a firstline examination tool for preoperative diagnoses of unsuspected foreign bodies and their complications.

Drakonaki E; Chatzioannou M; Spiridakis K; Panagiotakis G

2011-06-01

248

Acute abdomen caused by a small bowel perforation due to a clinically unsuspected fish bone.  

Science.gov (United States)

We report the case of a 78-year-old woman with a three-day history of abdominal pain and vomiting. An abdominal plain film showed a distended small bowel loop and no signs of free intra-abdominal gas. An abdominal ultrasound revealed a mass containing a linear, hyperechoic structure. The mass was connected through a sinus tract to an adjacent aperistaltic small bowel loop. A laparotomy revealed a jejunal perforation and an omental granuloma containing a fish bone. Accidentally ingested foreign bodies should always be suspected in cases of acute abdomen, and ultrasonography remains a firstline examination tool for preoperative diagnoses of unsuspected foreign bodies and their complications. PMID:20683816

Drakonaki, Eleni; Chatzioannou, Maria; Spiridakis, Konstantinos; Panagiotakis, George

2010-08-03

249

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

Directory of Open Access Journals (Sweden)

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

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

2008-01-01

250

[Small bowel obstruction secondary to incomplete torsion of proximal ileum following laparoscopic hysterectomy. Case report].  

UK PubMed Central (United Kingdom)

A minimally invasive approach for gynecologic procedures has become popular in recent years. Despite the advantages of this kind of surgery over open technique, laparoscopic hysterectomy is not free of complications. A case of small bowel obstruction secondary to incomplete torsion of proximal ileum ten days after an uneventful total laparoscopic hysterectomy is reported. Partial small bowel obstruction (PSBO) is a rare complication after gynecologic laparoscopy; its post-operatory incidence is 0.036% within a month after. A clean, adequate surgical technique, with minimal manipulation of internal organs, reduces the risk of adhesive process and PSBO.

López Rangel JA; Audifred Salomón J; Ortiz Reyes H; Cervantes Mondragón PJ

2012-10-01

251

JEJUNAL ANGIOFIBROMA AS AN UNUSUAL CAUSE OF SMALL BOWELL INTUSSUSCEPTION IN ADULT - CASE REPORT  

Directory of Open Access Journals (Sweden)

Full Text Available Adult intussusception represents only about 5% of all intussusceptions and is usually caused by a small bowel tumor acting as the apex of invagination. We report an unusual case in a 57-years-old woman with intussusception caused by a tumor located in the jejunum. We performed jejunal resection with end-to-end anastomosis. Histologically the diagnosis was angiofibroma with mixoid areas, without malign aspects. Benign tumors of the small bowell are rare clinical entities and angiofibroma is a very unusual benign tumor of the gastrointestinal tract.

C.N. Neacsu; D. Vintila; Paula Popa; D. Ferariu; Felicia Crumpei

2005-01-01

252

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

International Nuclear Information System (INIS)

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

2005-01-01

253

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.

Samel Stephan; Keese Michael; Kleczka Martha; Lanig Sybille; Gretz Norbert; Hafner Mathias; Sturm Jörg; Post Stefan

2002-01-01

254

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

UK PubMed Central (United Kingdom)

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 GD; Masone S; Persico M; Siciliano S; Salvatori F; Maione F; Esposito D; Persico G

2012-01-01

255

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; Masone Stefania; Persico Marcello; Siciliano Saverio; Salvatori Francesca; Maione Francesco; Esposito Dario; Persico Giovanni

2012-01-01

256

Ileocolic versus Small-Bowel Intussusception in Children: Can US Enable Reliable Differentiation?  

UK PubMed Central (United Kingdom)

Purpose:To assess clinical and ultrasonographic (US) criteria that can be used to confidently differentiate ileocolic from small-bowel intussusception.Materials and Methods:Institutional review board approval was obtained for this retrospective study, and the need to obtain informed consent was waived. US and clinical data for children given a diagnosis of intussusception in the years 2007 through 2011 were evaluated. The diameters of the intussusception and the inner fat core, the outer bowel wall thickness, and the presence or absence of lymph nodes inside the intussusception and mesentery were noted. The Student t test, the Mann-Whitney test, and the Levene test were used for comparison of parametric variables, while the ?(2) and Fisher exact tests were used for comparison of categoric data.Results:There were 200 cases of intussusception in 174 patients (126 boys, 48 girls; mean age, 17.2 months (range, 0 years to 7 years 1 month); 57 (28.5%) were small-bowel and 143 (71.5%) were ileocolic intussusceptions. Mean lesion diameter was 2.63 cm (range, 1.3-4.0 cm) for ileocolic versus 1.42 cm (range, 0.8-3.0 cm) for small-bowel intussusception (P < .0001). Mean fat core diameter was 1.32 cm (range, 0.6-2.2 cm) for ileocolic versus 0.1 cm (range, 0-0.75 cm) for small-bowel intussusception (P < .0001). The ratio of inner fat core diameter to outer wall thickness was greater than 1.0 in all ileocolic intussusceptions and was less than 1.0 in all small-bowel intussusceptions (P < .0001). Lymph nodes inside the lesion were seen in 128 (89.5%) of the 143 ileocolic intussusceptions versus in eight (14.0%) of the 57 small-bowel intussusceptions (P < .0001). Children with ileocolic intussusception had more severe clinical symptoms and signs, with more vomiting (P = .003), leukocytosis (P = .003), and blood in the stool (P = .00005).Conclusion:The presence of an inner fatty core in the intussusception, lesion diameter, wall thickness, the ratio of fatty core thickness to outer wall thickness, and the presence of lymph nodes in the lesion may enable reliable differentiation between ileocolic and small-bowel intussusceptions.© RSNA, 2013.

Lioubashevsky N; Hiller N; Rozovsky K; Segev L; Simanovsky N

2013-06-01

257

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

Directory of Open Access Journals (Sweden)

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

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

2009-01-01

258

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in english Small bowel transplantation is associated with a patient survival at one and five years, of 80% and 63%, respectively. We repon a 36 year-old female with short bowel syndrome, subjected to the first small bowel transplantation performed in Chile. A cadaveric gran was used. Immunosuppression was achieved by means of alemtuzumab, tacrolimus, sirolimus, micofenolate mofetil and steroids. Serial endoscopies and biopsies were performed during seven months after transplantation (more) . 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

2009-02-01

259

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; Sultan Sufian; Kubba Faris; Sellu David P

2010-01-01

260

Radiological assessment of small bowel obstructions: value of conventional enteroclysis and dynamic MR-enteroclysis  

International Nuclear Information System (INIS)

[en] Purpose: To compare small bowel lesions, especially stenoses, with conventional enteroclysis, static MRI and dynamic MR-enteroclysis. Materials and Methods: Forty-two patients with Crohn's disease or other suspected small bowel lesions were examined. MRI was performed in a static and a dynamic way either within one hour after conventional enteroclysis (n = 30) or a few days afterwards (n = 12). In order to monitor bowel filling and to characterize stenoses in a dynamic fashion, 4 series of coronal T2w HASTE breath hold sequences were used, first without additional bowel opacification and then during administration of 1,5 l methyl cellulose via a naso-intestinal tube in the MR unit. Intravenously applied Buscopan was used to reduce bowel movement. Results: In 4 out of 42 Patients, application of methylcellulose was limited to 1000 ml because of gastrointestinal complaints or visible gastral reflux. All patients could be evaluated. Static MRI performed within one hour after conventional enteroclysis and no additional bowel opacification showed insufficient bowel distension. Distension was still better than in MRI without prior application of contrast medium. On the contrary, dynamic MR - enteroclysis lead to controlled and complete bowel distension which allowed for significantly better evaluation of normal bowel anatomy and pathological alterations of the gut. Because of a better bowel distension and dynamic evaluation, MR-enteroclysis revealed significantly more stenoses (n = 42) than MRI obtained with less distension (n = 27, p [de] Zielsetzung: Vergleich von konventionellem Enteroklysma und dynamischen MR-Enteroklymsa zur Darstellung von Duenndarmlaesionen, insbesondere zur Charakterisierung von Stenosen. Patienten und Methodik: 42 Patienten mit M. Crohn oder anderen vermuteten Duenndarmerkrankungen wurden untersucht. Eine statische MRT ohne intestinales Kontrastmittel sowie eine dynamische MRT mit intestinalem Kontrastmittel erfolgten entweder im unmittelbaren Anschluss an ein konventionelles Enteroklysma (n = 30) oder zeitlich versetzt (n = 12). 4 Schnittbildserien (T2-HASTE koronar in Atemanhaltetechnik) wurden als ''Leeraufnahme'' sowie nach fraktionierter Applikation von insg. 1,5 L Methylzellulose ueber eine Duenndarmsonde im MRT angefertigt, um dynamisch die Darmkontrastierung zu erfassen und funktionelle Informationen ueber Stenosen zu gewinnen. Ergebnisse: Im MR-Enteroklysma nach Applikation von Methylzellulose liessen sich aufgrund der besseren Darmdistension und der dynamischen Beurteilbarkeit deutlich mehr Stenosen (n = 42) als bei ungenuegender Distension ohne vorherige Gabe von Methylzellulose (n = 27 Stenosen) darstellen (p

2002-01-01

 
 
 
 
261

Aflatoxin B1-adduct formation in rat and human small bowel enterocytes.  

UK PubMed Central (United Kingdom)

BACKGROUND/AIMS: Hepatic CYP3A enzymes have been implicated in the bioactivation of aflatoxin B1 (AFB1) to DNA binding metabolites. CYP3A enzymes are also abundant in the small bowel, and we therefore examined the ability of this tissue to form intracellular AFB1 adducts. METHODS: Immunohistochemistry using a antibody to the stable AFB1-DNA adduct was performed on small bowel sections obtained from rats orally gavaged with AFB1 and on human small bowel biopsy specimens maintained in explant culture. 3H-AFB1 was instilled into a loop of small bowel of untreated rats and rats pretreated with the CYP3A inducer dexamethasone during vivisection. DNA was isolated from the loop 2 hours later and assayed for specific activity. RESULTS: In both rats and humans, AFB1-adducts were detected exclusively in mature enterocytes in a pattern similar to the distribution of CYP3A enzymes. Induction of enterocyte CYP3A in rats resulted in an increase in enterocyte immunoreactive AFB1 adducts and in a 1.8-fold increase in 3H-AFB1-nucleic acid adducts (P = 0.01). CONCLUSIONS: Intracellular AFB1 adducts are formed in the small intestine, and this reflects, at least in part, the catalytic activity of CYP3A enzymes. Because these AFB1 adducts should ultimately pass in stool, enterocyte CYP3A may represent a regulatable barrier to dietary aflatoxins.

Kolars JC; Benedict P; Schmiedlin-Ren P; Watkins PB

1994-02-01

262

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

International Nuclear Information System (INIS)

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

2007-12-07

263

Simethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Capsule endoscopy is a new imaging method for visualization of the entire small bowel. However, no standardized protocol for bowel preparation for capsule endoscopy has been evaluated. METHODS: Capsule endoscopy was performed in 36 consecutive patients, all of whom fasted for 12 hours before ingestion of the capsule. Before capsule endoscopy, 18 patients received 80 mg simethicone and 18 had no supplemental medication for bowel preparation. Two observers, both experienced endoscopists, independently reviewed the examinations in a single-blinded and randomly assigned fashion. Mucosal visibility and intraluminal gas bubbles were assessed and graded by both observers. RESULTS: Bowel preparation with simethicone resulted in significantly better visibility because of fewer intraluminal bubbles (p<0.01). Interobserver agreement was excellent (r>/=0.8; k 0.78: 95% CI[0.57, 0.98] ). No adverse effect of simethicone was observed. CONCLUSIONS: Simethicone may be added to the routine preparation for capsule endoscopy to improve the visibility of small bowel mucosa.

Albert J; Göbel CM; Lesske J; Lotterer E; Nietsch H; Fleig WE

2004-04-01

264

Diverticular disease: An experience at King Faisal specialist hospital  

Directory of Open Access Journals (Sweden)

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

265

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

266

Acute small bowel obstruction due to ileal endometriosis: A case report and review of the most recent literature  

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Introduction. Endometriosis is defined as the presence of benign endometrial glands and stroma outside the normal anatomical location. Endometriosis of the small bowel, especially symptomatic small bowel involvement, is very unusual. Case report. We presented a 45-year-old woman with acute intest...

Unalp Recai Haluk; Akguner Taner; Yavuzcan Ali; Ek?nc? Nese

267

Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults  

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Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. I...

Guner, Ali; Karyagar, Sava?; Livaoglu, Ayten; Kece, Can; Kucuktulu, Uzer

268

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

269

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. Computer...

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

270

Small bowel herniation and gangrene from peritoneal dialysis catheter exit site  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Peritoneal dialysis is one of the standard methods for blood purification. It is particularly well suited for treating children with acute renal failure. Here we report a rare case of small bowel herniation at the peritoneal catheter exit site following removal, leading to gangrenous infarction.

Wong, KKY; Lan, LCL; Lin, SCL; Tam, PKH

271

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

1990-01-01

272

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel.

Blank Gregor; Königsrainer Alfred; Sipos Bence; Ladurner Ruth

2012-01-01

273

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

International Nuclear Information System (INIS)

[en] 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

274

Complete small bowel obstruction caused by metastasis from primary nasopharyngeal carcinoma  

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We here report the first case in the literature on a surgical emergency of complete small bowel obstruction caused by metastasis from nasopharyngeal carcinoma nine months after the primary tumor was treated with concurrent chemoradiation. The patient achieved prolonged survival with prompt surgical ...

Chi Pan Lau; Edwin Pun Hui; Anthony Tak-Cheung Chan

275

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2007-08-15

276

The effect of osmolarity and caloric load on small bowel motility.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although there is profound knowledge about cyclic fasting motility, the postprandial intestinal motor response is not well investigated. It is intriguing to speculate that nutrient composition alters small bowel motility significantly and, in a clinical setting, may account for adverse gastrointestinal symptoms in enteral nutrition (EN). We aimed to assess the impact of different caloric loads and osmolarities of EN on human jejunal motility. METHODS: Sixteen healthy subjects underwent a series of duodenal infusions of EN solutions, either with iso-osmolar solution with different caloric loads (1.32, 2.64, or 3.96 kcal min(-1)), or with solutions of different osmolarities with constant caloric loads (300, 600, or 1200 mosmol). Jejunal solid-state manometry was analyzed over 90 min both visually and using dedicated computer software. KEY RESULTS: All tested nutrient solutions were able to trigger conversion to a postprandial jejunal motility pattern after a mean lag phase of 9.4 + 2.3 min (P = NS between different nutrient solutions). Different caloric loads did not result in significant differences in small bowel motility. However, increasing osmolarities caused a significant inhibition of contractile and propagative activity. CONCLUSIONS & INFERENCES: Small bowel motility under duodenal infusion of nutrient solutions is not influenced by caloric load in a physiological range, whereas high osmolarities inhibit small bowel motility.

Seidl H; Schmidt T; Gundling F; Pfeiffer A

2013-01-01

277

An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament  

Energy Technology Data Exchange (ETDEWEB)

Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment. (orig.)

Sourtzis, S.; Canizares, C.; Damry, N. [Department of Radiology, Brugmann University Hospital, Brussels (Belgium); Thibeau, J.F.; Philippart, P. [Department of Surgery, Brugmann University Hospital, Brussels (Belgium)

2002-03-01

278

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

2008-01-01

279

The lactulose hydrogen breath test as a diagnostic test for small-bowel bacterial overgrowth.  

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The lactulose hydrogen breath test has been evaluated as a diagnostic test for small-bowel bacterial overgrowth using the 14C-glycocholate breath test for comparison. Twenty-seven patients with suspected bacterial overgrowth and 37 control patients were studied. The lactulose test was positive in 8 ...

Rhodes, JM; Middleton, P; Jewell, DP

280

Small-bowel perforation complicating the open treatment of generalized peritonitis.  

UK PubMed Central (United Kingdom)

Fourteen patients were found to have developed 53 small-bowel perforations in the absence of pathogenic factors during "open abdominal treatment" for generalized peritonitis. They occurred after three to 17 laparotomies, on average at the eighth postoperative day (one to 120 days). Forty-nine lesions were located superficially. A relation with organ system failure, routine blood tests, type of nutrition, or microorganisms could not be demonstrated. The etiology of the lesions remains uncertain, but the open abdominal treatment must play some important role in its pathophysiology. Five patients survived. The therapy of choice appears to be mobilization of the bowel with resection of the affected part and primary anastomosis.

Mastboom WJ; Kuypers HH; Schoots FJ; Wobbes T

1989-06-01

 
 
 
 
281

Small bowel capsule endoscopy vs conventional techniques in patients with symptoms highly compatible with Crohn's disease.  

UK PubMed Central (United Kingdom)

BACKGROUND & AIMS: The diagnostic role of Small Bowel Capsule Endoscopy (SBCE) in Crohn's Disease (CD) is under investigation. In a prospective study we investigated the diagnostic role of SBCE in patients with symptoms highly compatible with CD and undefined diagnosis after conventional techniques. METHODS: From September 2005 to May 2009, all patients with clinically suspected CD and not conclusive diagnosis after Ileocolonoscopy (IC), Small Bowel Follow Through (SBFT) and Small Intestine Contrast Ultrasonography (SICUS) were enrolled. Findings compatible with CD included: bowel wall thickness (BWT) >3mm (for SICUS), ulcers, stenosis/strictures, fistulae (for SICUS, SBFT); >5 aphtoid ulcers, deep ulcers and/or strictures (for SBCE). RESULTS: Conventional techniques did not lead to a conclusive diagnosis in 30 patients (19 F, median age 31 years, range 8-57), showing chronic diarrhoea (n=27), abdominal pain (n=23), weight loss (n=5), fever (n=5), Iron Deficiency Anaemia (IDA)(n=5) and/or perianal disease (n=4). Findings compatible but not diagnostic for small bowel CD were detected in 19 (63%) by IC in 12 (40%) by SICUS and in 15 (50%) by SBFT. SBCE showed ileal lesions in 15 (50%) patients, including findings compatible with CD in 12 (40%). SBCE retention requiring surgery was observed in 1 patient. A significant concordance was observed between SBCE and IC k=0.33 C(k)=[0.25;0.42], but not between SBCE and SICUS k=0.13 IC(k)=[0.045;0.22] and between SBCE and SBFT k=0 IC(k)=[-0.089;0.089]. CONCLUSIONS: SBCE may detect lesions compatible with small bowel CD in almost one third of patients with symptoms highly compatible with CD and not conclusive diagnosis by using conventional techniques.

Petruzziello C; Calabrese E; Onali S; Zuzzi S; Condino G; Ascolani M; Zorzi F; Pallone F; Biancone L

2011-04-01

282

Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier?  

UK PubMed Central (United Kingdom)

BACKGROUND/OBJECTIVES: In older people, small bowel bacterial overgrowth syndrome may be a common, but under-diagnosed, cause of diarrhoea and nutrient malabsorption. We aim to determine which clinical features and baseline laboratory investigations indicate a high likelihood of small bowel bacterial overgrowth as defined by a positive glucose breath test. METHODS: A retrospective analysis of records for all patients referred for glucose breath test over a 6-year period to a teaching hospital. RESULTS: Out of 197 referrals, 168 patient records were located and analysed (62 male, 106 female; median age 65). Patient characteristics predictive of a positive glucose breath test were: increasing age (p < 0.01), low serum vitamin B12 (p = 0.02), low serum albumin (p = 0.03), previous partial gastrectomy (p < 0.01), previous right hemi-colectomy (p < 0.01), presence of small bowel diverticulae (p = 0.01) and concurrent use of a proton pump inhibitor (p < 0.01). 52.5% (n = 21/40) of patients studied who were over 75 years old versus 21.8% (n = 28/128) of those under 75 years old had a positive glucose breath test (p < 0.01). The median time to diagnosis, from first hospital visit to positive glucose breath test, was 39 weeks. CONCLUSIONS: There is often a significant delay in diagnosis of small bowel bacterial overgrowth. We suggest that this diagnosis should be considered earlier in the investigative algorithm in older patients with indicative symptoms and a predisposing factor (including previous partial gastrectomy, previous right hemi-colectomy, small bowel diverticulae or use of a proton pump inhibitor) or concurring laboratory indices (low vitamin B12 or albumin).

Elphick DA; Chew TS; Higham SE; Bird N; Ahmad A; Sanders DS

2005-11-01

283

Chemotherapy-induced bowel obstruction in small cell lung cancer: a case report.  

UK PubMed Central (United Kingdom)

This case report focuses on an elderly gentleman with extensive stage small cell lung cancer (SCLC) who experienced episodes of bowel obstruction shortly after commencing first-line chemotherapy with cisplatin and etoposide. The patient had no radiological or pathological evidence of intra-abdominal carcinomatosis or paraneoplastic bowel disease secondary to SCLC. Although neurotoxicity is commonly associated with platinum agents, the effect is predominantly peripheral as opposed to autonomic. The authors conclude that the observations documented in this case were secondary to etoposide; a podophyllotoxin that can bind microtubules and inhibit fast axonal transport. Although paralytic ileus is well recognised with podophyllotoxin poisoning, to our knowledge, this is the first report to associate bowel obstruction with standard doses of etoposide and highlights the need for physicians to be aware of such deleterious effects in patients treated with this cytotoxic agent.

Coward JI; Ding NL; Feakins R; Kocher H; Popat S; Szlosarek PW

2012-12-01

284

Chemotherapy-induced bowel obstruction in small cell lung cancer: a case report.  

Science.gov (United States)

This case report focuses on an elderly gentleman with extensive stage small cell lung cancer (SCLC) who experienced episodes of bowel obstruction shortly after commencing first-line chemotherapy with cisplatin and etoposide. The patient had no radiological or pathological evidence of intra-abdominal carcinomatosis or paraneoplastic bowel disease secondary to SCLC. Although neurotoxicity is commonly associated with platinum agents, the effect is predominantly peripheral as opposed to autonomic. The authors conclude that the observations documented in this case were secondary to etoposide; a podophyllotoxin that can bind microtubules and inhibit fast axonal transport. Although paralytic ileus is well recognised with podophyllotoxin poisoning, to our knowledge, this is the first report to associate bowel obstruction with standard doses of etoposide and highlights the need for physicians to be aware of such deleterious effects in patients treated with this cytotoxic agent. PMID:22203382

Coward, Jermaine I G; Ding, Nicola-Louise; Feakins, Roger; Kocher, Hermant; Popat, Sanjay; Szlosarek, Piotr W

2011-12-28

285

Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films  

Energy Technology Data Exchange (ETDEWEB)

For colorectal cancer, the adjuvant radiation dose levels required to achieve a high incidence of local control closely parallel the radiation tolerance of small bowel (4500-5000 rad), and for patients with partially resected or unresected disease, the dose levels exceed tolerance (6000-7000 rad). Therefore, both the surgeon and the radiation oncologist should use techniques that localize tumor volumes and decrease the amount of small intestine within the irradiation field. Surgical options include pelvic reconstruction and clip placement. Radiation options include the use of radiographs to define small bowel location and mobility combined with treatment techniques using multiple fields, bladder distention, shrinking or boost fields, and/or patient position changes. When both specialties interact in optimum fashion, local control can be increased with minimal side effects to the small intestine.

Gunderson, L.L.; Russell, A.H.; Llewellyn, H.J.; Doppke, K.P.; Tepper, J.E.

1985-07-01

286

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

287

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

2001-10-01

288

Small bowel perforation secondary to fish bone ingestion managed non-operatively.  

UK PubMed Central (United Kingdom)

BACKGROUND: The presurgical diagnosis of foreign body (FB)-induced bowel perforation is exceedingly difficult. Perforation most commonly occurs in the ileocecal region and typically mimics diagnoses more common to the right lower quadrant (RLQ), including appendicitis and diverticulitis. OBJECTIVES: This report will discuss the events of this particular case of fish bone ingestion and subsequent small bowel perforation and the epidemiology, diagnosis, and management of FB ingestions. CASE REPORT: This case describes a 28-year-old man who presents with a 4-h history of sharp, stabbing abdominal pain localized to the RLQ. Abdominal computed tomography revealed a 1.5-cm curvilinear foreign body traversing through a loop of small bowel in the RLQ. Upon further questioning, the patient recalled eating northern pike 2 days before. During his hospital stay, the patient noted improvement of his symptoms and thus was managed non-operatively without complication. The patient was discharged after complete resolution of his abdominal pain on hospital day number 2. CONCLUSION: This represents a rare case of small bowel perforation secondary to fish bone ingestion that was managed non-operatively without complication.

Ward MA; Tews MC

2012-11-01

289

Warfarin Overdose Induced Intramural Small-Bowel Hematoma (Case Report)  

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Uncontrolled use of anticoagulants may cause bleeding. Warfarin- dependent spontaneous intramural hematoma of the small intestine is a rare complication. Although warfarin using patients with abdominal pain were usually treated medically, surgical interventions should be considered in selected cases...

?brahim Yetim; Ersan Semerci; Orhan Veli Özkan; Muyittin Temiz; Ahmet Aslan

290

Efficacy and efficiency of small bowel double contrast enema  

International Nuclear Information System (INIS)

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

1986-01-01

291

Efficacy and efficiency of small bowel double contrast enema  

Energy Technology Data Exchange (ETDEWEB)

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

Roedl, W.; Possel, H.M.; Prull, A.; Wunderlich, L.

1986-02-01

292

Small bowel lesion due to spiral tacks after laparoscopic intraperitoneal onlay mesh repair for incisional hernia.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Laparoscopic intraperitoneal onlay mesh (IPOM) repair has become a widely accepted operative technique for incisional hernias. However, tack fixation poses the risk of adhesions and injury to the intestine. We report the case of spiral tacks adherent to the small bowel after IPOM repair for incisional hernia. PRESENTATION OF CASE: 64 years old male patient who underwent laparoscopic IPOM repair for incisional hernia 1 year after open sigmoid resection. A laminated polypropylene mesh was fixed with titanium spiral tacks. 4 years later, elective open cholecystectomy was performed. Two spiral tacks integrated in the seromusular layer of the small bowel were encountered. Tacks were removed and bowel lesions oversewn with interrupted seromuscular stitches. DISCUSSION: According to the current literature, complications related to metal spiral tacks in IPOM mesh repair such as intestinal perforation or strangulation ileus seem to be rare. To our knowledge, spiral tacks adherent to the intestine have not yet been published to date. Alternative techniques for mesh fixation are transfascial sutures with single stitches, continuous sutures or fibrin glue, as already used in TAPP and TEP procedures for inguinal hernia repair. The ideal and safest technique for mesh fixation in IPOM repair for incisional hernias remains controversial. CONCLUSION: Spiral tacks used for intraperitoneal mesh fixation can lead to adhesions and bowel lesions. Sutures, absorbable tacks or fibrin glue are alternatives for mesh fixation. Further clinical trials are needed to evaluate the safest technique of laparoscopic IPOM incisional hernia repair.

Haltmeier T; Groebli Y

2013-01-01

293

Small bowel obstruction due to inflammatory fibroid polyp.  

UK PubMed Central (United Kingdom)

Inflammatory fibroid polyp is a benign and non-neoplastic condition of the intestinal tract, commonly affecting the gastric antrum, though it can affect any part of the gastro-intestinal tract. It is a submucosal, sessile, poypoid mass composed of myofibroblast like mesenchymal cells, numerous small blood vessels and marked inflammatory cell infiltrate mainly eosinophils. It commonly presents as intestinal obstruction or intussusception. A case of recurrent partial small intestinal obstruction due to intermittent intussusception associated with inflammatory fibroid polyp of jejunum is being reported.

Das S; Mandal TS; Sinhababu AK; Chatterjee TK; Khamrui TK; Bhattacharya H

2012-01-01

294

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

Science.gov (United States)

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

Chen, Wen-Guo; Shan, Guo-Dong; Zhang, Hong; Li, Lin; Yue, Min; Xiang, Zun; Cheng, Ying; Wu, Chen-Jiao; Fang, Ying; Chen, Li-Hua

2013-01-01

295

Warfarin Overdose Induced Intramural Small-Bowel Hematoma (Case Report)  

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Full Text Available Uncontrolled use of anticoagulants may cause bleeding. Warfarin- dependent spontaneous intramural hematoma of the small intestine is a rare complication. Although warfarin using patients with abdominal pain were usually treated medically, surgical interventions should be considered in selected cases with intestinal intramural hematoma. Here we present a patient who was treated surgically to bring to mind this rare condition.

?brahim Yetim; Ersan Semerci; Orhan Veli Özkan; Muyittin Temiz; Ahmet Aslan

2011-01-01

296

Incidence patterns of small bowel cancer in a population-based study in Sweden: increase in duodenal adenocarcinoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Increasing incidences of malignant small bowel tumours have been reported, but data from European populations are limited. This study aimed to clarify the incidence patterns of malignant small bowel tumours in Sweden. METHODS: Patients with a first and primary malignant small bowel tumour were identified from the Swedish Cancer Register during the study period 1960-2009. Sex-specific and age-standardised incidence rates of these tumours were calculated by their anatomical location and histological type in different time periods. Figures were plotted to show the proportions and incidence rates over time, and joinpoint loglinear regression models were estimated to assess any time trends. RESULTS: A total of 6604 patients with malignant small bowel tumours were identified. The age-standardised incidence of all malignant small bowel tumours increased from 14.2 to 19.7 per 1,000,000 person-years during the study period. The incidence of duodenal cancer increased more than 3-fold (from 1.6 to 5.4 per 1,000,000 person-years), which was mainly expained by a dramatical rising trend of adenocarcinoma of the duodenum (from 0.7 to 4.2 per 1,000,000 person-years). Malignant tumours of small bowel with unspecified anatomical locations showed a slight increase (from 7.0 to 7.9 per 1,000,000). The incidence of small bowel tumours in other locations or of other histological types was more stable. CONCLUSIONS: The incidence of small bowel malignancies has increased during the period 1960-2009. Among the specific types of small bowel cancer, a particularly rapid increase was found for duodenal adenocarcinoma.

Lu Y; Fröbom R; Lagergren J

2012-06-01

297

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

International Nuclear Information System (INIS)

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

1987-01-01

298

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

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

2003-01-01

299

Diverticular Bleeding of the Colon during Combination Chemotherapy with Bevacizumab and Paclitaxel for Recurrent Breast Cancer.  

UK PubMed Central (United Kingdom)

BACKGROUND: Bevacizumab has been increasingly used in combination chemotherapy with paclitaxel for treatment of metastatic or recurrent breast cancer. The aim of this report is to underline possible risks associated with the new combination chemotherapy. CASE PRESENTATION: A 39-year-old woman with recurrent breast cancer was treated with bevacizumab and paclitaxel. Positron emission tomography revealed breast cancer metastasis to the left supraclavicular lymph nodes and right axillary lymph nodes, with no distant metastasis. RESULTS: After the third cycle of bevacizumab and paclitaxel, the patient developed a bloody bowel discharge. Emergent colonoscopy demonstrated diverticular bleeding on one of the multiple diverticula in the ascending colon. The bleeding point was successfully clipped colonoscopically. CONCLUSION: The factors for diverticular bleeding are believed to be non-steroidal anti-inflammatory drugs, constipation, and bevacizumab. We recommend reviewing anamneses for diverticulitis, multiple prior abdominal surgeries, peritoneal carcinomatosis, and regular use of certain drugs.

Nakayama Y; Ito Y; Tanabe M; Takahashi S

2013-01-01

300

Recent advances in small bowel diseases: Part?I  

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

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

2012-01-01

 
 
 
 
301

Effect of leptin on intestinal re-growth following massive small bowel resection in rat.  

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Recent evidence suggests that the adipose tissue-derived cytokine leptin (LEP) is involved in modulation of growth and differentiation of normal small intestine. The purpose of the present study was to evaluate the effects of parenteral LEP on structural intestinal adaptation, cell proliferation and apoptosis in a rat model of short bowel syndrome (SBS). Male Sprague-Dawley rats were divided into three experimental groups: Sham rats underwent bowel transection and re-anastomosis, SBS-rats underwent a 75% small bowel resection, and SBS-LEP-rats underwent bowel resection and were treated with LEP given subcutaneously at a dose of 20 mug/kg, once daily, from day 3 through 14. Parameters of intestinal adaptation (bowel and mucosal weights, mucosal DNA and protein, villus height and crypt depth in jejunum and ileum), enterocyte proliferation and enterocyte apoptosis were determined on day 15 following operation. Ileal tissue samples were taken for detection of bax and bcl-2 gene expression using RT-PCR technique. Statistical analysis was performed using the non-parametric Kruskal-Wallis ANOVA test, with P<0.05 considered statistically significant. Treatment with subcutaneous LEP resulted in a significant increase in jejunal (17%, P<0.05) and ileal (13%, P<0.05) bowel weight, jejunal (10%, P<0.05) and ileal (25%, P<0.05) mucosal weight, jejunal (26%, P<0.05) and ileal (38%, P<0.05) mucosal DNA, ileal (25%, P<0.05) mucosal protein, jejunal (41%, P<0.05) and ileal (21%, P<0.05) villus height, jejunal (37%, P<0.05) crypt depth, and jejunal (24%, P<0.05) and ileal (21%, P<0.05) enterocyte proliferation compared to SBS-animals. Enterocyte apoptosis increased significantly after bowel resection in jejunum and ileum compared to sham animals and was accompanied by an increased bax gene expression and a decreased bcl-2 gene expression in ileal samples. SBS-LEP rats showed a trend toward a decrease in enterocyte apoptosis in ileum and a mild decrease in bax gene expression compared to SBS-untreated animals. In conclusion, in a rat model of SBS parenteral LEP stimulates structural intestinal adaptation. Increased cell proliferation and decreased cell death via apoptosis may be responsible for this increased cell mass. PMID:16328335

Sukhotnik, Igor; Vadasz, Zahava; Coran, Arnold G; Lurie, Michael; Shiloni, Eitan; Hatoum, Ossama A; Mogilner, Jorge G

2006-01-01

302

[Clinical value of wireless capsule endoscopy in diagnosis of small bowel disease in children].  

UK PubMed Central (United Kingdom)

OBJECTIVE: The pathological change of small bowel is difficult to examine because it is anatomically unique. The development of wireless capsule endoscopy provides an unique opportunity to visualize the entire small bowel in a minimally invasive manner. The aim of this study was to assess the safety and clinical value of wireless capsule endoscopy in children. METHODS: During the last 4 years (June, 2004-June, 2008), 46 times of wireless capsule endoscopy were performed in 43 patients with suspected small bowel disease, including obscure gastrointestinal bleeding (n = 11), recurrent abdominal pain (n = 20), chronic diarrhea (n = 9), protein losing enteropathy (n = 2), recurrent vomiting (n = 1). Of the 43 cases, 28 were male and 15 were female, the age ranged from 6 to 18 years, 8 of these cases were < 10 years old. The weight of the patients ranged between 15 kg and 60 kg. The average time of capsule passing through the stomach and the small intestine, the tolerance to and complication of wireless capsule endoscopy in patients, the image quality of capsule endoscopy, and the cleanliness of small intestine after fasting for 8 hours were observed and recorded. RESULT: All the patients could easily swallow the capsule and had good tolerance. The overall success rate was 94% (43/46). The median time of capsule passing through the stomach and small intestine was 73 min (range, 3 - 600 min) and 246 min (range, 73 - 413 min), respectively. The diagnostic yield of pathological change in small intestine was 90% (37/41), and the diagnostic accordance rate was 84% (31/37). Based on the wireless capsule endoscopy, diagnostic findings included Crohn's diseases (15), lymph follicular hyperplasia (4), nonspecific enteritis (4), vascular malformations (3), small bowel tumour (2), primary intestinal lymphangiectasia (2), gastrointestinal motility disorders (2), Meckel's diverticulum (1), angioma (1), small intestinal worm disease (1), duodenal ulcer (1), and polyposis syndromes (1). The capsule of 1 patient remained in the stomach. The cleanliness of small intestine after 8 hours fasting was good. And the capsule endoscopy can show high quality small intestine image. CONCLUSION: Wireless capsule endoscopy is a noninvasive, safe and useful tool for the investigation of the small intestine in children, especially for obscure gastrointestinal bleeding and Crohn's disease.

Ma M; Zhang BL; Chen CX; Li FB; Huang XL; Wang PX; Chen J

2009-10-01

303

The effects of erythromycin in small-bowel follow-through  

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To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspension and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4points), but mean SBTT was not significantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying.

Jang, Hyun Yong; Lee, Young Hwan; Jung, Kyung Jae; Chung, Duck Soo; Kim, Ok Dong; Hwang, Jin Bok [Catholic Univ. School of Medicine, Daegu (Korea, Republic of)

2001-05-01

304

The effects of erythromycin in small-bowel follow-through  

International Nuclear Information System (INIS)

[en] To evaluate the efficacy of erythromycin(EM), known to accelerate gastric emptying, in modified small-bowel follow-through(SBFT). We evaluated 32 normal patients who underwent modified SBFT by oral administration of methylcellulose. In the EM injection group(n=20), 500 mg EM (3 mg/kg in pediatric patients) in 100 ml saline was infused intravenously over a 15-minute period prior to the administration of a barium meal, while in the control group(n=12), EM was not infused. Gastric emptying time(GET), small-bowel transit time(SBTT) for barium and methylcellulose, small-bowel transit(SBT) during the first 15 minutes, luminal diameter and quality of image were compared between the two groups. SBT was assigned 1, 2, 3, or 4 points, depending on the extent to which the barium head reached the proximal or distal jejunum, and the proximal or distal ileum during the initial 15-minute. Three radiologists reached a consensus as to image quality. Mean GET was significantly faster in the EM injection group (18.5 mins for 150 ml barium suspension and 25.8 mins for 600 ml methylcellulose). The SBT score during the initial 15 minutes was significantly higher in the EM injection group (3.3 points) than in the control group (2.4points), but mean SBTT was not significantly different between the two groups. Luminal diameter and image quality were also higher in the EM injection group. EM does not decrease SBTT but is highly effective for shortening gastric emptying time, helping to increase the range of fluoroscopic examination and improve image quality in modified small-bowel follow-through, especially in patients with delayed gastric emptying

2001-01-01

305

Laparoscopic repair of spontaneous vaginal evisceration of small bowel: report of a case.  

UK PubMed Central (United Kingdom)

Spontaneous vaginal evisceration of the small bowel is a rare event. It is precipitated in the postmenopausal woman commonly by hysterectomy and in the premenopausal woman by vaginal trauma. We report a case of a 75-year-old woman presenting with a protruding mass in her vagina and associated abdominal pain. A combined laparoscopic and transvaginal method of repair is described and the advantage of using both techniques highlighted.

Sinclair MD; Davies AR; Sankaran S; Agnihotri S; Andreani SM

2010-01-01

306

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.

Mohamed Moftah; Ronan Cahill; Sean Johnston

2012-01-01

307

Intussusception caused by an inverted Meckel's diverticulum: a rare cause of small bowel obstruction in adults  

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Adult intussusception due to Meckel's diverticulum is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report one case of intussusception due to Meckel's diverticulum in an adult. A 22-year-old patient was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness. We diagnosed an acute small bowel obstruction and performed emergency surgery. The intra operative findings were distention of the small bowel and intussusception of ileus due to an inverted Meckel's diverticulum located 70 cm from the ileocecal valve. 30 cm ischemic loop was identified. A segmental small bowel resection and hand-sewn anastomosis was performed. Histopathology distinguished Meckel's diverticulum measuring 5 cm x 3.5 cm x 1 cm and no signs of malignancy.

Bouassida, Mahdi; Feidi, Bilel; Ben Ali, Mechaal; Chtourou, Mohamed Fadhel; Krifa, Marouene; Sassi, Selim; Chebbi, Fathi; Mighri, Mohamed Mongi; Touinsi, Hassen; Sassi, Sadok

2011-01-01

308

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

309

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

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

Cirillo, L.C.; Della Noce, M. [Dept. of Radiology, University ' ' Federico II' ' , Naples (Italy); Camera, L.; Salvatore, M. [Dept. of Radiology, University ' ' Federico II' ' , Naples (Italy); National Research Council, Center of Nuclear Medicine, Naples (Italy); Castiglione, F.; Mazzacca, G. [Dept. of Gastroenterology, University ' ' Federico II' ' , Naples (Italy)

2000-12-01

310

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

International Nuclear Information System (INIS)

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

2000-01-01

311

Multi-slice spiral CT evaluation in Crohn's disease of small bowel  

International Nuclear Information System (INIS)

Objective: To assess the value of enhanced MSCT scan for the Crohn's disease of small bowel. Methods: Fourty-five patients of small bowel Crohn's disease who were proved by multi-method were examined by two-phase enhanced scan with MSCT. The images were reformed in ADW 4.2 by MPR mainly. The CT values of the lesion segments in different phases were tested, with one way ANOVA in statistical analysis; the density difference between the lesion segments and normal segments in different phases were tested, the cases were divided according to 10 HU, and compared them with each other by ?2 test. Results: The average CT value of lesion segments was (39.3±3.7) HU in plain scan, (74.8±13.8) HU in artery phase, (90.2±12.3) HU in portal vein phase, there were sinigicant difference in them (F=258.87, P10 HU respectively in plain scan, 6 cases and 39 cases in artery phase, 2 cases and 43 cases in portal vein phase, by ?2 test, there were sinigicant difference between plain scan and artery phase (?2=32.49, P2= 39.22, P2= 1.10, P>0.05). After enhancement, the lesions can display clearly than plain scan, and the detectable rate was raised highly. Conclusion: Two-phase enhancement scan can diagnosis the Crohn's disease of small bowel and evaluate it overall. (authors)

2009-01-01

312

Decompression of the small bowel by endoscopic long-tube placement  

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Full Text Available AIM: To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement. METHODS: Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups. Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other. The duration of the procedure and the success rate for each group were evaluated. RESULTS: A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group (32.6 ± 14.6 min) and the endoscopic group (16.5 ± 7.8 min) among the cases classified as successful (P < 0.05). The success rate was significantly different between the groups: 88.6% in the fluoroscopic group and 100% in the endoscopic group (P < 0.05). CONCLUSION: For patients with adhesive small bowel obstruction, long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.

Shi-Bin Guo; Zhi-Jun Duan

2012-01-01

313

Small bowel capsule endoscopy for management of Crohn's disease: a retrospective tertiary care centre experience.  

UK PubMed Central (United Kingdom)

BACKGROUND: The role of small bowel capsule endoscopy in the management of established Crohn's disease is uncertain. METHODS: A retrospective study of small bowel capsule endoscopy tests performed in a referral centre from 2008 to 2011; 77 tests were performed in patients with known Crohn's disease. Six patients were excluded due to capsule test retention. Patients were classified into 4 indication groups: unexplained anaemia (G1, n = 6); discrepancy between clinical symptoms and morphology (G2, n = 25), full assessment of Crohn's disease location (G3, n = 37) and evaluation of mucosal healing (G4, n = 3). RESULTS: Twenty-seven (38%) patients had no lesions, 32 (45%) moderate and 12 (17%) severe lesions. Endoscopic lesions were found in 4/6 (67%) G1 patients, 11/25 (44%) G2 and 28/37 (76%) G3 (p < 0.03). Three months after endoscopy was performed, 38/71 patients experienced a change in their treatment that was significantly associated with the severity of endoscopic lesions and with test indications; in 60%, 20% and 58% of patients from G1, G2 and G3, respectively (p < 0.01). CONCLUSION: Small bowel capsule endoscopy resulted in management changes in the majority of patients with established Crohn's disease.

Dussault C; Gower-Rousseau C; Salleron J; Vernier-Massouille G; Branche J; Colombel JF; Maunoury V

2013-07-01

314

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

UK PubMed Central (United Kingdom)

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.

Rácz I; Szalai M; Kovács V; Reg?czi H; Kiss G; Horváth Z

2013-02-01

315

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; Milán Szalai; Valéria Kovács; Henriett Reg?czi; Gyöngyi Kiss; Zoltán Horváth

2013-01-01

316

NiTi Shape Memory Compression Anastomosis Clip in Small- and Large-Bowel Anastomoses: First Experience.  

UK PubMed Central (United Kingdom)

The aim of the study was to present a clinical use of compression anastomosis clip (CAC) implants made of shape memory materials-nickel titanium alloys (NiTi). The concept involved in the use of CAC was to compress 2 bowel walls together, cause necrosis, and detach the CAC from the tissue to be expelled with the stool. The CAC is a double-ring elliptical device with a diameter of 30 mm. The device has the ability to recover its original closed shape when it senses a change in ambient temperature. In all, 20 anastomoses using CACs were performed: 6 of the small with the large bowel and 14 between the small bowel and small bowel. Two patients experienced complications. Although the anastomosis is not difficult to perform, the rules on how to apply the CAC must be well known. Because only a small number of anastomoses have been performed by us to date, this procedure requires further study.

Kusnierz K; Morawiec H; Lekston Z; Zhavoronkov D; Lucyga M; Lampe P

2013-01-01

317

NiTi Shape Memory Compression Anastomosis Clip in Small- and Large-Bowel Anastomoses: First Experience.  

Science.gov (United States)

The aim of the study was to present a clinical use of compression anastomosis clip (CAC) implants made of shape memory materials-nickel titanium alloys (NiTi). The concept involved in the use of CAC was to compress 2 bowel walls together, cause necrosis, and detach the CAC from the tissue to be expelled with the stool. The CAC is a double-ring elliptical device with a diameter of 30 mm. The device has the ability to recover its original closed shape when it senses a change in ambient temperature. In all, 20 anastomoses using CACs were performed: 6 of the small with the large bowel and 14 between the small bowel and small bowel. Two patients experienced complications. Although the anastomosis is not difficult to perform, the rules on how to apply the CAC must be well known. Because only a small number of anastomoses have been performed by us to date, this procedure requires further study. PMID:23355421

Kusnierz, Katarzyna; Morawiec, Henryk; Lekston, Zbigniew; Zhavoronkov, Dmytro; Lucyga, Magdalena; Lampe, Pawel

2013-01-24

318

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

International Nuclear Information System (INIS)

[en] 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) (? = 0.031). All of the children (100%) and 8 adults (29.6%) had abdominal symptoms (?

2008-01-01

319

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

320

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

International Nuclear Information System (INIS)

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.)

2003-01-01

 
 
 
 
321

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

International Nuclear Information System (INIS)

[en] 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.)

1998-01-01

322

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

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

Xiao-Li Chen; Feng Ji; Qi Lin; Yi-Peng Chen; Jian-Jiang Lin; Feng Ye; Ji-Ren Yu; Yi-Jun Wu

2012-01-01

323

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

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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; Emanuele Rondonotti; Alexandros Karargyris

2013-01-01

324

Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs  

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Full Text Available AIM: To summarize clinical, endoscopic, radiologic and pathologic features of special diaphragm-like strictures found in small bowel, with no patient use of non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: From January 2000 to December 2009, 5 cases (2 men and 3 women, with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures of small bowel on imaging, operation and pathology. All the patients denied the use of NSAIDs. The clinical, endoscopic, radiologic and pathologic findings in these 5 patients were retrospectively reviewed from the hospital database. Images of capsule endoscopy (CE) and small bowel follow-through (SBFT) obtained in 3 and 3 patients, respectively, and images of double-balloon enteroscopy and computed tomography enterography (CTE) obtained in all 5 patients were available for review. RESULTS: All patients presented with long-term (2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia. There was only one stricture in four cases and three lesions in one case, and all the lesions were located in the middle or distal segment of ileum. Circumferential stricture was shown in the small bowel in three cases in the CE image, but the capsule was retained in the small bowel of 2 patients. Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient. The lesions were shown as circumferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE (in all 5 cases), SBFT (in 2 cases) and double-balloon enteroscopy (in all cases). On microscopy, a chronic inflammatory infiltrate and circumferential diaphragm were found in all lesions. CONCLUSION: Diaphragm-like strictures of small bowel might be a special consequence of unclear damaging insults to the intestine, having similar clinical, endoscopic, radiologic and pathologic features.

Ming-Liang Wang; Fei Miao; Yong-Hua Tang; Xue-Song Zhao; Jie Zhong; Fei Yuan

2011-01-01

325

MRI diffusion-weighted imaging (DWI) in pediatric small bowel Crohn disease: correlation with MRI findings of active bowel wall inflammation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Restricted diffusion on diffusion-weighted imaging (DWI) sequences during magnetic resonance enterography (MRE) has been shown in segments of bowel affected by Crohn disease. However, the exact meaning of this finding, particularly within the pediatric Crohn disease population, is poorly understood. OBJECTIVE: The purpose of this study was to determine the significance of bowel wall restricted diffusion in children with small bowel Crohn disease by correlating apparent diffusion coefficient (ADC) values with other MRI markers of disease activity. MATERIALS AND METHODS: A retrospective review of pediatric patients (? 18 years of age) with Crohn disease terminal ileitis who underwent MRE with DWI at our institution between May 1, 2009 and May 31, 2011 was undertaken. All of the children had either biopsy-proven Crohn disease terminal ileitis or clinically diagnosed Crohn disease, including terminal ileal involvement by imaging. The mean minimum ADC value within the wall of the terminal ileum was determined for each examination. ADC values were tested for correlation/association with other MRI findings to determine whether a relationship exists between bowel wall restricted diffusion and disease activity. RESULTS: Forty-six MRE examinations with DWI in children with terminal ileitis were identified (23 girls and 23 boys; mean age, 14.3 years). There was significant negative correlation or association between bowel wall minimum ADC value and established MRI markers of disease activity, including degree of bowel wall thickening (R?=?(-)0.43; P?=?0.003), striated pattern of arterial enhancement (P?=?0.01), degree of arterial enhancement (P?=?0.01), degree of delayed enhancement (P?=?0.045), amount of mesenteric inflammatory changes (P?bowel wall T2-weighted signal intensity, length of disease involvement or mesenteric fibrofatty proliferation. CONCLUSION: Increasing bowel wall restricted diffusion (lower ADC values) is associated with multiple MRI findings that are traditionally associated with active inflammation in pediatric small bowel Crohn disease.

Ream JM; Dillman JR; Adler J; Khalatbari S; McHugh JB; Strouse PJ; Dhanani M; Shpeen B; Al-Hawary MM

2013-09-01

326

Breath Hydrogen Gas Concentration Linked to Intestinal Gas Distribution and Malabsorption in Patients with Small-bowel Pseudo-obstruction  

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Full Text Available Background: The patient with colonic obstruction may frequently have bacterial overgrowth and increased breath hydrogen (H2) levels because the bacterium can contact with food residues for longer time. We experienced two cases with intestinal obstruction whose breath H2 concentrations were measured continuously.Case 1: A 70-year-old woman with small bowel obstruction was treated with a gastric tube. When small bowel gas decreased and colonic gas was demonstrated on the plain abdominal radiograph, the breath H2 concentration increased to 6 ppm and reduced again shortly.Case 2: A 41-year-old man with functional small bowel obstruction after surgical treatment was treated with intravenous administration of erythromycin. Although the plain abdominal radiograph demonstrated a decrease of small-bowel gas, the breath H2 gas kept the low level. After a clear-liquid meal was supplied, fasting breath H2 concentration increased rapidly to 22 ppm and gradually decreased to 9 ppm despite the fact that the intestinal gas was unchanged on X-ray. A rapid increase of breath H2 concentration may reflect the movement of small bowel contents to the colon in patients with small-bowel pseudo-obstruction or malabsorption following diet progression.Conclusions: Change in breath H2 concentration had a close association with distribution and movement of intestinal gas.

Yoshihisa Urita; Toshiyasu Watanabe; Tadashi Maeda; Yosuke Sasaki; Susumu Ishihara; Kazuo Hike; Masaki Sanaka; Hitoshi Nakajima; Motonobu Sugimoto

2009-01-01

327

Recurrent small bowel infarction in a young man: polycythaemia or vasculitis?  

UK PubMed Central (United Kingdom)

A 29-year-old man presented with a 3 day history of right lower quadrant pain, nausea and vomiting. There was tenderness in the right lower quadrant. At surgery the appendix was normal but an infarcted terminal ileum segment was found and resected. Histopathological examination was suggestive of vasculitis. The patient was discharged in good condition and follow-up for the first year was unremarkable. Unfortunately he developed another episode of bowel ischaemia in the second year and underwent resection of a short segment of proximal ileum. An autoimmune profile was negative. However, subsequent blood tests confirmed polycythaemia. Small bowel infarction due to polycythaemia in a young patient is rare and may be difficult to diagnose on clinical grounds.

Hussain A; Ansari T; Mahmood H; Ellul J

2009-01-01

328

Breathhold MRI of the small bowel in Crohn's disease after enteroklysis with oral magnetic particles  

International Nuclear Information System (INIS)

Purpose: To evaluate the efficacy of breathhold MRI following enteroclysis with addition of oral magnetic particles to study the extension, detection of stenoses and extraluminal manifestations in Crohn's disease. Results: Typical findings were marked bowel wall thickening with strong contrast enhancement. 95.8% of affected small bowel segments and 94.7% of stenoses were correctly detected by MRI. All four fistulas were detected and important extraluminal findings were seen in 6/18 patients. Additionally, one ileoileal and two ileosigmoidal adhesions, two extraluminal abscesses and affection of the right ureter were delineated. Conclusion: MRI in Crohn's disease offers the potential to avoid radiation exposure in this relatively young patient group. Important additional findings relevant to indication of surgery are seen in approximately one third of cases. The replacement of transduodenal intubation by oral contrast application remains to be further studied. (orig./AJ).

1998-01-01

329

Gastrointestinal stromal tumor causing small bowel intussusception in a patient with Crohn's disease  

Science.gov (United States)

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.

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

2009-01-01

330

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

2009-01-01

331

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

UK PubMed Central (United Kingdom)

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

Bickelhaupt S; Froehlich JM; Cattin R; Patuto N; Tutuian R; Wentz KU; Culmann JL; Raible S; Bouquet H; Bill U; Patak MA

2013-08-01

332

The interdigestive myo-electric complex of the stomach and small bowel of dogs.  

UK PubMed Central (United Kingdom)

1. Szurszewski (1969) described a cyclic recurring, caudally migrating band of intense action potential activity, the activity fromt, in the small bowel of dogs fasted 18-21 hr. The finding has been confirmed by Carlson, Bedi & Code (1972) and by Grivel & Ruckebusch (1972). The objectives of the present study were to extend these observations first by indentifying the full sequence of myo-electric events in the stomach and small bowel of healthy conscious dogs fasted for 24-48 hr and for longer periods and second by determining the effect of ingestion of mild and of saline solution on the complex and the role of gastric distension in their action. 2. Under surgical anaesthesia, silver-silver chloride electrodes were implanted on the serosal surface of the stomach and small bowel of seven dogs, and recordings of electric activity were started when the dogs had recovered. One hundred and nine interdigestive complexes were studied in detail in five of the dogs during period ranging from 5 to 14 months. All observations were made while the dogs were healthy, conscious, and fasted. 3. The period of intense action potential activity, the activity frot or band, was found to be one phase of a cyclic-recurring sequence of changes in action potential activity. The entire sequence, composed of four phases, occured almost simultaneously in the stomach and duodenun and then migrated distally in sequence over the entire small bowel. As one cycle terminated in the distal ileum, another had started in the stomach and duodenum, and this cyclic recurrence continued during fasts of 4 and 5 days. 4. The cycles of the interdigestive complex tended to recur at the same time each day in three of the dogs. The mean periods of the cycles ranged from 90 to 114 min, and the mean time of their propagation from stomach to terminal ileim ranged from 105 to 134 min. The mean velocity of the activity fronts (phase III of the cycles) was 5-7-11-7 cm/min in the orad portion of the small bowel and 0-9-2-5 cm/min in the distal half. The mean calculated length of the activity front diminished from a range of 42-62 cm in the duodenum to 5-10 cm in the ileum. 5. Intragastric instillation of 400 ml. milk always interrupted the complex present in the bowel at the time of instillation and usually suppressed the next, whereas 400 ml. saline solution interrupted the complex present in the bowel only at the time of instillation. Distension of the stomach with a ballon always suppressed the interdigestive complex in the stomach and duodenum but sometimes failed to interrupt its migration along the bowe.

Code CF; Marlett JA

1975-03-01

333

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

International Nuclear Information System (INIS)

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

2009-05-01

334

Small intestinal bacterial overgrowth and lactose intolerance contribute to irritable bowel syndrome symptomatology in Pakistan.  

UK PubMed Central (United Kingdom)

UNLABELLED: BACKGROUND /AIM: The symptoms of irritable bowel syndrome resemble those of small intestinal bacterial overgrowth (SIBO). The aim of this study was to determine the frequency of SIBO and lactose intolerance (LI) occurrence in patients with diarrhea-predominant irritable bowel syndrome (IBS-D) according to Rome III criteria. PATIENTS AND METHODS: In this retrospective case-control study, patients over 18 years of age with altered bowel habit, bloating, and patients who had lactose Hydrogen breath test (H 2 BT) done were included. The "cases" were defined as patients who fulfill Rome III criteria for IBS-D, while "controls" were those having chronic nonspecific diarrhea (CNSD) who did not fulfill Rome III criteria for IBS-D. Demographic data, predominant bowel habit pattern, concurrent use of medications, etc., were noted. RESULTS: Patients with IBS-D were 119 (51%) with a mean age of 35 ± 13 years, while those with CNSD were 115 (49%) with mean age 36 ± 15 years. Patients in both IBS-D and CNSD were comparable in gender, with male 87 (74%) and female 77 (64%). SIBO was documented by lactose H?BT in 32/234 (14%) cases. It was positive in 22/119 (19%) cases with IBS-D, while 10/115 (9%) cases had CNSD (P = 0.03). LI was positive in 43/234 (18%) cases. Of these, 25/119 (21%) cases had IBS-D and 18/115 (16%) cases had CNSD (P = 0.29). CONCLUSION: SIBO was seen in a significant number of our patients with IBS-D. There was no significant age or gender difference in patients with or without SIBO.

Yakoob J; Abbas Z; Khan R; Hamid S; Awan S; Jafri W

2011-11-01

335

CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases.  

Science.gov (United States)

Computed tomographic (CT) enterography combines the improved spatial and temporal resolution of multi-detector row CT with large volumes of ingested neutral enteric contrast material to permit visualization of the small bowel wall and lumen. Adequate luminal distention can usually be achieved with oral hyperhydration, thereby obviating nasoenteric intubation and making CT enterography a useful, well-tolerated study for the evaluation of diseases affecting the mucosa and bowel wall. Unlike routine CT, which has been used to detect the extraenteric complications of Crohn disease such as fistula and abscess, CT enterography clearly depicts the small bowel inflammation associated with Crohn disease by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory changes. As a result, CT enterography is becoming the first-line modality for the evaluation of suspected inflammatory bowel disease. CT enterography has also become an important alternative to traditional fluoroscopy in the assessment of other small bowel disorders such as celiac sprue and small bowel neoplasms. PMID:16702444

Paulsen, Scott R; Huprich, James E; Fletcher, Joel G; Booya, Fargol; Young, Brett M; Fidler, Jeff L; Johnson, C Daniel; Barlow, John M; Earnest, Franklin

336

Phytobezoars--an overlooked cause of small bowel obstruction following vagotomy and drainage operations for duodenal ulcer.  

UK PubMed Central (United Kingdom)

Phytobezoar impaction is an important cause of small bowel obstruction in patients who have had previous vagotomy and drainage procedures for duodenal ulcer. Most cases present with typical symptoms and signs of small bowel obstruction, but in some there are no definite radiological signs of bowel obstruction on plain X-ray. In these the phytobezoar is often located by barium studies. Operation is required in the majority of cases and the phytobezoar milked into the large bowel or removed at enterotomy. Before laparotomy is performed, it is essential to endoscope these patients to avoid overlooking gastric phytobezoars which are easily removed via a gastrotomy at the time of the laparotomy. The incidence of phytobezoar obstruction will be reduced by the giving of simple dietary advice and by employing highly selective vagotomy whenever possible in the surgery of duodenal ulcer.

Vellar DJ; Vellar ID; Pucius R; Steedman PK

1986-08-01

337

Phytobezoars--an overlooked cause of small bowel obstruction following vagotomy and drainage operations for duodenal ulcer.  

Science.gov (United States)

Phytobezoar impaction is an important cause of small bowel obstruction in patients who have had previous vagotomy and drainage procedures for duodenal ulcer. Most cases present with typical symptoms and signs of small bowel obstruction, but in some there are no definite radiological signs of bowel obstruction on plain X-ray. In these the phytobezoar is often located by barium studies. Operation is required in the majority of cases and the phytobezoar milked into the large bowel or removed at enterotomy. Before laparotomy is performed, it is essential to endoscope these patients to avoid overlooking gastric phytobezoars which are easily removed via a gastrotomy at the time of the laparotomy. The incidence of phytobezoar obstruction will be reduced by the giving of simple dietary advice and by employing highly selective vagotomy whenever possible in the surgery of duodenal ulcer. PMID:3463292

Vellar, D J; Vellar, I D; Pucius, R; Steedman, P K

1986-08-01

338

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

Directory of Open Access Journals (Sweden)

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; Udom Kachintorn; Siriporn Kongphlay

2012-01-01

339

Diagnosis of celiac disease in adults based on serology test results, without small-bowel biopsy.  

UK PubMed Central (United Kingdom)

BACKGROUND & AIMS: Celiac disease is underdiagnosed, with nonspecific symptoms and high morbidity. New diagnostic factors are needed. We aimed to estimate the frequency at which adult patients with positive results from serology tests are referred for small-bowel biopsies and to identify factors that improve the diagnosis of celiac disease. METHODS: We performed a retrospective analysis of data from 2477 subjects who received serology tests for celiac disease between 2005 and 2007. We analyzed results for total levels of IgA, IgA against human tissue transglutaminase (hTTG), IgA and IgG against gliadin, as well as dilution titers of IgA against endomysial antibodies (EMA). Biopsy samples were analyzed by pathologists experienced in detecting mucosal changes associated with celiac disease and graded according to the Marsh system. RESULTS: Of the 2477 patients, 610 (25%) had abnormal results from serology tests, and 39% of these patients (240 of 610) underwent small-bowel biopsy analyses. Of these patients, 50 (21%) had biopsy findings consistent with celiac disease (Marsh 3 lesions) and were placed on gluten-free diets. Titers of IgA hTTG greater than 118 U identified patients with celiac disease with a 2% false-positive rate. Titers of 21 to 118 U, in combination with an EMA dilution titer of 1:160 or greater, had a positive predictive value of 83% for celiac disease. IgA hTTG levels less than 20 U, in combination with an EMA dilution titer less than 1:10, had a negative predictive value of 92% for celiac disease. CONCLUSIONS: Serum levels of IgA hTTG greater than 118 U, or 21 to 118 U in combination with an EMA dilution titer of 1:160 or greater, can be used to identify adult symptomatic patients with celiac disease, in the absence of a small-bowel biopsy.

Wakim-Fleming J; Pagadala MR; Lemyre MS; Lopez R; Kumaravel A; Carey WD; Zein NN

2013-05-01

340

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

2013-01-01

 
 
 
 
341

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

UK PubMed Central (United Kingdom)

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

Amzallag-Bellenger E; Soyer P; Barbe C; Diebold MD; Cadiot G; Hoeffel C

2013-07-01

342

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

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

Fagundes-Neto U.; De Martini-Costa S.; Pedroso M.Z.; Scaletsky I.C.A.

2000-01-01

343

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

Scientific Electronic Library Online (English)

Full Text Available 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 secretion, at concentrations above 10(4) colonies/ml, was present in 11 (68.7%) patients. The stool culture was positive for an enteropathogenic agent in 8 (50.0%) patients: for EPEC (more) 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.

Fagundes-Neto, U.; De Martini-Costa, S.; Pedroso, M.Z.; Scaletsky, I.C.A.

2000-12-01

344

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

345

First clinical trial of a newly developed capsule endoscope with panoramic side view for small bowel: A pilot study.  

UK PubMed Central (United Kingdom)

BACKGROUND AND STUDY AIMS: Capsule endoscopy is the first-line diagnostic technique for the small bowel. However, the inability to visualize the duodenal papilla is an inherent limitation of this method. In the present study, we evaluated feasibility of a newly developed CapsoCam SV1 capsule. PATIENTS AND METHODS: This is a prospective dual center study of a newly developed video capsule CapsoCam SV1 from Capsovision, CA, providing panoramic 360° imaging. A high frequency of 20 frames occurs per second for the first 2?h and thereafter 12 frames/s, with a battery life of 15?h. We evaluated feasibility and completeness of small bowel examination together with secondary endpoints of duodenal papilla detection in 33 patients. Patients swallowed the capsules following colonoscopy or were prepared with 2?L of polyethylene glycol solution prior to the examination. All patients swallowed 20?mg of metoclopramide and 160?mg of simethicone 30?min before ingestion of the capsule. RESULTS: Thirty-one of the 33 patients' data could be evaluated. Small bowel examination was complete in all procedures. Mean time to pass the small bowel was 258?±?136?min. Average small bowel cleanliness was 3.3?±?0.5. In 71% of the patients, we identified the duodenal papilla. No adverse reaction in relation to the capsule examination was observed. CONCLUSIONS: CapsoCam SV1 is a safe and efficient tool in small bowel examination. The duodenal papilla as the only landmark in small bowel is detected in more than 70% of the patients.

Friedrich K; Gehrke S; Stremmel W; Sieg A

2013-09-01

346

Small bowel angiodysplasia in association with Crohn's ileitis. A case report.  

UK PubMed Central (United Kingdom)

A case of a female patient affected by Crohn's ileitis associated with small bowel angiodysplasia is reported. Despite a good clinical and laboratory response to steroid therapy the patient showed an unexplained hypochromic microcytic anemia. At laparotomy Crohn's ileitis as well as an angiodysplastic lesion were found. Both lesions were resected in continuity. During a 2-year follow-up the patient did not show anemia despite pregnancy. It is suggested that the angiodysplastic lesion was the possible cause of hypochromic anemia and that the patient should have been operated on before, based on her recurrent anemia.

Minervini S; Boirivant M; Peronace ML; Speranza V

1989-01-01

347

Small bowel angiodysplasia in association with Crohn's ileitis. A case report.  

Science.gov (United States)

A case of a female patient affected by Crohn's ileitis associated with small bowel angiodysplasia is reported. Despite a good clinical and laboratory response to steroid therapy the patient showed an unexplained hypochromic microcytic anemia. At laparotomy Crohn's ileitis as well as an angiodysplastic lesion were found. Both lesions were resected in continuity. During a 2-year follow-up the patient did not show anemia despite pregnancy. It is suggested that the angiodysplastic lesion was the possible cause of hypochromic anemia and that the patient should have been operated on before, based on her recurrent anemia. PMID:2628394

Minervini, S; Boirivant, M; Peronace, M L; Speranza, V

1989-01-01

348

[Granulocytic sarcoma (chloroma) of small bowel: an unfrequent cause of intestinal obstruction  

UK PubMed Central (United Kingdom)

Granulocytic sarcoma or chloroma is a malignant extra medullar tumor, based on inmature myeloid cells. It usually emerges as a secondary manifestation of acute myeloid leukemia. Chloromas are scarcely diagnosed in patiens without hematological malignances, either peripheral or medullar, and are thus frequently misdiagnosed for other tumors. In these patients, further development of acute leukemia seems to stand as a rule. Small bowel location of these tumors has hardly been reported. A case of granulocytic sarcoma in a non-leukemic at time of diagnosis patient is reported therein. Medical literature is briefly reviewed.

Rodríguez Guerrero JM; Martín Hidalgo JR; Alonso Alejandro E; Pérez Ríos N; Roussel J; Rodríguez Pardo F; Rosal Obrador J; Bascuñana Quirel A

2003-06-01

349

Amebic perforation of small bowel: an unexpected localization of a fatal complication.  

UK PubMed Central (United Kingdom)

The intestinal protozoan parasite E. histolytica is the causative organism responsible for human amebiasis and amebic dysentery. Although it is primarily an infection of the colon, it may also be spread by hematogenous path to other organs, especially the liver. In general, the clinical spectrum of colorectal amebiasis ranges from the state of asymptomatic carrier to severe fulminant necrotizing colitis with bleeding and perforation. Here we present an extremely rare case of necrotizing amebiasis of small bowel with a fatal outcome (Fig. 1, Ref. 4). Full Text (Free, PDF) www.bmj.sk.

Ozer M; Ergul E; Donmez C; Sisman IC; Ulger BV; Kusdemir A

2009-01-01

350

Ectopic intestinal glands after segmental small bowel irradiation in the cat  

International Nuclear Information System (INIS)

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

1983-01-01

351

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

Directory of Open Access Journals (Sweden)

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; Kantharia Chetan; Prabhu RamKrishna; Supe Avinash

2010-01-01

352

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; Lei Du; Yong-Tao Xiao; Wei Cai

2013-01-01

353

Detection of gastric MALT lymphoma spreading to the small bowel by enteroscopy.  

Science.gov (United States)

Mucosa-associated lymphoid tissue (MALT) lymphoma is thought to be a multifocal disease with sometimes synchronous involvement of various mucosal structures. In this study we aimed to evaluate the potential involvement of the small bowel in patients suffering from gastric MALT lymphoma by analyzing the results of enteroscopy, a technique that allows easy and safe access to the small bowel with the potential for histological assessment of biopsy samples. We have retrospectively evaluated 347 enteroscopies and found nine patients with gastric MALT lymphoma who had undergone push enteroscopy with serial biopsies during staging. All patients tolerated enteroscopy without side effects, and no local complications occurred. In eight cases no evidence of duodenal or jejunal involvement was found macroscopically or by histological assessment of biopsies, while in one patient enteroscopy revealed jejunal MALT lymphoma infiltration with macroscopic accentuation of mucosal parts and consecutive histopathological verification more distal than 50 cm. This single-center retrospective analysis shows that enteroscopy can provide additional diagnostic information in patients with gastric MALT lymphoma, although the number of patients was small and only one out of nine patients showed hitherto undetected MALT lymphoma deposits. Further studies may quantify the additional diagnostic yield provided by this easy and safe endoscopic method. PMID:21656457

Dolak, W; Raderer, M; Maresch, J; Muellauer, L; Puespoek, A; Chott, A; Haefner, M

2011-06-07

354

Acute small bowel obstruction as a result of a Meckel's diverticulum encircling the terminal ileum: A case report  

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Full Text Available Abstract Background In the developed world, small bowel obstruction accounts for 20% of all acute surgical admissions. The aetiology for majority of these cases includes postoperative adhesions and herniae. However, a relatively uncommon cause is a Meckel's diverticulum. Although this diagnosis is primarily reported in the adolescent population, it should also be considered in adults. Case Presentation In the present report, we present a rare case where a fit and healthy 74-year-old gentleman, with no previous history of abdominal surgery, presented with the cardinal symptoms and signs of small bowel obstruction as the result of a Meckel's diverticulum encircling his terminal ileum. Initial investigations included a supine abdominal x-ray showing dilated loops of small bowel and computerised tomographic imaging of the abdomen, which revealed a stricture in the terminal ileum of unknown aetiology. At laparotomy, multiple loops of distended small bowel were seen from the duodeno-jeujenal junction to the terminal ileum, which was encircled by a Meckel's diverticulum. The Meckel's diverticulum was then divided to release the obstruction, mobilised and subsequently removed. Finally, the small bowel contents were decompressed into the stomach and the nasogastric tube aspirated, before returning the loops of bowel into the abdomen in sequence. The patient made a good postoperative recovery and was discharged home 5 days later. Conclusion This report highlights the importance of considering a Meckel's diverticulum as a cause of small bowel obstruction in individuals from all age groups and especially in a person with no previous abdominal pathology or surgery.

Thakor Avnesh S; Liau Siong S; o'Riordan Dermot C

2007-01-01

355

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.

1988-01-01

356

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

Energy Technology Data Exchange (ETDEWEB)

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

357

Small bowel homing T cells are associated with symptoms and delayed gastric emptying in functional dyspepsia.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Immune activation may have an important pathogenic role in the irritable bowel syndrome (IBS). While little is known about immunologic function in functional dyspepsia (FD), we have observed an association between cytokine secretion by peripheral blood mononuclear cells (PBMCs) and symptoms in IBS. Upper gastrointestinal inflammatory diseases are characterized by enhanced small bowel homing ?4-, ?7-integrin, chemokine receptor 9 (CCR9) positive T lymphocytes. We hypothesized that increased cytokine release and elevated circulating small bowel homing T cells are linked to the severity of symptoms in patients with FD. Thus, we aimed to (i) compare cytokine release in FD and healthy controls (HCs), (ii) quantify "gut homing" T cells in FD compared with HC and patients with IBS, and (iii) correlate the findings to symptom severity and gastric emptying. METHODS: PBMC from 45 (Helicobacter pylori negative) patients with FD (Rome II) and 35 matched HC were isolated by density gradient centrifugation and cultured for 24 h. Cytokine production (tumor necrosis factor (TNF)-?, interleukin (IL)-1?, IL-6, IL-10) was measured by enzyme-linked immunosorbent assay. CD4+ ?4?7+CCR9+ T cells were quantified by flow cytometry in FD, HC and 23 patients with IBS. Gastric emptying was measured by scintigraphy. Symptom severity was assessed utilizing the standardized Gastrointestinal Symptom Score. RESULTS: FD patients had significantly higher TNF-? (107.2 ± 42.8 vs. 58.7 ± 7.4 pg/ml), IL-1? (204.8 ± 71.5 vs. 80.2 ± 17.4 pg/ml), and IL-10 (218 ± 63.3 vs. 110.9 ± 18.5 pg/ml) levels compared with HC, and enhanced gut homing lymphocytes compared with HC or IBS. Cytokine release and CD4+?4?7+CCR9+ lymphocytes were correlated with the symptom intensity of pain, cramps, nausea, and vomiting. Delayed gastric emptying was significantly associated (r = 0.78, P = 0.021) with CD4+?4?7+CCR9+ lymphocytes and IL-1?, TNF-?, and IL-10 secretion. CONCLUSIONS: Cellular immune activation with increased small bowel homing T cells may be key factors in the clinical manifestations of H. pylori-negative FD.

Liebregts T; Adam B; Bredack C; Gururatsakul M; Pilkington KR; Brierley SM; Blackshaw LA; Gerken G; Talley NJ; Holtmann G

2011-06-01

358

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

359

Computed tomographic enterography adds information to clinical management in small bowel Crohn's disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: CT enterography yields striking findings in the bowel wall in Crohn's disease. These images may help to evaluate whether small bowel narrowing results from active disease requiring anti-inflammatory therapy. However, the clinical relevance of these images is unknown. It is also not known if these radiologic findings correlate with objective biomarkers of inflammation. METHODS: In a blinded and independent evaluation, IBD subspecialty gastroenterologists reviewed clinical data, and CT radiologists reviewed CT enterography scans of 67 consecutive patients with Crohn's disease and suspicion of either small bowel inflammation or stricture. Comparisons were made between (1) clinical and radiologic assessments of inflammation and stricture, (2) clinical assessments before and after computed tomographic enterography (CTE) reports were revealed, and (3) radiologic findings and objective biomarkers of inflammation. RESULTS: (1) Individual CTE findings correlated poorly (Spearman's rho < 0.30) with clinical assessment; (2) clinicians did not suspect 16% of radiologic strictures, and more than half the cases of clinically suspected strictures did not have them on CTE; (3) CTE data changed clinicians' perceptions of the likelihood of steroid benefit in 41 of 67 cases; (4) specific CTE findings correlated with CRP, and a distinct set of CTE findings correlated with ESR in the subset of patients who had these biomarkers measured. CONCLUSIONS: CTE seems to add unique information to clinical assessment, both in detecting additional strictures and in changing clinicians' perceptions of the likelihood of steroids benefiting patients. The biomarker correlations suggest that CTE is measuring real biologic phenomena that correlate with inflammation, providing information distinct from that in a standard clinical assessment.

Higgins PD; Caoili E; Zimmermann M; Bhuket TP; Sonda LP; Manoogian B; Platt JF; Zimmermann EM

2007-03-01

360

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

Directory of Open Access Journals (Sweden)

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

 
 
 
 
361

Successful treatment of recurrent small bowel adenocarcinoma by cytoreductive surgery and chemotherapy: a case report and review of the literature  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Small bowel adenocarcinoma is a rare malignancy associated with a poor prognosis and there is little evidence of effective treatment. Recurrent small bowel adenocarcinoma is an intractable disease for which there is little information available regarding its treatment by palliative therapy. We present a case of recurrent small bowel adenocarcinoma successfully treated by cytoreductive surgery and palliative chemotherapy. Case presentation We report the case of a 72-year-old Japanese female who developed a peritoneal metastasis from recurrent small bowel adenocarcinoma after curative resection and adjuvant chemotherapy with S-1 and polysaccharide K. She underwent cytoreductive surgery followed by chemotherapy with folinic acid/fluorouracil/oxaliplatin and folinic acid/fluorouracil/irinotecan with polysaccharide K. Subsequently, no sign of a recurrence was observed 42 months after the second operation. Conclusion To the best of our knowledge, this is the first case report of the successful treatment of peritoneal metastasis from small bowel adenocarcinoma by cytoreductive surgery and combination chemotherapy (folinic acid/fluorouracil/oxaliplatin and folinic acid/fluorouracil/irinotecan with polysaccharide K).

Yamano Tomoki; Morii Eiichi; Arai Isao; Takada Toshiaki; Aozasa Katsuyuki

2010-01-01

362

Differentiation of small bowel and pancreatic neuroendocrine tumors by gene-expression profiling.  

UK PubMed Central (United Kingdom)

BACKGROUND: Between 10% and 20% of patients with neuroendocrine tumors (NETs) present with metastases of unknown primary site. Because knowledge of the primary site has important implications for treatment, we set out to define gene-expression profiles to differentiate between small-bowel NETs (SBNETs) and pancreatic NETs (PNETs). METHODS: RNA was extracted from tumor and normal tissues in 11 patients with SBNETs and 15 patients with PNETs, and qPCR was performed for 367 GPCR genes. Differentially expressed genes were identified using the RT2 Profiler. Whole genome expression analysis was performed on 11 SBNETs, 5 PNETS, and corresponding normal tissues. Statistical significance was evaluated by the Student t test and ANOVA. RESULTS: Whole-genome analysis revealed 173 significantly differentially expressed genes in SBNETs and normal tissues and in 52 in PNETs. GPCR arrays identified 28 genes in SBNETs and 18 in PNETs, with significant expression differences from normal tissues. In all SBNETs, 2 genes were significantly upregulated by more than fivefold: OXTR and GPR113. No PNETs shared this profile, whereas 73% had a greater than fivefold downregulation of ADORA1 and SCTR. These genes also allowed for determination of the primary site in 8 of 10 liver metastases. CONCLUSION: Differential expression patterns using as few as 2 to 4 GPCR genes successfully discriminated primary sites in small bowel and pancreatic NETs.

Carr JC; Boese EA; Spanheimer PM; Dahdaleh FS; Martin M; Calva D; Schafer B; Thole DM; Braun T; O'Dorisio TM; O'Dorisio MS; Howe JR

2012-12-01

363

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

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

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

2008-01-01

364

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

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS). Although small bowel infection is less common than infection of other parts of the gastrointestinal system, it may lead to perforation, an acute complication, with dreadful results. Case presentation This article reports a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum. The patient had poor prognosis and deceased despite the prompt surgical intervention and the antiviral therapy he received. At pathology a remarkable finding was the presence of viral inclusions in smooth muscle fibers. The destruction of muscle cells was the main cause of perforation. Conclusion Morbidity and mortality associated with perforation from CMV enteritis in AIDS patients are high and the life expectancy is short. Cytomegalovirus disease is multifocal; therefore, excision of one portion of the gastrointestinal tract may be followed by a complication elsewhere. Our case elucidate that muscle cell destruction by the virus is a significant cause leading to perforation.

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

2013-01-01

365

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

International Nuclear Information System (INIS)

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

1998-01-01

366

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

Energy Technology Data Exchange (ETDEWEB)

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

367

Small-bowel bacterial overgrowth and systemic immunosuppression in experimental peritonitis.  

UK PubMed Central (United Kingdom)

The effect of intraperitoneal infection on small-bowel flora and on systemic immunity was studied in a rat model, with use of the delayed-type hypersensitivity (DTH) response to keyhole limpet hemocyanin (KLH) as a measure of global immunologic integrity. Twenty-four hours after the induction of peritonitis by cecal ligation and puncture, concentrations of Escherichia coli in the proximal gastrointestinal tract increased from fewer than 10(3) colony-forming units (CFU)/ml to more than 10(9) CFU/ml, and the DTH response decreased from 10.0 +/- 0.2 to 2.1 +/- 0.4 mm. To assess the contribution of this altered luminal flora to the observed suppression of DTH scores, cecal ligation without puncture was performed in a group of animals whose endogenous flora had been suppressed by administration of oral neomycin. Oral administration of live antibiotic-resistant E. coli to the study animals resulted in significant DTH depression compared with controls given saline solution (2.7 +/- 0.4 vs 4.4 +/- 0.4 mm, p less than 0.005), even though the gastrointestinal tract was anatomically intact. Similar depression was seen if the challenge was limited to the small bowel as a result of the prior performance of an ileostomy and occurred in the absence of significant systemic or portal levels of viable bacteria. The results suggest that gut endotoxin plays a role in the immunosuppression associated with peritonitis.

Marshall JC; Christou NV; Meakins JL

1988-08-01

368

The role of D-dimer in the diagnosis of strangulated small-bowel obstruction.  

UK PubMed Central (United Kingdom)

BACKGROUND: Various diagnostic utilities have been used in the diagnosis of strangulated obstruction. Despite this, there is no simple and reliable marker for it, and diagnosis in most cases is based on clinical, laboratory, and radiological investigations. The purpose of the present study was to assess D-dimer value in the diagnosis of strangulated obstruction. METHODS: A prospective study of 53 patients with small-bowel obstruction was conducted. Strangulated obstruction was present in 15 (28.3%) patients. Eight (53%) had intestinal necrosis, while 7 (47%) reversible ischemia. The blood samples were taken and analyzed with NycoCard Reader method with monoclonal antibodies specific for D-dimer neoantigens. RESULTS: In the presence of intestinal necrosis, there was a higher D-dimer level found than in the cases with reversible ischemia or simple small-bowel obstruction, although this difference did not reach statistically significant level. The D-dimer test had a sensitivity of 60%, specificity of 68%, positive predictive value of 43%, and negative predictive value of 81% in diagnosing strangulated obstruction. CONCLUSION: In present series, D-dimer test was neither sensitive nor specific in diagnosing strangulation.

Bogusevicius A; Grinkevicius A; Maleckas A; Pundzius J

2007-01-01

369

Contrast-enhanced ultrasound of the small bowel in Crohn's disease.  

Science.gov (United States)

Crohn's disease (CD) is a chronic transmural inflammatory disease of the gastrointestinal tract characterized by episodes of inflammation alternating with periods of remission. Unenhanced grey-scale ultrasound may evaluate the localisation and the length of the affected intestinal segments and may detect transmural complications, including fistulas, abscesses and phlegmons, but it is less accurate to assess the CD activity. Contrast-enhanced ultrasound has become an important imaging modality in patients with CD for the grading of disease activity, the differentiation between small bowel stricture due to inflammation or mural fibrosis, and for the assessment of the response to specific therapy. New dedicated software packages allow the accurate quantification of the enhancement within the small bowel wall after microbubble contrast agent injection to obtain different kinetic semi-quantitative parameters-the percentage of the maximal enhancement, the time-to-the peak enhancement, and the area under the time-intensity curve-which are very useful to differentiate the inflammatory oedema from fibrosis and to differentiate responders from non-responders to the specific therapy among patients with CD. PMID:23728306

Quaia, Emilio

2013-10-01

370

Apple peel deformity of the small bowel without atresia in a congenital mesenteric defect.  

UK PubMed Central (United Kingdom)

Congenital mesenteric defects are rare causes of bowel obstruction. Even rarer are mesenteric defects with an apple peel type of deformity, probably described definitively only once previously. We present a case of a 3 year old boy who presented with a septic-like picture of severe metabolic acidosis and lethargy from a bowel obstruction with bowel ischemia. At laparotomy he was found to have bowel infarction due to herniation through a congenital mesenteric defect with an apple peel type of deformity of the bowel without bowel atresia.

Llore N; Tomita S

2013-01-01

371

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

Science.gov (United States)

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 findings. Our case has highlighted that although small bowel perforation is a rare occurrence, it may be more common in Ehlers Danlos and may present with atypical features. Perforation may also occur alongside normal bowel as well as diverticulae within the bowel. Where diverticulae exists within a patient with Ehlers Danlos syndrome and there is some diagnostic uncertainty, there should be a lower threshold for operative intervention. We present in the discussion a number of salient features and learning points. PMID:20205912

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

2010-02-12

372

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

UK PubMed Central (United Kingdom)

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 findings. Our case has highlighted that although small bowel perforation is a rare occurrence, it may be more common in Ehlers Danlos and may present with atypical features. Perforation may also occur alongside normal bowel as well as diverticulae within the bowel. Where diverticulae exists within a patient with Ehlers Danlos syndrome and there is some diagnostic uncertainty, there should be a lower threshold for operative intervention. We present in the discussion a number of salient features and learning points.

Leake TF; Singhal T; Chandra A; Ashcroft A; Doddi S; Hussain A; Smedley F

2010-01-01

373

Understanding about diagnosis of acute small bowel retrograde intussusception in adults by means of 64-slice-spinal CT  

International Nuclear Information System (INIS)

Objective: To have a further study of the value of MSCT in diagnosing acute small bowel retrograde intussusception in adults by means of 64-slice-spinal CT. Methods: A 46-year-old female patient with the history of abdominal operation was found having acute mechanical small bowel obstruction through plain X-ray radiograph. 64-slice MSCT was performed afterwards (plain scan + 3 stage contrast scans). Hence, evidence is provided for operation. Results: Using the technique of MSCT for the patient can promptly approach the diagnosis of jejuno-jejunal intussusception with severe bowel obstruction; no small bowel tumor or other organic lesion found in this case. With the patient who has the history of abdominal operations, MSCT can predict the reason of adhesion causing bowel intussusception, and provide the evidence for operation; whereas MSCT with contrast media offers a further investigation of the blood supply to the bowels through SMA, and observation of blood circulation through the intussuscepting site, which represents venous congestion of intussusception. This case is a retrograde small bowel intussusception and confirmed with operation evidence. A greater amount of gas and fluid is accumulated between the dilated space of middle-distal portion of intussusceptum and intussuscipiens. Nevertheless, less gas at the proximal portion and that can be an important sign for retrograde intussusception. Conclusion: MSCT is a good choice of examination for diagnosis of adult's intussusception. As the literature mentioned the advantages of MSCT for observing the circulation of intussusceptum and whether the diagnosis is antegrade or retrograde intussusception is also essential. (authors)

2009-01-01

374

Evaluation of gastric and small bowel transit times in coeliac disease with the small bowel PillCam®: a single centre study in a non gluten-free diet adult Italian population with coeliac disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: The mechanisms underlying bowel disturbances in coeliac disease are still relatively unclear. Past reports suggested that small bowel motor abnormalities may be involved in this pathological condition; there are no studies addressing small bowel transit in coeliac disease before and after a gluten-free diet. AIM: The objective of this study was to determine whether capsule endoscopy (CE) could serve as a test for measurement of gastric and small bowel transit times in a group of symptomatic or asymptomatic coeliac patients at the time of diagnosis with respect to a control group. PATIENTS AND METHODS: Thirty coeliac untreated patients and 30 age-, sex- and BMI-matched healthy controls underwent CE assessment of whole gut transit times. RESULTS: All subjects completed the study per protocol and experienced natural passage of the pill. No statistical significant differences between gastric emptying and small bowel transit times both in coeliac and control group were found (p = 0.1842 and p = 0.7134; C.I. 95%, respectively). No correlation was found in coeliac patients and control group between transit times and age, sex and BMI. By using the Pearson's correlation test, significant correlation emerged between gastric emptying time and small bowel transit times in coeliac disease (r = 0.1706). CONCLUSIONS: CE reveals unrecognized gender differences and may be a novel outpatient technique for gut transit times' assessment without exposure to radiation and for the evaluation of upper gut dysfunction in healthy patients suffering from constipation without evidence of intestinal malabsorption. Nevertheless, CE does not seem to be the most suitable method for studying gut transit times in untreated coeliac patients; this might be ascribed to the fact that CE consists of inert (non-digestible, non-absorbable) substances.

Urgesi R; Cianci R; Bizzotto A; Costamagna G; Riccioni ME

2013-05-01

375

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

Scientific Electronic Library Online (English)

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

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

2011-02-01

376

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

Directory of Open Access Journals (Sweden)

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

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

2011-01-01

377

A retrospective analysis comparing small bowel follow-through with wireless capsule endoscopy in the evaluation of obscure gastrointestinal bleeding.  

UK PubMed Central (United Kingdom)

A comparative retrospective study was conducted to evaluate diagnostic findings between small bowel follow-through (SBFT) and wireless capsule endoscopy in the presence of obscure gastrointestinal bleeding. A convenience sample of 31 patients with previous negative upper and lower endoscopy was included in the study. Wireless capsule endoscopy established a significant source of obscure gastrointestinal bleeding 53% of the time. The diagnostic capacity of radiographic SBFT was measured at 17% as compared with that of the wireless capsule endoscopy. The clinical findings along with the digital images obtained from the wireless capsule endoscopy was found to be the optimum diagnostic tool in the evaluation of obscure gastrointestinal bleeding in the small bowel.

Nutter M; Dunston D; Ieyoub J; Hart A 4th; Harper J; Burke MS

2010-07-01

378

Morphology and histochemistry of the mucosa surrounding small oligotubular adenomas of the large bowel.  

UK PubMed Central (United Kingdom)

The transitional mucosa surrounding adenomas and carcinomas of the large bowel is characterized by a reversion of mucus secretion from sulphomucin to sialomucin and a hyperplasia of crypts and epithelial cells. The specificity of this phenomenon is still a controversial issue. Therefore we studied 72 oligotubular adenomas of the large bowel and the adjacent mucosa by means of histochemistry and morphometry. The peak of sialomucin production is found within the crypts immediately adjacent to the adenoma, whereas the more distant crypts secrete less. The cellular diameter and the depth of the crypts behave in a similar manner, they decrease with increasing distance from the adenoma, still being much higher than in the normal mucosa. The crypt depth correlates well to sialomucin production. The existence of the transitional mucosa around small oligotubular adenomas may indicate, that this mucosal change is not merely secondary to the presence of carcinoma but may be of importance as a precursor lesion of neoplastic changes of the colon and rectum.

Schmidbauer G; Heilmann KL

1985-07-01

379

Morphology and histochemistry of the mucosa surrounding small oligotubular adenomas of the large bowel.  

Science.gov (United States)

The transitional mucosa surrounding adenomas and carcinomas of the large bowel is characterized by a reversion of mucus secretion from sulphomucin to sialomucin and a hyperplasia of crypts and epithelial cells. The specificity of this phenomenon is still a controversial issue. Therefore we studied 72 oligotubular adenomas of the large bowel and the adjacent mucosa by means of histochemistry and morphometry. The peak of sialomucin production is found within the crypts immediately adjacent to the adenoma, whereas the more distant crypts secrete less. The cellular diameter and the depth of the crypts behave in a similar manner, they decrease with increasing distance from the adenoma, still being much higher than in the normal mucosa. The crypt depth correlates well to sialomucin production. The existence of the transitional mucosa around small oligotubular adenomas may indicate, that this mucosal change is not merely secondary to the presence of carcinoma but may be of importance as a precursor lesion of neoplastic changes of the colon and rectum. PMID:4034431

Schmidbauer, G; Heilmann, K L

1985-07-01

380

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

International Nuclear Information System (INIS)

[en] 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)

2002-01-01

 
 
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