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

LENUS (Irish Health Repository)

Holleran, Grainne

2013-04-01

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

Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction

Directory of Open Access Journals (Sweden)

Zuhal Ozisler

2015-01-01

Full Text Available In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80% of the 55 patients before bowel program. Constipation (56%, 31/55 and incontinence (42%, 23/55 were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55 and after (73%, 40/55 bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

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

Energy Technology Data Exchange (ETDEWEB)

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

2010-01-15

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

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

International Nuclear Information System (INIS)

Ryu, Guen Ho; Hong, Seong Sook; Kim, Jung Hoon; Chang, Yun Woo; Choi, Duek Lin; Hwang, Jung Hwa; Kwon, Kui Hyang

2010-01-01

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

Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

Science.gov (United States)

Pesenti, Sebastien; Blondel, Benjamin; Faure, Alice; Peltier, Emilie; Launay, Franck; Jouve, Jean-Luc

2016-01-01

Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic (CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-to-end anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions. PMID:27672641

Small Bowel Follow-Through

Science.gov (United States)

... Small bowel follow-through uses a form of real-time x-ray called fluoroscopy and a barium-based ... Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow ...

Surgical treatment of intestinal radiation injury

International Nuclear Information System (INIS)

Maekelae, J.Ne.; Nevasaari, K.; Kairaluoma, M.I.

1987-01-01

A review of 43 consecutive patients requiring operation for serious intestinal radiation injury was undertaken to elucidate the efficacy of surgical treatment. The most common site of radiation injury was the rectum (19 cases), followed by the small bowel (13 cases), the colon (7 cases), and the combination of these (4 cases). The overall operative mortality was 14%; morbidity, 47%; and the postoperative symptom-free period, 18 +/- 30 months. Colostomy (N = 20) carried the lowest risk of mortality, 0%, as compared with resection (N = 17) and bypass procedure (N = 6), which were accompanied by the mortalities of 24% and 33%, respectively. During the follow-up (3-13 years) 12 patients (28%) died of recurrent cancer and 9 patients (21%) of persistent radiation injury, which yielded an overall mortality of 65% after resection and 50% and 65% after bypass and colostomy procedures, respectively. Continuing radiation damage led to 15 late reoperations. Ten of these were performed after colostomy, four after resection, and one after bypass. We conclude that colostomy cannot be regarded as a preferred operative method, because it does not prevent the progression of radiation injury and because it is, for this reason, associated with a higher late-complication rate. A more radical surgery is recommended but with the limitation that the operative method must be adapted to the operative finding

Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

Science.gov (United States)

Hayashi, Yoshikazu; Yamamoto, Hironori; Kita, Hiroto; Sunada, Keijiro; Sato, Hiroyuki; Yano, Tomonori; Iwamoto, Michiko; Sekine, Yutaka; Miyata, Tomohiko; Kuno, Akiko; Iwaki, Takaaki; Kawamura, Yoshiyuki; Ajibe, Hironari; Ido, Kenichi; Sugano, Kentaro

2005-01-01

AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy. METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone double-balloon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient. RESULTS: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively. The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug. CONCLUSION: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon. PMID:16097059

Small bowel perforation without tumor recurrence after radiotherapy for cervical carcinoma: report of seven cases.

Science.gov (United States)

Yamashita, Hideomi; Nakagawa, Keiichi; Tago, Masao; Igaki, Hiroshi; Shiraishi, Kenshirou; Nakamura, Naoki; Sasano, Nakashi; Yamakawa, Sen; Ohtomo, Kuni

2006-04-01

We describe the clinical presentation, evaluation, management and outcome of patients experiencing small bowel perforation following radiation therapy for cervical cancer. A database consisting of 95 Japanese women with stage 0-4 A cervix cancer treated between 1991 and 2004 contained seven patients (7.4%) with small bowel perforation. The median age at the time of perforation was 72.5 years (range 62-78). The median time from completion of radiotherapy to perforation was 6 months (range 2-58). Surgery (one small bowel resection and anastomosis with diversion; six small bowel resection and anastomosis) was performed immediately in all seven patients. One of seven patients died of small bowel perforation (i.e. mortality rate was 14%). Bowel adhesion was detected during the operation in only three cases (43%). Signs of peritonitis were absent in six cases (86%). Severe abdominal pain was seen in all seven patients. The perforation site was ileum in all seven cases. In all patients, pathological changes were compatible with postirradiation injury of the gastrointestinal tract. The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.

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

LENUS (Irish Health Repository)

O'Dowd, Vincent

2012-01-31

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

Surgical treatment of radiation injuries after radiotherapy for uterine carcinoma

Energy Technology Data Exchange (ETDEWEB)

Cochrane, J P.S.; Yarnold, J R; Slack, W W [Middlesex Hospital, London (UK)

1981-01-01

The outcome of serious radiation injuries to the pelvic viscera in 400 patients treated by radiotherapy for carcinoma of the uterus between January 1974 and December 1978 has been reviewed. Twenty-eight instances of serious radiation damage have been found, 13 of predominantly small bowel damage, 11 of predominantly large bowel damage and 4 of bladder damage. Many patients had involvement at multiple sites. Fourteen patients have died, and 9 survivors have artificial abdominal stomas. Leaking anastomoses and progressive sepsis were major problems in the postoperative period and could be related either to inadequate resection of irradiated bowel or to damage to other organs at operation. The possibilities of earlier diagnosis and better surgical procedures are discussed.

Non-small-bowel abnormalities identified during small bowel capsule endoscopy

NARCIS (Netherlands)

Hoedemakers, Reinier; Westerhof, Jessie; Weersma, Rinse K.; Koornstra, Jan J.

2014-01-01

AIM: To investigate the incidence of non-small-bowel abnormalities in patients referred for small bowel capsule endoscopy, this single center study was performed. METHODS: Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding. This is defined as

Small bowel volvulus in children

International Nuclear Information System (INIS)

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

1980-01-01

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

Primary malignant small bowel tumor

Energy Technology Data Exchange (ETDEWEB)

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

1990-07-15

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.

Primary malignant small bowel tumor

International Nuclear Information System (INIS)

Oh, Kyung Seung; Suh, Ho Jong; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duk

1990-01-01

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

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

International Nuclear Information System (INIS)

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

2013-01-01

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

The surgical treatment of radiation injuries after radiotherapy for uterine carcinoma

International Nuclear Information System (INIS)

Cochrane, J.P.S.; Yarnold, J.R.; Slack, W.W.

1981-01-01

The outcome of serious radiation injuries to the pelvic viscera in 400 patients treated by radiotherapy for carcinoma of the uterus between January 1974 and December 1978 has been reviewed. Twenty-eight instances of serious radiation damage have been found, 13 of predominantly small bowel damage, 11 of predominantly large bowel damage and 4 of bladder damage. Many patients had involvement at multiple sites. Fourteen patients have died, and 9 survivors have artificial abdominal stomas. Leaking anastomoses and progressive sepsis were major problems in the postoperative period and could be related either to inadequate resection of irradiated bowel or to damage to other organs at operation. The possibilities of earlier diagnosis and better surgical procedures are discussed. (author)

Radiation enteropathy and leucocyte-endothelial cell reactions in a refined small bowel model

Directory of Open Access Journals (Sweden)

Osman Nadia

2004-09-01

Full Text Available Abstract Background Leucocyte recruitment and inflammation are key features of high dose radiation-induced tissue injury. The inflammatory response in the gut may be more pronounced following radiotherapy due to its high bacterial load in comparison to the response in other organs. We designed a model to enable us to study the effects of radiation on leucocyte-endothelium interactions and on intestinal microflora in the murine ileum. This model enables us to study specifically the local effects of radiation therapy. Method A midline laparotomy was performed in male C57/Bl6 mice and a five-centimetre segment of ileum is irradiated using the chamber. Leucocyte responses (rolling and adhesion were then analysed in ileal venules 2 – 48 hours after high dose irradiation, made possible by an inverted approach using intravital fluorescence microscopy. Furthermore, intestinal microflora, myeloperoxidase (MPO and cell histology were analysed. Results The highest and most reproducible increase in leucocyte rolling was exhibited 2 hours after high dose irradiation whereas leucocyte adhesion was greatest after 16 hours. Radiation reduced the intestinal microflora count compared to sham animals with a significant decrease in the aerobic count after 2 hours of radiation. Further, the total aerobic counts, Enterobacteriaceae and Lactobacillus decreased significantly after 16 hours. In the radiation groups, the bacterial count showed a progressive increase from 2 to 24 hours after radiation. Conclusion This study presents a refinement of a previous method of examining mechanisms of radiation enteropathy, and a new approach at investigating radiation induced leucocyte responses in the ileal microcirculation. Radiation induced maximum leucocyte rolling at 2 hours and adhesion peaked at 16 hours. It also reduces the microflora count, which then starts to increase steadily afterwards. This model may be instrumental in developing strategies against pathological

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

Energy Technology Data Exchange (ETDEWEB)

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

2004-12-01

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.)

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

International Nuclear Information System (INIS)

Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F.

2004-01-01

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.)

Stricturoplasty—a bowel-sparing option for long segment small bowel Crohn's disease

OpenAIRE

Limmer, Alexandra M.; Koh, Hoey C.; Gilmore, Andrew

2017-01-01

Abstract Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes...

Stricturoplasty-a bowel-sparing option for long segment small bowel Crohn's disease.

Science.gov (United States)

Limmer, Alexandra M; Koh, Hoey C; Gilmore, Andrew

2017-08-01

Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes the performance of 12 Heineke-Mikulicz stricturoplasties in a 23-year-old patient with multiple short fibrotic strictures.

The effect of obesity levels on irradiated small bowel volume in belly board with small bowel displacement device for rectal cancer radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Kim, Se Young; Kim, Joo Ho; Park, Hyo Kuk; Cho, Jeong Hee [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul (Korea, Republic of)

2013-03-15

For radiotherapy in rectal cancer patients treated with small bowel displacement device (SBDD) and belly board, We will suggest new indication of using SBDD depending on obesity index by analyzing correlation between obesity and irradiated small bowel volume. In this study, We reviewed 29 rectal cancer patients who received pelvic radiation therapy with belly board and SBDD from January to April in 2012. We only analyzed those patients treated with three-field technique (PA and both LAT) on 45 Gy (1.8 Gy/fx). We measured patients' height, weight, body mass index (BMI), waist-hip ratio (WHR) and divided BMI into two groups.(≥23:BMI=group 1, <23:BMI=group 2) We performed a statistical analysis to evaluate correlation between total volume of bladder (TV{sub bldder}), obesity index and high dose volume of small bowel (small bowel volume irradiated at 90% of prescribed dose, HDV{sub sb}), low dose volume of small bowel (small bowel volume irradiated at 33% of prescribed dose, LDV{sub sb}). The result shows, gender, WHR and status of pre operative or post operative do not greatly affect HDV{sub sb} and LDV{sub sb}. Statistical result shows, there are significant correlation between HDV{sub sb} and BMI (p<0.04), HDV{sub sb} and TV{sub bladder} (p<0.01), LDV{sub sb} and TV{sub bladder} (p<0.01). BMI seems to correlate with HDV{sub sb} but does not with LDV{sub sb} (p>0.05). There are negative correlation between HDV{sub sb} and BMI, TV{sub bladder} and HDV{sub sb}, TV{sub bladder} and LDV{sub sb} . Especially, BMI group1 has more effective and negative correlation with HDV{sub sb} (p=0.027) than in BMI group 2. In the case of BMI group 1, TV{sub bladder} has significant negative correlation with HDV{sub sb} and LDV{sub sb} (p<0.04). In conclusions, we confirmed that Using SBDD with belly board in BMI group 1 could more effectively reduce irradiated small bowel volume in radiation therapy for rectal cancer. Therefore, We suggest using belly board with SBDD in order

The effect of obesity levels on irradiated small bowel volume in belly board with small bowel displacement device for rectal cancer radiotherapy

International Nuclear Information System (INIS)

Kim, Se Young; Kim, Joo Ho; Park, Hyo Kuk; Cho, Jeong Hee

2013-01-01

For radiotherapy in rectal cancer patients treated with small bowel displacement device (SBDD) and belly board, We will suggest new indication of using SBDD depending on obesity index by analyzing correlation between obesity and irradiated small bowel volume. In this study, We reviewed 29 rectal cancer patients who received pelvic radiation therapy with belly board and SBDD from January to April in 2012. We only analyzed those patients treated with three-field technique (PA and both LAT) on 45 Gy (1.8 Gy/fx). We measured patients' height, weight, body mass index (BMI), waist-hip ratio (WHR) and divided BMI into two groups.(≥23:BMI=group 1, <23:BMI=group 2) We performed a statistical analysis to evaluate correlation between total volume of bladder (TV bldder ), obesity index and high dose volume of small bowel (small bowel volume irradiated at 90% of prescribed dose, HDV sb ), low dose volume of small bowel (small bowel volume irradiated at 33% of prescribed dose, LDV sb ). The result shows, gender, WHR and status of pre operative or post operative do not greatly affect HDV sb and LDV sb . Statistical result shows, there are significant correlation between HDV sb and BMI (p<0.04), HDV sb and TV bladder (p<0.01), LDV sb and TV bladder (p<0.01). BMI seems to correlate with HDV sb but does not with LDV sb (p>0.05). There are negative correlation between HDV sb and BMI, TV bladder and HDV sb , TV bladder and LDV sb . Especially, BMI group1 has more effective and negative correlation with HDV sb (p=0.027) than in BMI group 2. In the case of BMI group 1, TV bladder has significant negative correlation with HDV sb and LDV sb (p<0.04). In conclusions, we confirmed that Using SBDD with belly board in BMI group 1 could more effectively reduce irradiated small bowel volume in radiation therapy for rectal cancer. Therefore, We suggest using belly board with SBDD in order to reduce the small bowel toxicity in rectal radiotherapy, if patients' BMI is above 23

Bowel injury following gynecological laparoscopic surgery.

African Journals Online (AJOL)

Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatment. ... cluding less post-operative pain, earlier return of normal bowel function, shorter hospital ... and presence of previous abdominal surgery increase the risk of bowel ...

Small bowel lymphangiectasia and angiodysplasia: a positive association; novel clinical marker or shared pathophysiology?

Science.gov (United States)

Macdonald, Jonathan; Porter, Victoria; Scott, Neil W; McNamara, Deirdre

2010-10-01

Small bowel angiodysplasia accounts for 30 to 40% of cases of obscure gastrointestinal bleeding and is associated with significant morbidity and mortality. Identifying lesions can be difficult. Small bowel capsule endoscopy (SBCE) is a significant advance on earlier diagnostic techniques. The cause of angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing, local vascular anomalies, and tissue hypoxia. Nonpathologic lymphangiectasias are commonly seen throughout the small bowel and are considered a normal finding. To determine whether there is an association between lymphangiectasias, angiodysplasia, and atherosclerosis related conditions. Relevant information was collected from a dedicated SBCE database. Logistic regression analysis was used to examine associations between angiodysplasia, lymphangiectasia, patient demographics, and comorbidity. In all, 180 patients underwent SBCE during the study period, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasia were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure gastrointestinal bleeding without angiodysplasia and in 7 (14%) of 50 without gastrointestinal bleeding. Logistic regression analysis confirmed a strong positive association between angiodysplasia and lymphangiectasia; odds ratio 4.42, PLymphangiectasia are strongly associated with the presence of small intestinal angiodysplasia and may represent a useful clinical marker for this condition. Angiodysplasia are also associated with increasing age. Conditions associated with systemic atherosclerosis did not increase the risk of angiodysplasia.

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

Energy Technology Data Exchange (ETDEWEB)

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

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.

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

International Nuclear Information System (INIS)

Kim, Jee Young; Rha, Sung Eun; Oh, Soon Nam; Bo, Seal Hwang; Byun, Jae Young

2004-01-01

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

Small Bowel Bleeding

Science.gov (United States)

... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer

International Nuclear Information System (INIS)

Baglan, Kathy L.; Frazier, Robert C.; Yan Di; Huang, Raywin R.; Martinez, Alvaro A.; Robertson, John M.

2002-01-01

Purpose: A direct relationship between the volume of small bowel irradiated and the degree of acute small bowel toxicity experienced during concurrent 5-fluorouracil (5-FU)-based chemoradiotherapy for rectal carcinoma is well recognized but poorly quantified. This study uses three-dimensional treatment-planning tools to more precisely quantify this dose-volume relationship. Methods and Materials: Forty patients receiving concurrent 5-FU-based chemotherapy and pelvic irradiation for rectal carcinoma had treatment-planning CT scans with small bowel contrast. A median isocentric dose of 50.4 Gy was delivered using a posterior-anterior and opposed lateral field arrangement. Bowel exclusion techniques were routinely used, including prone treatment position on a vacuum bag cradle to allow anterior displacement of the abdominal contents and bladder distension. Individual loops of small bowel were contoured on each slice of the planning CT scan, and a small bowel dose-volume histogram was generated for the initial pelvis field receiving 45 Gy. The volume of small bowel receiving each dose between 5 and 40 Gy was recorded at 5-Gy intervals. Results: Ten patients (25%) experienced Common Toxicity Criteria Grade 3+ acute small bowel toxicity. A highly statistically significant association between the development of Grade 3+ acute small bowel toxicity and the volume of small bowel irradiated was found at each dose level. Specific dose-volume threshold levels were found, below which no Grade 3+ toxicity occurred and above which 50-60% of patients developed Grade 3+ toxicity. The volume of small bowel receiving at least 15 Gy (V 15 ) was strongly associated with the degree of toxicity. Univariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicity. Conclusions: A strong dose-volume relationship exists for the development of Grade 3+ acute small bowel toxicity in patients receiving concurrent 5-FU-based chemoradiotherapy

Adenocarcinoma of the small bowel

International Nuclear Information System (INIS)

Savli, M.; Jamar, B.

2007-01-01

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)

Adenocarcinoma of the small bowel

Energy Technology Data Exchange (ETDEWEB)

Savli, M; Jamar, B [Inst. of Clinical Radiology, Univ. Medical Centre, Ljubljana (Slovenia)

2007-06-15

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)

Multi-institutional Prospective Evaluation of Bowel Quality of Life After Prostate External Beam Radiation Therapy Identifies Patient and Treatment Factors Associated With Patient-Reported Outcomes: The PROSTQA Experience

Energy Technology Data Exchange (ETDEWEB)

Hamstra, Daniel A., E-mail: dhamm@med.umich.edu [Department of Radiation Oncology, The University of Michigan Medical Center, Ann Arbor, Michigan (United States); Conlon, Anna S.C.; Daignault, Stephanie [Department of Biostatistics, The University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan (United States); Dunn, Rodney L. [Department of Urology, The University of Michigan Medical Center, Ann Arbor, Michigan (United States); Sandler, Howard M. [Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, California (United States); Hembroff, A. Larry [Office for Survey Research, Michigan State University, East Lansing, Michigan (United States); Zietman, Anthony L. [Department of Radiation Oncology, The Massachusetts General Hospital, Boston, Massachusetts (United States); Kaplan, Irving [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States); Ciezki, Jay [Department of Radiation Oncology, The Cleveland Clinic, Cleveland, Ohio (United States); Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, John T. [Department of Urology, The University of Michigan Medical Center, Ann Arbor, Michigan (United States); Sanda, Martin G. [Department of Urology, Emory University Medical Center, Atlanta, Georgia (United States); Michalski, Jeff M. [Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri (United States)

2013-07-01

Purpose: To evaluate patients treated with external beam radiation therapy as part of the multicenter Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA), to identify factors associated with posttreatment patient-reported bowel health-related quality of life (HRQOL). Methods and Materials: Pretreatment characteristics and treatment details among 292 men were evaluated using a general linear mixed model for their association with measured HRQOL by the Expanded Prostate Cancer Index Composite instrument through 2 years after enrollment. Results: Bowel HRQOL had a median score of 100 (interquartile range 91.7-100) pretreatment and 95.8 (interquartile range 83.3-100) at 2 years, representing new moderate/big problems in 11% for urgency, 7% for frequency, 4% for bloody stools, and 8% for an overall bowel problems. Baseline bowel score was the strongest predictor for all 2-year endpoints. In multivariable models, a volume of rectum ≥25% treated to 70 Gy (V70) yielded a clinically significant 9.3-point lower bowel score (95% confidence interval [CI] 16.8-1.7, P=.015) and predicted increased risks for moderate to big fecal incontinence (P=.0008). No other radiation therapy treatment-related variables influenced moderate to big changes in rectal HRQOL. However, on multivariate analyses V70 ≥25% was associated with increases in small, moderate, or big problems with the following: incontinence (3.9-fold; 95% CI 1.1-13.4, P=.03), rectal bleeding (3.6-fold; 95% CI 1.3-10.2, P=.018), and bowel urgency (2.9-fold; 95% CI 1.1-7.6, P=.026). Aspirin use correlated with a clinically significant 4.7-point lower bowel summary score (95% CI 9.0-0.4, P=.03) and an increase in small, moderate, or big problems with bloody stools (2.8-fold; 95% CI 1.2-6.4, P=.018). Intensity modulated radiation therapy was associated with higher radiation therapy doses to the prostate and lower doses to the rectum but did not independently correlate with bowel HRQOL

Multi-institutional Prospective Evaluation of Bowel Quality of Life After Prostate External Beam Radiation Therapy Identifies Patient and Treatment Factors Associated With Patient-Reported Outcomes: The PROSTQA Experience

International Nuclear Information System (INIS)

Hamstra, Daniel A.; Conlon, Anna S.C.; Daignault, Stephanie; Dunn, Rodney L.; Sandler, Howard M.; Hembroff, A. Larry; Zietman, Anthony L.; Kaplan, Irving; Ciezki, Jay; Kuban, Deborah A.; Wei, John T.; Sanda, Martin G.; Michalski, Jeff M.

2013-01-01

Purpose: To evaluate patients treated with external beam radiation therapy as part of the multicenter Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA), to identify factors associated with posttreatment patient-reported bowel health-related quality of life (HRQOL). Methods and Materials: Pretreatment characteristics and treatment details among 292 men were evaluated using a general linear mixed model for their association with measured HRQOL by the Expanded Prostate Cancer Index Composite instrument through 2 years after enrollment. Results: Bowel HRQOL had a median score of 100 (interquartile range 91.7-100) pretreatment and 95.8 (interquartile range 83.3-100) at 2 years, representing new moderate/big problems in 11% for urgency, 7% for frequency, 4% for bloody stools, and 8% for an overall bowel problems. Baseline bowel score was the strongest predictor for all 2-year endpoints. In multivariable models, a volume of rectum ≥25% treated to 70 Gy (V70) yielded a clinically significant 9.3-point lower bowel score (95% confidence interval [CI] 16.8-1.7, P=.015) and predicted increased risks for moderate to big fecal incontinence (P=.0008). No other radiation therapy treatment-related variables influenced moderate to big changes in rectal HRQOL. However, on multivariate analyses V70 ≥25% was associated with increases in small, moderate, or big problems with the following: incontinence (3.9-fold; 95% CI 1.1-13.4, P=.03), rectal bleeding (3.6-fold; 95% CI 1.3-10.2, P=.018), and bowel urgency (2.9-fold; 95% CI 1.1-7.6, P=.026). Aspirin use correlated with a clinically significant 4.7-point lower bowel summary score (95% CI 9.0-0.4, P=.03) and an increase in small, moderate, or big problems with bloody stools (2.8-fold; 95% CI 1.2-6.4, P=.018). Intensity modulated radiation therapy was associated with higher radiation therapy doses to the prostate and lower doses to the rectum but did not independently correlate with bowel HRQOL

Multi-detector CT (MDCT in bowel and mesenteric injury

Directory of Open Access Journals (Sweden)

Vajjalla Ravikumar

2013-04-01

Full Text Available Objectives: To evaluate multi-detector CT (MDCT findings in bowel and mesenteric injury due to blunt abdominal trauma.Method: Retrospective evaluation of MDCT scan reports of patients admitted in Hamad Medical Corporation, Doha, Qatar with bowel and mesenteric injury during the period of January 2005 to April 2008.Results: MDCT, without using oral contrast, clearly demonstrated various specific and less specific findings of bowel and mesenteric injury.Conclusion: Multi-detector CT is an excellent diagnostic modality in bowel and mesenteric injury. Routine administration of oral contrast agent is not mandatory for initial evaluation of these patients.

Bowel injuries secondary to induced abortion: a dilemma

International Nuclear Information System (INIS)

Rehman, A.; Fatima, S.; Soomro, N.

2006-01-01

To study the pattern of bowel injuries incurred by induced abortion, and the morbidity and mortality associated with them. All patients with bowel injuries due to induced abortion. Detailed data of all the patients was collected and analyzed. A total of 22 patients, mostly young with an average age of 26.86 years, presented with bowel injuries following induced abortion. Severe hemorrhage occurred in 8(36.4%) patients while 11(50%) had ileal perforation; 9(40.9%) underwent primary repair and 2(9.1%) ileostomy formation. Two (9.1%) patients with jejunal perforation had primary repair, whereas two with both jejunal and ileal perforations underwent resections with anastomosis in one and ileostomy in another. Seven (31.8%) with large gut involvement had colostomy formation. Septicemia and wound infection occurred in 7(31.8%) patients each, faecal fistula and abdominal wound dehiscence in 3(13.6%), and pelvic abscess in 1(4.6%) patient. The total mortality in this series was 6(27.3%) patients. Iatrogenic injuries during induced abortion, most commonly caused by quacks, can be minimized substantially if the procedure is performed by qualified medical personnel in proper health care facilities. There is a need for radical overhauling of the mind set in our society together with legislation. (author)

Late radiation injury of the colon and rectum. Surgical management and outcome

International Nuclear Information System (INIS)

Kimose, H.H.; Fischer, L.; Spjeldnaes, N.; Wara, P.

1989-01-01

After a median latency of 2 years, the initial late colorectal radiation injuries in 182 patients were: stricture (37 percent), minor lesions (36 percent), rectovaginal fistula (22 percent), and gangrene or other fistulas (5 percent). Due to progression, new colorectal injuries, primarily stricture (55 percent) and fistula (42 percent), occurred in 68 patients (37 percent). Resection provided the best results. However, the resectability rate was low (46 percent) and resection was primarily performed in patients with a circumscript well-defined stricture of the proximal rectum or sigmoid colon with an anastomotic leakage rate of 5 percent. The prevailing management of 78 patients with fistula or stricture with synchronous fistula was defunctioning colostomy, primarily end-sigmoidostomy, providing fair results in half of the patients. Stomal complications occurred in 15 percent. The radiation-induced colorectal mortality was 8 percent. Colorectal fistula and associated radiation injuries of the urinary tract, and especially of the small bowel, were the major determinants of fatal outcome, yielding an overall radiation-induced mortality of 25 percent. After a median observation time of 13 years, half of the patients were alive at follow-up; 56 percent of these had a fair outcome whereas the remaining patients continued to have mild symptoms responding to conservative measures (34 percent) or disabling symptoms (10 percent)

The protective effect of lycopene against radiation injury to the small intestine of abdominally radiated mice

International Nuclear Information System (INIS)

Itoh, Youko; Kurabe, Teruhisa; Ishiguchi, Tsuneo

2004-01-01

To reduce the side effects of radiotherapy, radioprotective effects of lycopene on villi and crypts in the small intestine of abdominally radiated mice (15 Gy) were examined with administration pre-, continuous and post-radiation. In the lycopene group, the ratio of the villus length to the crypt was significantly increased in comparison with the radiation only group at 2 days after radiation. At 7 days after radiation, the ratio of necrotic cells in crypt/total was significantly decreased and the ratio of necrotic cells in villus/total was significantly increased by lycopene administration, which indicated an acceleration of the recovery from the radiation injury with lycopene. Each lycopene administered group showed a significant radioprotective effect, with the pre-radiation administration inducing a smaller effect than that of continuous and post-radiation administration. Radiation induced apoptosis was also decreased by lycopene administration. It is concluded that pre-, continuous and post-radiation administration of lycopene protects against radiation injury of the small intestine and accelerate the recovery. (author)

MR enterography in the evaluation of small bowel dilation

Energy Technology Data Exchange (ETDEWEB)

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

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.

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

International Nuclear Information System (INIS)

Kim, Sung Kyu; Kim, Yong Soo; Kim, Young Sun; Cho, On Koo; Koh, Byung Hee; Rhim, Hyun Chul; Park, Choog Ki; Park, Dong Woo; Park, Yong Wook; Oh, Young Ha

2005-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2005-07-15

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

Electrocautery-induced localized colonic injury elicits increased levels of pro-inflammatory cytokines in small bowel and decreases jejunal alanine absorption.

Science.gov (United States)

Barada, Kassem; Mourad, Fadi H; Noutsi, Bakiza; Saadé, Nayef E

2015-01-01

Colitis is associated with functional abnormalities in proximal non-inflamed gut areas, but animal models to study small bowel dysfunction in colitis have limitations. This study aims to determine small intestinal alanine absorption and cytokine expression in a novel model of colonic ulceration induced by electro-cautery. A descending colon ulcer was induced in rats by a bipolar electro-cautery probe. Ulcer score was determined using Satoh's criteria. Jejunal alanine absorption was measured immediately and at different time intervals post ulcer induction. Levels of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) protein and m-RNA were determined in mucosal scrapings obtained from the colon, duodenum, jejunum and ileum at various time intervals after colonic ulcer induction. The mean ulcer score was 3 up to 48h, followed by healing by 96h post ulcer induction. Small bowel histology was normal throughout. Jejunal alanine absorption was reduced by 12-34% immediately and up to 72h after cautery and returned to normal at 96h. IL-1 and TNF-α mRNA increased significantly in the colon, duodenum, jejunum and ileum 3h post electro-cautery and returned to normal at 48h, while that of IL-6 increased significantly at 48h post ulcer induction. Similarly, IL-1, IL-6 and TNF-α protein levels increased in the duodenum, jejunum, ileum and colon up to 48h post ulcer induction. Electrically induced localized colonic injury increased production of pro-inflammatory cytokines in non-inflamed segments of the small intestine and was associated with derangements of jejunal absorptive function. Copyright © 2014 Elsevier Ltd. All rights reserved.

Efficacy of an absorbable mesh in keeping the small bowel out of the human pelvis following surgery

International Nuclear Information System (INIS)

Devereux, D.F.; Chandler, J.J.; Eisenstat, T.; Zinkin, L.

1988-01-01

Patients with pelvic malignancies frequently require postoperative radiation therapy either as adjunctive or palliative treatment. Tumoricidal doses, however, are frequently associated with small-bowel damage. Animal experiments demonstrated tolerance to high-dose radiation therapy and protection from radiation enteritis by use of an absorbable polymer polyglycolic acid (PGA) that is used as an intestinal sling to elevate the small bowel away from the operated site. Sixty patients (42 with rectal carcinomas and 18 with gynecologic malignancies) underwent surgical treatment that included the intestinal sling procedure. Postoperative radiation was begun within three weeks following surgery and patients received a mean approximating 5500 rads in fractionated doses. A mean follow-up time of 28 months has not revealed a single case of radiation enteritis (by either contrast studies or physiologic studies) or PGA mesh-related complications. The authors believe that this surgical technique should be employed in patients who may require postoperative radiation treatment for pelvic malignancy

Transabdominal Ultrasonography of the Small Bowel

Directory of Open Access Journals (Sweden)

Rudolf Kralik

2013-01-01

Full Text Available In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism, is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT and magnetic resonance imaging (MRI in small bowel examination.

Radiation-induced enteropathy

Energy Technology Data Exchange (ETDEWEB)

Sher, M.E.; Bauer, J. (Mount Sinai Hospital, New York, NY (USA))

1990-02-01

The incidence of chronic radiation enteritis appears to have risen in recent years due to the increasing utilization of radiotherapy for abdominal and pelvic malignancies. The etiology, pathogenesis, and management of radiation enteritis are discussed. Two case reports exemplify the progressive nature of the disease. Case 1 demonstrates the classical picture of multiple exacerbations and remissions of partial small bowel obstruction and the eventual need for surgical management ten years after radiation therapy. Case 2 presents the more severe sequelae of an acute perforation with a 14-yr latency period. Predisposing factors in the progression of radiation injury include excessive radiation, underlying cardiovascular disease, fixation of the bowel, and an asthenic habitus. In both cases, radiation injury was localized to a discrete segment of bowel; therefore, resection with a primary end-to-end anastomosis was performed. In addition, diseased bowel was eliminated and, therefore, would not cause further complications such as intractable bleeding or fistula formation. The review focuses on current knowledge which may be applied to the treatment and prevention of radiation enteritis.

Radiation exposure and examination time during enteroclysis and small bowel follow-through

International Nuclear Information System (INIS)

Thoeni, R.F.; Gould, R.G.

1989-01-01

The authors have investigated radiation exposures and total examination and fluoroscopy times in enterolysis and small-bowel-follow-through (SBFT). Enteroclysis was performed in 25 patients and SBFT in another 25 (17 with UGI/SBFT and 8 with SBFT alone), with 5 TLD dosimeters placed in areas of the back exposed to primary x-rays during fluoroscopy, spot, and overhead radiography. Skin entry exposures, fluoroscopy, and total examination times in enteroclysis were compared to those in SBFTs. Biphasic enteroclyis was performed, with an average of 18 radiographs per study, SBFT with 16, and UGI/SBFT with 23. Indications and pathology for enteroclysis and SBFT were similar. Detailed findings are presented. The authors conclude that total examination time for enteroclysis is two to three times shorter and skin entry exposure is less than two to three times higher than for SBFT. Higher radiation exposure of enteroclysis should be weighted against very short examination times and reported high accuracy in deciding between enteroclysis and SBFT

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

International Nuclear Information System (INIS)

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

2008-01-01

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.)

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

International Nuclear Information System (INIS)

Torkzad, Michael R.; Blomqvist, Lennart; Vargas, Roberto; Tanaka, Chikako

2007-01-01

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

Small-bowel permeability in collagenous colitis

DEFF Research Database (Denmark)

Wildt, Signe; Madsen, Jan L; Rumessen, Jüri J

2006-01-01

Collagenous colitis (CC) is a chronic inflammatory bowel disease that affects the colon. However, some patients with CC present with accompanying pathologic small-bowel manifestations such as coeliac disease, defects in bile acid absorption and histopathologic changes in small-intestinal biopsies......, indicating that CC is a pan-intestinal disease. In small-intestinal disease, the intestinal barrier function may be impaired, and the permeability of the small intestine altered. The purpose of this research was to study small-bowel function in patients with CC as expressed by intestinal permeability....

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

Energy Technology Data Exchange (ETDEWEB)

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

2009-06-15

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

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

Science.gov (United States)

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

2015-09-01

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

Late small bowel toxicity after aggressive abdominopelvic intensity modulated radiation therapy

Directory of Open Access Journals (Sweden)

Andrew Ling, BA

2017-10-01

Conclusion: It may be possible with IMRT to deliver high doses to small volumes of small bowel with low rates of significant long-term complications. Further studies should explore tolerable dose-volume relationships in cases in which aggressive abdominal or pelvic treatment may be warranted to treat the underlying malignancy.

Endoscopic management of intraoperative small bowel laceration during natural orifice translumenal endoscopic surgery: a blinded porcine study.

Science.gov (United States)

Fyock, Christopher J; Forsmark, Chris E; Wagh, Mihir S

2011-01-01

Natural orifice translumenal endoscopic surgery (NOTES) has recently gained great enthusiasm, but there is concern regarding the ability to endoscopically manage complications purely via natural orifices. To assess the feasibility of endoscopically managing enteral perforation during NOTES using currently available endoscopic accessories. Twelve pigs underwent transgastric or transcolonic endoscopic exploration. Full-thickness enterotomies were intentionally created to mimic accidental small bowel lacerations during NOTES. These lacerations were then closed with endoclips. In the blinded arm of the study, small bowel repair was performed by a second blinded endoscopist. Adequate closure of the laceration was confirmed with a leak test. Primary access sites were closed with endoclips or T-anchors. At necropsy, the peritoneal cavity was inspected for abscesses, bleeding, or damage to surrounding structures. The enterotomy site was examined for adequacy of closure, adhesions, or evidence of infection. Fifteen small bowel lacerations were performed in 12 animals. Successful closure was achieved in all 10 cases in the nonblinded arm. Survival animals had an uncomplicated postoperative course and all enterotomy sites were well healed without evidence of necrosis, adhesions, abscess, or bleeding at necropsy. Leak test was negative in all animals. In the blinded arm, both small intestinal lacerations could not be identified by the blinded endoscopist. Necropsy revealed open small bowel lacerations. Small intestinal injuries are difficult to localize with currently available flexible endoscopes and accessories. Endoscopic clips, however, may be adequate for closure of small bowel lacerations if the site of injury is known.

A simple technique to reduce small bowel toxicity when irradiating the periaortic area

International Nuclear Information System (INIS)

Hernandez, J.C.; Fine, B.; Herman, T.S.; Rothenberg, M.; Nicol, N.

1996-01-01

Purpose/Objective: Patients receiving periaortic radiation are normally treated in the supine position. We decided to evaluate whether positioning the patient prone on a modified 'belly-board' can reduce the volume of small bowel within the lateral fields in patients receiving four field periaortic radiation. Materials and Methods: Sixteen consecutive women with gynecologic primaries underwent simulation of the periaortic area using a four-field set up (AP, PA, Lats). The fields extended from the top of the L1 vertebral body to the bottom of L5 and had a mean length of 16.2 cm. The AP and PA fields had a width of 8 cm (centered on the midline of the vertebral bodies) while the right and left lateral fields had a width of 4 cm (2 cm anterior and 2 cm posterior to the anterior margin of the vertebral bodies) and did not include the spinal cord. Following oral ingestion of small bowel contrast, simulation films were obtained in the supine position and in the prone position on a modified 'belly-board' (with the pelvic opening extended superiorly to the superior abdomen). It was hypothesized that the prone position on a modified 'belly-board' would allow the abdominal small bowel to fall by gravity away from the periaortic area. We measured the volume of small bowel irradiated through the lateral fields for both the supine and prone-in-belly-board positions using the method described by Gallagher et al. Results: The volume of small bowel included within the lateral fields in the supine position ranged from 164 to 359.5 cc 3 (mean 285 cc 3 ) while placement in the prone-in-bellyboard position reduced the volume of small bowel within the lateral fields to a range of 35-152 cc 3 (mean 86 cc 3 ), an overall reduction of approximately 70% in the volume of small bowel included within lateral fields. Conclusion: The use of lateral fields in the prone-in-bellyboard position allows for significant small bowel sparing through the lateral component of a four-field periaortic set

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

International Nuclear Information System (INIS)

Letschert, J.G.J.; Lebesque, J.V.; Aleman, B.M.P.; Bartelink, H.; Bosset, J.F.; Horiot, J.C.; Cionini, L.; Hamers, J.P.; Leer, J.W.H.; van Glabbele, M.

1994-01-01

The purpose of this study was to quantify the correlation between irradiated small bowel volume and late occurring small bowel complications. Methods: Small bowel volumes in the high-dose region were measured using orthogonal barium films for 203 patients treated for rectal carcinoma with pelvic postoperative radiotherapy to 50 Gy in an EORTC multicentric study. Results: The 5-year estimate of lat pelvic small bowel obstruction requiring surgery was 11%. No correlation between the irradiated small bowel volume and obstruction was detected. The actuarial 5-year estimate of chronic diarrhea varied from 31% in patients with irradiated small bowel volumes below 77 cm 3 to 42% in patients with volumes over 328 cm 3 . This correlation was significant in the univariate and multivariate analysis (p=0.025). The type of rectal surgery significantly influenced the incidence of chronic diarrhea and malabsorption, the actuarial 5-year estimate being 49% and 26% after low anterior resection and abdominoperineal resection, respectively (p=0.04). Conclusions: This study demonstrated that there is a volume-effect in radiation-induced diarrhea atr a dose of 50 Gy in 25 fractions. No volume-effect for small bowel obstruction was detected at this dose-level in pelvic postoperative radiotherapy. A review of the literature data on small bowel obstruction indicates that the volume effect at this dose level can only be demonstrated in patients who were treated with extended field radiotherapy (estimated small bowel volume 800 cm 3 ) after intra-abdominal surgery. (author). 22 refs., 5 tabs

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

International Nuclear Information System (INIS)

Ko, Young Hwan; Hwang, Dae Hyun; Min, Seon Jeong; Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul

2013-01-01

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.

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

International Nuclear Information System (INIS)

Ajaj, Waleed; Kuehle, Christiane; Nuefer, Michael; Goehde, Susanne C.; Lauenstein, Thomas C.; Goyen, Mathias; Schneemann, Hubert; Ruehm, Stefan G.

2005-01-01

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

Protection from radiation enteritis by an absorbable polyglycolic acid mesh sling

International Nuclear Information System (INIS)

Devereux, D.F.; Thompson, D.; Sandhaus, L.; Sweeney, W.; Haas, A.

1987-01-01

Patients with malignant tumors of the pelvis who cannot be cured surgically often are treated with radiation after surgery. A devastating side effect of this treatment is radiation-associated small bowel injury (RASBI). The purpose of this study was to test the hypothesis that removal of the small bowel from the radiation field would protect it against RASBI. Twenty cebus monkeys underwent low anterior resection. In 10 animals an absorbable polyglycolic acid (PGA) mesh was sewn circumferentially around the interior of the abdominal cavity as a supporting apron, which prevented the small bowel's descent into the pelvis. The other 10 monkeys did not receive the mesh. All animals received 2000 rads by linear acceleration in a single dose. Twenty-four-hour stool fat, serum vitamin B12, and other serum values were obtained during the study. Animals were sacrificed after 1, 2, 3, 6, and 12 months, and the small bowel and rectum were examined histologically in a blind manner. Two monkeys who did not undergo surgery, or exposure to radiation served as controls. At all sacrifice periods, the animals with PGA mesh slings demonstrated normal small bowel function and histologic structure. Animals without mesh slings had abnormal stool and blood values at 1 month, and by 2 months all had died of small bowel necrosis. The animals that received the slings had no evidence of infection or obstruction, and by 6 months all evidence of the mesh was gone. Support of the small bowel out of the pelvis by an absorbable PGA mesh sling protects against RASBI and is without apparent complications

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

Energy Technology Data Exchange (ETDEWEB)

Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Wang, Hong-Hau [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Department of Radiology, Taipei (China); Fan, Hsiu-Lung [Tri-Service General Hospital, National Defense Medical Center, Division of General Surgery, Department of Surgery, Taipei (China); Chen, Ran-Chou [Taipei City Hospital, Department of Radiology, Taipei (China); National Yang-Ming Univeristy, Department of Biochemical Imaging and Radiological Sciences, Taipei (China); Chang, Wei-Chou [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); National Yang-Ming Univeristy, Department of Biochemical Imaging and Radiological Sciences, Taipei (China)

2015-04-01

The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small- bowel obstruction

International Nuclear Information System (INIS)

Chen, Ya-Cheng; Liu, Chang-Hsien; Hsu, Hsian-He; Yu, Chih-Yung; Wang, Hong-Hau; Fan, Hsiu-Lung; Chen, Ran-Chou; Chang, Wei-Chou

2015-01-01

The objective is to use multidetector computed tomography (MDCT) to differentiate phytobezoar impaction and small-bowel faeces in patients with small-bowel obstruction (SBO). We retrospectively reviewed 91 consecutive SBO patients with surgically proven phytobezoars (n = 31) or adhesion with small-bowel faeces (n = 60). Two readers blinded to the diagnosis recorded the following MDCT features: degree of obstruction, transition point, mesenteric fatty stranding, intraperitoneal fluid, air-fluid level, pneumatosis intestinalis, and portal venous gas. MDCT measurements of the food debris length, attenuation, luminal diameter, and wall thickness of the obstructed bowel were also compared. A higher grade of obstruction with an absence of mesenteric fatty stranding and intraperitoneal fluid was more commonly seen in the phytobezoar group than in the small-bowel faeces group (p < 0.01). The food debris length (phytobezoar, 5.7 ± 2.8 cm; small-bowel feces, 20.3 ± 7.9 cm, p < 0.01) and mean attenuation (phytobezoar, -59.6 ± 43.3 Hounsfield units (HU); small-bowel faeces, 8.5 ± 7.7 HU, p <0.01) were significantly different between the two groups. The ROC curve showed that food debris length <9.5 cm and mean attenuation value < -11.75 HU predicted phytobezoar impaction. MDCT features with measurements of the food debris length and mean attenuation assist the differentiation of phytobezoar impaction and small-bowel faeces. (orig.)

[Premalignant conditions of the small bowel].

Science.gov (United States)

Drastich, P

2013-01-01

Small intestinal dysplastic lesions are rare and difficult to detect before they progress to cancer. New investigative modalities, such as capsule endoscopy and doubleballoon enteroscopy, are very promising in search for premalignant lesions. Screening patients at high-risk for small bowel neoplasia is the only sensible approach. Duodenal adenoma represents the most easily accessible tumors with the possibility of curative endoscopic resection. Due to the strong association of the small bowel and colonic adenomas, it is always necessary to perform colonoscopy. In young patients, the exclusion of familial polyposis by genetic testing is always mandatory. Patients with celiac disease are especially at risk of developing nonHodgkins lymphomas and adenocarcinomas. There is a high-risk of ampuloma and other adenomas in patients with familial adenomatous polyposis. Patients with prolonged and complicated course of Crohns disease, Peutz Jeghers syndrome and patients with ileoanal pouch have higher risk of adenocarcinoma of the small intestine.

International bowel function extended spinal cord injury data set

DEFF Research Database (Denmark)

Krogh, K; Perkash, I; Stiens, S A

2008-01-01

and the ASIA Board. Relevant and interested scientific and professional organizations and societies (around 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCoS Scientific Committee, ISCoS Council and ASIA Board......STUDY DESIGN: International expert working group.Objective:To develop an International Bowel Function Extended Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of an extended amount of information on bowel function. SETTING: Working group...... consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets and later by the ISCoS Scientific Committee...

International bowel function basic spinal cord injury data set

DEFF Research Database (Denmark)

Krogh, K; Perkash, I; Stiens, S A

2008-01-01

S Scientific Committee and the ASIA Board. Relevant and interested scientific and professional (international) organizations and societies (approximately 40) were also invited to review the data set and it was posted on the ISCoS and ASIA websites for 3 months to allow comments and suggestions. The ISCo......STUDY DESIGN: International expert working group. OBJECTIVE: To develop an International Bowel Function Basic Spinal Cord Injury (SCI) Data Set presenting a standardized format for the collection and reporting of a minimal amount of information on bowel function in daily practice or in research....... SETTING: Working group consisting of members appointed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: A draft prepared by the working group was reviewed by Executive Committee of the International SCI Standards and Data Sets, and later by ISCo...

A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia.

Science.gov (United States)

Inskip, Jessica A; Lucci, Vera-Ellen M; McGrath, Maureen S; Willms, Rhonda; Claydon, Victoria E

2018-05-01

Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.

Computed tomography features of small bowel volvulus

International Nuclear Information System (INIS)

Loh, Y.H.; Dunn, G.D.

2000-01-01

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

A case of closed loop small bowel obstruction within a strangulated incisional hernia in association with an acute gastric volvulus.

Science.gov (United States)

Kosai, Nik Ritza; Gendeh, H S; Noorharisman, M; Sutton, Paul Anthony; Das, Srijit

2014-01-01

Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

Volvulus of the Small Bowel and Colon

Science.gov (United States)

Kapadia, Muneera R.

2017-01-01

Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection. PMID:28144211

A CASE OF CLOSED LOOP SMALL BOWEL OBSTRUCTION WITHIN A STRANGULATED INCISIONAL HERNIA IN ASSOCIATION WITH AN ACUTE GASTRIC VOLVULUS

Directory of Open Access Journals (Sweden)

Nik Ritza Kosai

2014-01-01

Full Text Available Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

Diospyrobezoar as a Cause of Small Bowel Obstruction

Directory of Open Access Journals (Sweden)

Andréia Padilha de Toledo

2012-09-01

Full Text Available 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.

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

Energy Technology Data Exchange (ETDEWEB)

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

1980-01-01

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

The role of computed tomography in the diagnosis and management of clinically occult post-traumatic small bowel perforation

International Nuclear Information System (INIS)

Ahmed, I.; Ahmed, N.; Bell, D.J.; Hughes, D.V.; Evans, G.H.; Howlett, D.C.

2009-01-01

Purpose: To evaluate the use of computed tomography [CT] in the diagnosis of occult post-traumatic small bowel perforation and to discuss the role of CT in the management of this patient group. Method: This review includes three patients who presented with mild abdominal symptoms following minor blunt abdominal trauma. Initial radiographs and laboratory investigations were unremarkable but their symptoms failed to resolve and contrast-enhanced CT was performed for further evaluation. Results: In each case the CT appearances were indicative of localised small bowel perforation, with no evidence of other visceral injury. In two patients pockets of free intraperitoneal air were present closely related to the second part of the duodenum suggesting injury at this site. In the third case, a thickened proximal jejunal loop was demonstrated with free air and fluid in the adjacent mesentery consistent with a focal perforation. These CT findings were subsequently confirmed at laparotomy. Conclusion: CT is an accurate diagnostic tool in the assessment of clinically and radiologically occult traumatic small bowel injury. The use of CT should be considered in patients who have unresolving abdominal symptoms even after apparently insignificant abdominal trauma.

Effect of radiation on apoptosis in small intestine and colon of mice

International Nuclear Information System (INIS)

Ding Guirong; Guo Guozhen; Tian Furong; Wang Jin; Zhang Liyan; Guo Yao

2000-01-01

To discuss the changes of apoptosis level in small bowel and colon of mice after γ-ray irradiation. The mice were irradiated with different doses (1,6,12 Gy). The incidence of apoptosis in small bowel and colon were observed at different time (6,12,24h) after irradiation using morphological method. Then results indicate that there were apoptosis in small bowel of normal mice, the number of apoptotic cell was 0.038 +- 0.059 per whole crypt. No apoptosis was observed in colon of normal mice and irradiated mice; The incidence of apoptosis significantly increased in small bowel after different doses of irradiation (p < 0.05). The apoptosis peak appeared at 12, 24, 6 h after 1, 6, 12 Gy irradiation; The incidence of apoptosis was higher in small bowel than that of colon after different doses of irradiation and at different time after irradiation. From the results the authors propose that the radiation-damaged cells might be more effectively removed in small bowel than in colon after irradiation. Radiation-damaged cells may tend to remain in colon and related to later tumorigenesis

Associated injuries, management, and outcomes of blunt abdominal aortic injury.

Science.gov (United States)

de Mestral, Charles; Dueck, Andrew D; Gomez, David; Haas, Barbara; Nathens, Avery B

2012-09-01

Blunt abdominal aortic injury (BAAI) is very rare, and current literature is limited to case series of single-center experience. Through an analysis of the National Trauma Data Bank, the largest aggregation of United States trauma registry data, our aim was to characterize the associated injury pattern, contemporary management, and in-hospital outcomes of patients with BAAI. We used a nested case-control design. The overall cohort consisted of adult patients (age ≥ 16 years) severely injured (Injury Severity Score ≥ 16) after blunt trauma who were treated at a level 1 or 2 trauma center in years 2007 to 2009. Cases were patients with BAAI and were frequency-matched by age group and mechanism to randomly selected controls at a one-to-five ratio. Multivariable matched analysis (conditional logistic regression) was used to derive adjusted measures of association between BAAI and adjacent arterial, intra-abdominal, and bony injuries. We identified 436 patients with BAAI from 180 centers. The mean Injury Severity Score was 35 ± 14, and most patients were injured in motor vehicle crashes (84%). Multivariable analysis showed injury to the thoracic aorta, renal and iliac artery, small bowel, colon, liver, pancreas, and kidney, as well as lumbar spine fractures were independently associated with BAAI. A total of 394 patients (90%) were managed nonoperatively, and 42 (10%) underwent repair. Of these 42 patients, 29 (69%) underwent endovascular repair, with 11 patients undergoing open aortic repair and two extra-anatomic bypasses. Median time from admission to repair was 1 day (interquartile range, 1-2 days). Overall mortality was 29%. A total of 271 (69%) patients managed nonoperatively survived to hospital discharge. The index of suspicion for BAAI should be raised in severely injured patients by the presence of injuries to the lumbar spine, bowel, retroperitoneal organs, and adjacent major arteries. Although endovascular repair is the most common intervention, most

Intensity modulated radiation therapy (IMRT: differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma

Directory of Open Access Journals (Sweden)

Delclos Marc E

2011-06-01

Full Text Available Abstract Background A strong dose-volume relationship exists between the amount of small bowel receiving low- to intermediate-doses of radiation and the rates of acute, severe gastrointestinal toxicity, principally diarrhea. There is considerable interest in the application of highly conformal treatment approaches, such as intensity-modulated radiation therapy (IMRT, to reduce dose to adjacent organs-at-risk in the treatment of carcinoma of the rectum. Therefore, we performed a comprehensive dosimetric evaluation of IMRT compared to 3-dimensional conformal radiation therapy (3DCRT in standard, preoperative treatment for rectal cancer. Methods Using RTOG consensus anorectal contouring guidelines, treatment volumes were generated for ten patients treated preoperatively at our institution for rectal carcinoma, with IMRT plans compared to plans derived from classic anatomic landmarks, as well as 3DCRT plans treating the RTOG consensus volume. The patients were all T3, were node-negative (N = 1 or node-positive (N = 9, and were planned to a total dose of 45-Gy. Pairwise comparisons were made between IMRT and 3DCRT plans with respect to dose-volume histogram parameters. Results IMRT plans had superior PTV coverage, dose homogeneity, and conformality in treatment of the gross disease and at-risk nodal volume, in comparison to 3DCRT. Additionally, in comparison to the 3DCRT plans, IMRT achieved a concomitant reduction in doses to the bowel (small bowel mean dose: 18.6-Gy IMRT versus 25.2-Gy 3DCRT; p = 0.005, bladder (V40Gy: 56.8% IMRT versus 75.4% 3DCRT; p = 0.005, pelvic bones (V40Gy: 47.0% IMRT versus 56.9% 3DCRT; p = 0.005, and femoral heads (V40Gy: 3.4% IMRT versus 9.1% 3DCRT; p = 0.005, with an improvement in absolute volumes of small bowel receiving dose levels known to induce clinically-relevant acute toxicity (small bowel V15Gy: 138-cc IMRT versus 157-cc 3DCRT; p = 0.005. We found that the IMRT treatment volumes were typically larger than that

A novel diagnostic tool for detecting functional patency of the small bowel: the Given patency capsule.

Science.gov (United States)

Spada, C; Spera, G; Riccioni, M; Biancone, L; Petruzziello, L; Tringali, A; Familiari, P; Marchese, M; Onder, G; Mutignani, M; Perri, V; Petruzziello, C; Pallone, F; Costamagna, G

2005-09-01

The current visualization of small-bowel strictures using traditional radiological methods is associated with high radiation doses and false-negative results. These methods do not always reveal small-bowel patency for solids. The aim is to assess the safety of the Given patency system and its ability to detect intestinal strictures in patients with strictures that are known or suspected radiologically. The Given patency capsule is composed of lactose, remains intact in the gastrointestinal tract for 40-100 hours post ingestion, and disintegrates thereafter. A total of 34 patients with small-bowel stricture were prospectively enrolled; 30 had a previous diagnosis of Crohn's disease, three had adhesion syndrome and in one ischemic enteritis was suspected. Of the patients, 15 (44.1 %) had previously undergone surgery. Following ingestion, the capsule was monitored for integrity and transit time, using a specially designed Given scanner and also radiologically. Seventeen patients had been enrolled with the intent of using the patency capsule as a preliminary test in patients with small-bowel strictures before undergoing video capsule endoscopy. 30 patients (88.2 %) retrieved the capsule in the stool; it was intact in 20 (median transit time 22 hours), and disintegrated in 10 patients (median transit time 53 hours). Six patients complained of abdominal pain which disappeared within 24 hours. The scanner successfully indicated the presence of the capsule in 94 % of cases. Ten patients underwent video capsule endoscopy following the patency capsule examination; in all of these the video capsule passed through the small-bowel stricture. This feasibility study has shown that the Given patency capsule is a safe, effective, and convenient tool for assessment of functional patency of the small bowel. It can indicate functional patency even in cases where traditional radiology indicates stricture.

Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome.

Science.gov (United States)

Pereira, Ester; Estanqueiro, Paula; Almeida, Susana; Ferreira, Ricardo; Tellechea, Oscar; Salgado, Manuel

2014-09-01

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Transient small-bowel intussusception in children on CT

International Nuclear Information System (INIS)

Strouse, Peter J.; DiPietro, Michael A.; Saez, Fermin

2003-01-01

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.)

Small Bowel Perforation as a Postoperative Complication from a Laminectomy

Directory of Open Access Journals (Sweden)

Robert H. Krieger

2015-01-01

Full Text Available Chronic low back pain is one of the leading chief complaints affecting adults in the United States. As a result, this increases the percentage of patients that will eventually undergo surgical intervention to alleviate debilitating, chronic symptoms. A 37-year-old woman presented ten hours postoperatively after a lumbar laminectomy with an acute abdomen due to the extraordinarily rare complication of small bowel injury secondary to deep surgical penetration.

Synergistic Effect of Combined Hollow Viscus Injuries on Intra-Abdominal Abscess Formation.

Science.gov (United States)

Paulus, Elena M; Croce, Martin A; Shahan, Charles P; Zarzaur, Ben L; Sharpe, John P; Dileepan, Amirtha; Boyd, Brandon S; Fabian, Timothy C

2015-07-01

The strong association between penetrating colon injuries and intra-abdominal abscess (IAA) formation is well established and attributed to high colon bacterial counts. Since trauma patients are rarely fasting at injury, stomach and small bowel colony counts are also elevated. We hypothesized that there is a synergistic effect of increased IAA formation with concomitant stomach and/or colon injuries when compared to small bowel injuries alone. Consecutive patients at a level one trauma center with penetrating small bowel (SB), stomach (S), and/or colon (C) injuries from 1996 to 2012 were reviewed. Logistic regression determined associations with IAA, adjusting for age, gender, Injury Severity Score (ISS), admission Glasgow Coma Score, transfusions, and concurrent pancreas or liver injury. A total of 1518 patients (91% male, ISS = 15.9 ± 8.4) were identified: 496 (33%) SB, 231 (15%) S, 288 (19%) C, 40 (3%) S + SB, 69 (5%) S + C, 338 (22%) C + SB, and 56 (4%) S + C + SB. 148 (10%) patients developed IAA: 4 per cent SB, 9 per cent S, 10 per cent C, 5 per cent S + SB, 22 per cent S + C, 13 per cent C + SB, and 25 per cent S + C + SB. Multiple logistic regression demonstrated that ISS, 24 hour blood transfusions, and concomitant pancreatic or liver injuries were associated with IAA. Compared with reference SB, S or S + SB injuries were no more likely to develop IAA. However, S + C, SB + C, and S + C + SB injuries were significantly more likely to have IAA. In conclusion, combined stomach + colon, small bowel + colon, and stomach, colon, + small bowel injuries have a synergistic effect leading to increased IAA formation after penetrating injuries. Heightened clinical suspicion for IAA formation is necessary in these combined hollow viscus injury patients.

Small bowel resection

Science.gov (United States)

... Ileostomy and your diet Ileostomy - caring for your stoma Ileostomy - changing your pouch Ileostomy - discharge Ileostomy - what to ask your doctor Low-fiber diet Preventing falls Small bowel resection - discharge Surgical wound care - open Types of ileostomy Ulcerative colitis - discharge When ...

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

LENUS (Irish Health Repository)

O'Daly, Brendan J

2009-06-01

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

Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

Science.gov (United States)

Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

2015-06-01

The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

Small bowel carcinomas in celiac or Crohn's disease: distinctive histophenotypic, molecular and histogenetic patterns.

Science.gov (United States)

Vanoli, Alessandro; Di Sabatino, Antonio; Martino, Michele; Klersy, Catherine; Grillo, Federica; Mescoli, Claudia; Nesi, Gabriella; Volta, Umberto; Fornino, Daniele; Luinetti, Ombretta; Fociani, Paolo; Villanacci, Vincenzo; D'Armiento, Francesco P; Cannizzaro, Renato; Latella, Giovanni; Ciacci, Carolina; Biancone, Livia; Paulli, Marco; Sessa, Fausto; Rugge, Massimo; Fiocca, Roberto; Corazza, Gino R; Solcia, Enrico

2017-10-01

Non-familial small bowel carcinomas are relatively rare and have a poor prognosis. Two small bowel carcinoma subsets may arise in distinct immune-inflammatory diseases (celiac disease and Crohn's disease) and have been recently suggested to differ in prognosis, celiac disease-associated carcinoma cases showing a better outcome, possibly due to their higher DNA microsatellite instability and tumor-infiltrating T lymphocytes. In this study, we investigated the histological structure (glandular vs diffuse/poorly cohesive, mixed or solid), cell phenotype (intestinal vs gastric/pancreatobiliary duct type) and Wnt signaling activation (β-catenin and/or SOX-9 nuclear expression) in a series of 26 celiac disease-associated small bowel carcinoma, 25 Crohn's disease-associated small bowel carcinoma and 25 sporadic small bowel carcinoma cases, searching for new prognostic parameters. In addition, non-tumor mucosa of celiac and Crohn's disease patients was investigated for epithelial precursor changes (hyperplastic, metaplastic or dysplastic) to help clarify carcinoma histogenesis. When compared with non-glandular structure and non-intestinal phenotype, both glandular structure and intestinal phenotype were associated with a more favorable outcome at univariable or stage- and microsatellite instability/tumor-infiltrating lymphocyte-inclusive multivariable analysis. The prognostic power of histological structure was independent of the clinical groups while the non-intestinal phenotype, associated with poor outcome, was dominant among Crohn's disease-associated carcinoma. Both nuclear β-catenin and SOX-9 were preferably expressed among celiac disease-associated carcinomas; however, they were devoid, per se, of prognostic value. We obtained findings supporting an origin of celiac disease-associated carcinoma in SOX-9-positive immature hyperplastic crypts, partly through flat β-catenin-positive dysplasia, and of Crohn's disease-associated carcinoma in a metaplastic (gastric and

Oxidative stress gene expression profile in inbred mouse after ischemia/reperfusion small bowel injury.

Science.gov (United States)

Bertoletto, Paulo Roberto; Ikejiri, Adauto Tsutomu; Somaio Neto, Frederico; Chaves, José Carlos; Teruya, Roberto; Bertoletto, Eduardo Rodrigues; Taha, Murched Omar; Fagundes, Djalma José

2012-11-01

To determine the profile of gene expressions associated with oxidative stress and thereby contribute to establish parameters about the role of enzyme clusters related to the ischemia/reperfusion intestinal injury. Twelve male inbred mice (C57BL/6) were randomly assigned: Control Group (CG) submitted to anesthesia, laparotomy and observed by 120 min; Ischemia/reperfusion Group (IRG) submitted to anesthesia, laparotomy, 60 min of small bowel ischemia and 60 min of reperfusion. A pool of six samples was submitted to the qPCR-RT protocol (six clusters) for mouse oxidative stress and antioxidant defense pathways. On the 84 genes investigated, 64 (76.2%) had statistic significant expression and 20 (23.8%) showed no statistical difference to the control group. From these 64 significantly expressed genes, 60 (93.7%) were up-regulated and 04 (6.3%) were down-regulated. From the group with no statistical significantly expression, 12 genes were up-regulated and 8 genes were down-regulated. Surprisingly, 37 (44.04%) showed a higher than threefold up-regulation and then arbitrarily the values was considered as a very significant. Thus, 37 genes (44.04%) were expressed very significantly up-regulated. The remained 47 (55.9%) genes were up-regulated less than three folds (35 genes - 41.6%) or down-regulated less than three folds (12 genes - 14.3%). The intestinal ischemia and reperfusion promote a global hyper-expression profile of six different clusters genes related to antioxidant defense and oxidative stress.

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

Energy Technology Data Exchange (ETDEWEB)

Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen (Germany); Schneemann, Hubert [Institute of Pharmacy and Pharmaceutical Sciences, University Hospital Essen, Essen (Germany)

2004-03-01

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

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

International Nuclear Information System (INIS)

Ajaj, Waleed; Goehde, Susanne C.; Ruehm, Stefan G.; Debatin, Joerg F.; Lauenstein, Thomas C.; Schneemann, Hubert

2004-01-01

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

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

International Nuclear Information System (INIS)

Halteren, H.K. van; Gortzak, E.; Taal, B.G.; Helmerhorst, Th.J.M.; Aleman, B.M.P.; Hart, A.A.M.; Zoetmulder, F.A.N.

1993-01-01

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

Pathophysiology of the nodular and micronodular small bowel fold

International Nuclear Information System (INIS)

Olmstead, W.W.; Ros, P.R.; Moser, R.P.; Shekitka, K.M.; Lichtenstein, J.E.; Buck, J.L.

1987-01-01

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

Radiologic observations on pulmonary radiation injury

International Nuclear Information System (INIS)

Liang Yong

1992-01-01

Based on the data of pulmonary radiation injury in 16 cases, the relationship among the radiation dosage and field, the development and onset time of the pulmonary radiation injury were discussed, and the dynamic changes of pulmonary radiation injury in X-ray films were analysed. The author found that: (1) there was a close relationship between the development of radiation injury and radiation dosages and the size of radiation fields, i.e. for the large radiation field, a relatively small dosage was needed for developing radiation injury ; (2) most off acute radiation injury of the lungs appeared within one month of postirradiation therapy, and the chronic pulmonary fibrosis appeared at 4.23 months after radiation therapy, with a fibrosis rate of about 85.7% within a half year; (3) the clinical manifestations of pulmonary radiation injury were not parallel to the X-ray signs, namely the X-ray changes were more severe than clinical manifestations. On the basis of X-ray signs and the dynamic changes of pulmonary radiation injury, the differentiation of radiation injury from interstitial pulmonary metastasis, primary tumor, common pneumonia, and tumor recurrence after radiation therapy were discussed

An Intestinal Occlusion Device for Prevention of Small Bowel Distention During Transgastric Natural Orifice Transluminal Endoscopic Surgery

OpenAIRE

Tomasko, Jonathan M.; Mathew, Abraham; Moyer, Matthew T.; Haluck, Randy S.; Pauli, Eric M.

2013-01-01

Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subject...

Small bowel bacterial overgrowth

Science.gov (United States)

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

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

International Nuclear Information System (INIS)

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

2008-01-01

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

Arteriovenous Malformation Detected by Small Bowel Endoscopy

Directory of Open Access Journals (Sweden)

Takaaki Fujii

2014-10-01

Full Text Available Gastrointestinal bleeding that originates in the small intestine is often difficult to diagnose. When successful diagnosis reveals a lesion that can be localized preoperatively, the laparoscopic approach is an appropriate and beneficial treatment modality for small bowel resection. A 69-year-old man presented with a 6-month history of gastrointestinal bleeding and symptomatic transfusion-dependent anemia. Upper and lower endoscopy were normal. Double-balloon endoscopy established the source of the bleeding as a 0.5-cm polypoid mass appearing as a submucosal tumor with redness and pulsation in the lower ileum, suggesting a vascular lesion. Laparoscopic small bowel resection was successful in removing the mass in the ileum. Histological evaluation of the mass revealed an arteriovenous malformation. Preoperative small bowel endoscopy can be useful for diagnosing the cause and localization of arteriovenous malformation in the small intestine.

Late effects of radiation therapy on the gastrointestinal tract

International Nuclear Information System (INIS)

Coia, Lawrence R.; Myerson, Robert J.; Tepper, Joel E.

1995-01-01

Late gastrointestinal complications of radiation therapy have been recognized but not extensively studied. In this paper, the late effects of radiation on three gastrointestinal sites, the esophagus, the stomach, and the bowel, are described. Esophageal dysmotility and benign stricture following esophageal irradiation are predominantly a result of damage to the esophageal wall, although mucosal ulcerations also may persist following high-dose radiation. The major late morbidity following gastric irradiation is gastric ulceration caused by mucosal destruction. Late radiation injury to the bowel, which may result in bleeding, frequency, fistula formation, and, particularly in small bowel, obstruction, is caused by damage to the entire thickness of the bowel wall, and predisposing factors have been identified. For each site a description of the pathogenesis, clinical findings, and present management is offered. Simple and reproducible endpoint scales for late toxicity measurement were developed and are presented for each of the three gastrointestinal organs. Factors important in analyzing late complications and future considerations in evaluation and management of radiation-related gastrointestinal injury are discussed

Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure

Directory of Open Access Journals (Sweden)

Natalie Chen

2012-01-01

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

Small bowel volvulus with jejunal diverticulum: Primary or secondary?

Science.gov (United States)

Shen, Xiao-Fei; Guan, Wen-Xian; Cao, Ke; Wang, Hao; Du, Jun-Feng

2015-09-28

Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.

Small Bowel Obstruction Caused by Aloe vera Bezoars: A Case Report.

Science.gov (United States)

Hong, In Taik; Cha, Jae Myung; Ki, Hye Jin; Kwak, Min Seob; Yoon, Jin Young; Shin, Hyun Phil; Jeoun, Jung Won; Choi, Sung Il

2017-05-25

Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.

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

Energy Technology Data Exchange (ETDEWEB)

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

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.

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

International Nuclear Information System (INIS)

Maconi, G.; Radice, E.; Greco, S.; Bezzio, C.; Bianchi Porro, G.

2007-01-01

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

The impact of stoma for bowel management after spinal cord injury.

Science.gov (United States)

Coggrave, M J; Ingram, R M; Gardner, B P; Norton, C S

2012-11-01

Multi-centre, retrospective self-report postal survey. To characterise spinal cord injured (SCI) individuals with a stoma, their stoma management and outcomes, to identify sources of information and support for decision making and to explore the impact of a stoma on life satisfaction. Five UK spinal cord injury centres. A study-specific questionnaire accompanied by self-concept, life satisfaction and mood measures, and three simple rating scales for satisfaction, impact and restriction on life were sent to all known ostomates at five participating centres. Respondents were 92 individuals, mean age 56 years, mean duration of injury 26 years, 91% with colostomy. Multiple sources of information were utilised in deciding on surgery; discussion with other SCI ostomates was important. Duration of bowel care, faecal incontinence, bowel-related autonomic dysreflexia, dietary manipulation and laxative use were all significantly reduced following surgery. Rectal mucous discharge was the most common and bothersome post-stoma problem. Satisfaction with stoma was high; provision of sufficient information preoperatively was important, those with ileostomy were more dependent and less satisfied. Life satisfaction and physical self-concept were both lower in this sample than in previously reported samples of SCI individuals without reported bowel difficulties or stoma. The findings of this study of self-selected respondents with a stoma for bowel management after SCI emphasised the benefits of stoma in selected individuals and the importance of timely intervention, the complexity of the associated decision-making and of preoperative counselling. The impact of bowel dysfunction on physical self-concept warrants investigation.

Segmental small bowel necrosis associated with antiphospholipid syndrome: a case report.

Science.gov (United States)

Wang, Qun-Ying; Ye, Xiao-Hua; Ding, Jin; Wu, Xiao-Kang

2015-04-07

Antiphospholipid syndrome is a multi-system disease characterized by the formation of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. We report the case of a 50-year-old, previously healthy man who presented with fever and new-onset, dull abdominal pain. A contrast-enhanced computed tomography scan showed segmental small bowel obstruction, for which an emergency laparotomy was performed. Histopathologic examination of resected tissues revealed multiple intestinal and mesenteric thromboses of small vessels. Laboratory tests for serum antiphospholipid (anticardiolipin IgM) and anti-β2-glycoprotein I antibodies were positive. Despite proactive implementation of anticoagulation, steroid, and antibiotic therapies, the patient's condition rapidly deteriorated, and he died 22 d after admission. This case highlights that antiphospholipid syndrome should be suspected in patients with unexplainable ischemic bowel and intestinal necrosis presenting with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to implement timely treatments in order to ameliorate the disease course.

Radiographer performed single contrast small bowel enteroclysis

International Nuclear Information System (INIS)

Law, Robert L.; Slack, Nicola; Harvey, Richard F.

2005-01-01

Aim: To analyse the technical success and reporting sensitivity of radiographer performed small bowel enteroclysis (SBE) undertaken by a specialist radiographer according to a standard technique [Nolan DJ, Cadman PJ. The small bowel enema made easy. Clinical Radiology 1987;38(3):295-301]. Methods: Patients (1413) had 1646 SBE in 10 years from May 1992 to April 2002. The original request card and the separate radiographer and consultant radiologist reports were reviewed. Where the radiology reports were discordant or inconclusive, the clinical notes were also reviewed. Results: Patients (1022) X-ray films were available. Nine hundred and forty-three (93.3%) SBEs had been successfully completed. Radiographer and consultant radiologist reporting had a 99.3% concordance. There was a 98.4% sensitivity for Crohn's disease (181 of 184 cases where Crohn's disease was the clinical final diagnosis). Overall reporting sensitivity was 93.7% although correct 'probably normal and abnormal' reporting bias suggests a sensitivity of 96.9%. Sixty of 943 (6.4%) reports were inconclusive. Of 1022 patients, 68 (6.6%) of small bowel intubations were not achieved, or else consent was withdrawn at the time of the procedure. Conclusion: Specialist radiographers can perform small bowel enteroclysis with a reporting sensitivity equal to that of a consultant radiologist. Radiographers accustomed to providing an SBE service become skilled at passing fine bore feeding tubes into the small bowel and can provide this service also

Simvastatin Ameliorates Radiation Enteropathy Development After Localized, Fractionated Irradiation by a Protein C-Independent Mechanism

International Nuclear Information System (INIS)

Wang Junru; Boerma, Marjan; Fu Qiang; Kulkarni, Ashwini; Fink, Louis M.; Hauer-Jensen, Martin

2007-01-01

Purpose: Microvascular injury plays a key role in normal tissue radiation responses. Statins, in addition to their lipid-lowering effects, have vasculoprotective properties that may counteract some effects of radiation on normal tissues. We examined whether administration of simvastatin ameliorates intestinal radiation injury, and whether the effect depends on protein C activation. Methods and Materials: Rats received localized, fractionated small bowel irradiation. The animals were fed either regular chow or chow containing simvastatin from 2 weeks before irradiation until termination of the experiment. Groups of rats were euthanized at 2 weeks and 26 weeks for assessment of early and delayed radiation injury by quantitative histology, morphometry, and quantitative immunohistochemistry. Dependency on protein C activation was examined in thrombomodulin (TM) mutant mice with deficient ability to activate protein C. Results: Simvastatin administration was associated with lower radiation injury scores (p < 0.0001), improved mucosal preservation (p = 0.0009), and reduced thickening of the intestinal wall and subserosa (p = 0.008 and p = 0.004), neutrophil infiltration (p = 0.04), and accumulation of collagen I (p = 0.0003). The effect of simvastatin was consistently more pronounced for delayed than for early injury. Surprisingly, simvastatin reduced intestinal radiation injury in TM mutant mice, indicating that the enteroprotective effect of simvastatin after localized irradiation is unrelated to protein C activation. Conclusions: Simvastatin ameliorates the intestinal radiation response. The radioprotective effect of simvastatin after localized small bowel irradiation does not appear to be related to protein C activation. Statins should undergo clinical testing as a strategy to minimize side effects of radiation on the intestine and other normal tissues

CT findings of small bowel metastases from primary lung cancer

Energy Technology Data Exchange (ETDEWEB)

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

2002-11-01

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

CT findings of small bowel metastases from primary lung cancer

International Nuclear Information System (INIS)

Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu

2002-01-01

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

Small bowel endoscopy in familial adenomatous polyposis and Lynch syndrome

NARCIS (Netherlands)

Koornstra, Jan Jacob

Patients with familial adenomatous polyposis (FAP) and patients with Lynch syndrome have an increased risk of developing small intestinal neoplasia. In both conditions, the lifetime risk to develop small bowel cancer is estimated to be around 5%. In FAP, this risk is associated with the degree of

Circulating blocking factors of lymphoid-cell cytotoxicity in x-ray-induced rat small-bowel adenocarcinoma

International Nuclear Information System (INIS)

Stevens, R.H.; Brooks, G.P.; Osborne, J.W.

1979-01-01

Circulating blocking factors capable of abrogating cell-mediated immune responses measured by in vitro lymphoid-cell cytotoxicity were identified in the sera of Holtzman outbred rats 6 to 9 months after a single exposure of only the temporarily exteriorized, hypoxic ileum and jejunum to 1700 to 2000 R of X radiation. Such factors were found to exist in the serum of every animal exposed to the ionizing radiation regardless of whether a visibly identifiable small-bowel adenocarcinoma existed or subsequently would develop. Protection of cultured x-ray-induced rat small-bowel cancer cells from destruction by tumor-sensitized lymphoid cells as measured by the release of lactoperoxidase-catalyzed radioiodinated membrane proteins from the tumor target cells was conferred by the action of the blocking factors at both effector and target cell levels. The results of this study demonstrate that exposure of only the rat small intestine to ionizing radiation leads to elaboration of circulating factors identifiable several months postirradiation which will block cell-mediated immune responses directed against cancer cells developing in the exposed tissue

The pathophysiology of the nodular and micronodular small bowel fold

International Nuclear Information System (INIS)

Olmsted, W.W.; Ros, P.R.; Moser, R.P.; Shekita, K.M.; Lichtenstein, J.E.

1986-01-01

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

Pathophysiology of acute small bowel disease with CT correlation

International Nuclear Information System (INIS)

Sarwani, N.; Tappouni, R.; Tice, J.

2011-01-01

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

The radiolesions of the small bowel

International Nuclear Information System (INIS)

Bories-Azeau, A.; Dayan, L.

1980-01-01

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

The research progress of acute small bowel perforation

Directory of Open Access Journals (Sweden)

Rudolf Schiessel

2015-08-01

Full Text Available This article reviews the various aetiologies of small bowel perforations and their management. In addition to the well-known aetiologies such as trauma, inflammation and circulatory disorders, several new causes of small bowel perforation have been described in recent years. The spectrum reaches from iatrogenic perforations during laparoscopic surgery or enteroscopies to drug-induced perforations with new anticancer agents. The management of small bowel perforations requires a concept consisting of the safe revision of the leaking bowel and the treatment of the peritonitis. Depending on the local situation and the condition of the patient, several treatment options are available. The surgical management of the bowel leak can range from a simple primary closure to a delayed restoration of bowel continuity. When the condition of the bowel or patient is frail, the risk of a failure of a closure or anastomosis is too high, and the exteriorization of the bowel defect as a primary measure is a safe option. The treatment of the peritonitis is also dependent on the condition of the patient and the local situation. Early stages of peritonitis can be treated by a simple peritoneal lavage, either performed by laparoscopy or laparotomy. Severe forms of peritonitis with multi-organ failure and an abdominal compartment syndrome need repeated peritoneal revisions. In such cases, the abdomen can only be closed temporarily. Different technical options are available in order to overcome the difficult care of these patients.

Radiologic examination of the small bowel: 1987

International Nuclear Information System (INIS)

Carlson, H.C.; Maglinte, D.D.T.

1987-01-01

Effective clinical imaging of the small intestine is accomplished only with methods capable of accurately demonstrating bowel morphology. The two major approaches to barium enema examination of this segment of gut - orally and enteroclysis - will be described and illustrated with short videotape presentations. Pursued vigorously and with interest, both methods can yield excellent results in an efficient manner. Careful execution of the examination rather than use of a particular methodology is probably the most important factor in realizing such results. However, each method has its advantages and disadvantages, and these will be presented and discussed. A cursory small bowel examination has no role in modern medicine. Radiologists assume primary responsibility for the diagnostic evaluation of the small bowel and should strive to refine and advance the accuracy of the examination

Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction.

Directory of Open Access Journals (Sweden)

Xiaohang Li

Full Text Available Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features associated with small bowel volvulus and treatment and to identify risk factors for associated small bowel necrosis.Patients with small bowel volvulus who underwent operations from January 2001 to December 2015 at the First Affiliated Hospital of China Medical University (Shenyang, China were reviewed. Clinical, surgical and postsurgical data were registered and analyzed.Thirty-one patients were included for analysis. Fifteen patients were female (48.4%, with an average age of 47.7 years (18-79 years. The clinical signs and symptoms were unspecific and resembled intestinal obstruction. Clinical examination revealed abdominal distension and/or diffuse tenderness with or without signs of peritonitis. The use of CT scans, X-rays or ultrasound did not differ significantly between patients. In 9 of 20 patients that received abdominal CT scans, "whirlpool sign" on the CT scan was present. Secondary small bowel volvulus was present in 58.1% of patients, and causes included bands (3, adhesion (7, congenital anomalies (7 and stromal tumor (1. Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count (p<0.0001 and the presence of bloody ascites (p = 0.004. Three patients died of septic shock (9.68%, and the recurrence rate was 3.23%.To complete an early and accurate diagnosis, a CT scan plus physical exam seems to be the best plan. After diagnosis, an urgent laparotomy must be performed to avoid intestinal necrosis and perforation. After surgery, more than 90% of the patients can expect to have a favorable prognosis.

Diagnosis, treatment and prognosis of small bowel volvulus in adults: A monocentric summary of a rare small intestinal obstruction.

Science.gov (United States)

Li, Xiaohang; Zhang, Jialin; Li, Baifeng; Yi, Dehui; Zhang, Chengshuo; Sun, Ning; Lv, Wu; Jiao, Ao

2017-01-01

Small bowel volvulus is a rare disease, which is also challenging to diagnose. The aims of this study were to characterize the clinical and radiological features associated with small bowel volvulus and treatment and to identify risk factors for associated small bowel necrosis. Patients with small bowel volvulus who underwent operations from January 2001 to December 2015 at the First Affiliated Hospital of China Medical University (Shenyang, China) were reviewed. Clinical, surgical and postsurgical data were registered and analyzed. Thirty-one patients were included for analysis. Fifteen patients were female (48.4%), with an average age of 47.7 years (18-79 years). The clinical signs and symptoms were unspecific and resembled intestinal obstruction. Clinical examination revealed abdominal distension and/or diffuse tenderness with or without signs of peritonitis. The use of CT scans, X-rays or ultrasound did not differ significantly between patients. In 9 of 20 patients that received abdominal CT scans, "whirlpool sign" on the CT scan was present. Secondary small bowel volvulus was present in 58.1% of patients, and causes included bands (3), adhesion (7), congenital anomalies (7) and stromal tumor (1). Out of the 31 patients, 15 with gangrenous small bowel had to undergo intestinal resection. Intestinal gangrene was present with higher neutrophils count (p<0.0001) and the presence of bloody ascites (p = 0.004). Three patients died of septic shock (9.68%), and the recurrence rate was 3.23%. To complete an early and accurate diagnosis, a CT scan plus physical exam seems to be the best plan. After diagnosis, an urgent laparotomy must be performed to avoid intestinal necrosis and perforation. After surgery, more than 90% of the patients can expect to have a favorable prognosis.

Small bowel tissue engineering using small intestinal submucosa as a scaffold.

Science.gov (United States)

Chen, M K; Badylak, S F

2001-08-01

Small intestinal submucosa (SIS) is an extracellular matrix used in tissue engineering studies to create de novo abdominal wall, urinary bladder, tendons, blood vessels, and dura mater. The purpose of this study is to evaluate the feasibility of using SIS as a scaffold for small bowel regeneration in an in situ xenograft model. Twenty-three dogs had a partial defect created on the small bowel wall which was repaired with a SIS patch. Four dogs underwent small bowel resection with placement of an interposed tube of SIS. The animals were followed 2 weeks to 1 year. Three of the 23 dogs with SIS placed as a patch died shortly after surgery due to leakage from the site. The other 20 dogs survived up to time of elective necropsy with no evidence of intestinal dysfunction. At necropsy, the bowel circumference in the patched area had no stenosis. Histological evaluation showed the presence of a mucosal epithelial layer, varying amount of smooth muscle, sheets of collagen, and a serosal covering. Architecturally, the layers were not well organized in the submucosal region. An abundance of inflammatory cells was present in the early postoperative period but receded with time. All 4 dogs with a tubular segment of SIS interposed had significant problems. One had partial obstruction at 1 month, and 3 died in the early postoperative period due to leakage. This preliminary study suggests that SIS patches can be used for small bowel regeneration. Tubular segmental replacement is not feasible at this time. Copyright 2001 Academic Press.

Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life.

Science.gov (United States)

Pardee, Connie; Bricker, Diedre; Rundquist, Jeanine; MacRae, Christi; Tebben, Cherisse

2012-01-01

To investigate the association between characteristics of individuals with spinal cord injury and neurogenic bowel and their perceived quality of life. The study design is an exploratory, descriptive correlational design. To measure the variables of the study the Quality of Life Survey developed by Randell et al. (2001) was used to measure perceived quality of life related to bowel management. Individual bowel management preferences and subjective costs and benefits of the preferences were gathered through the Neurogenic Bowel Characteristics Survey. PARTICIPANTS/METHOD: Data were collected from a random half of the individuals who met the inclusion criteria from the patient database (n=1193). Two hundred and forty one surveys were analyzed for this study. More than half of the sample (n=134) provided their own bowel management consisting of digital stimulation, suppositories, and other aids; 8% (n=19) had a colostomy. Regardless of the bowel management program 54% (n=127) were satisfied with current methods. Although time reported to complete bowel programs ranged from 1 to 120 minutes, there was no difference in rating of satisfaction with time. There was a statistically significant difference between those satisfied and dissatisfied with current bowel management and quality of life; those satisfied demonstrated a higher quality of life on three subscales, work function (p= .021), bowel problems (p< .001), and social function (p< .001). Those dissatisfied with their bowel program perceived a lower quality of life and indicated problems of time (p= .001), pain or discomfort (p= .033), and poor results (p< .001). Research data provide the patient's perspective on bowel management characteristics, complications, satisfaction, and their perceived quality of life. Results of this research will be incorporated into bowel management education and possible modification of the current inpatient bowel management program. © 2012 Association of Rehabilitation Nurses.

Small Bowel Transplantation: Current Clinical Status

Directory of Open Access Journals (Sweden)

David Sigalet

1991-01-01

Full Text Available With recent refinements in immunosuppression techniques, the first successful reports of small bowel transplantation in humans have now been made, increasing interest in bowel transplantation among clinicians and patients alike. This article reviews recent developments in understanding of the functional capabilities and requirements for effective immune suppression in bowel transplantation. Both experimental and clinical experience with transplantation are discussed, as are the areas which appear to offer the most promise for future developments. Finally guidelines for consideration of patient selection for this procedure are reviewed.

Small bowel endoluminal imaging (capsule and enteroscopy).

Science.gov (United States)

Murino, Alberto; Despott, Edward J

2017-04-01

Over the last 16 years, the disruptive technologies of small bowel capsule endoscopy and device-assisted enteroscopy have revolutionised endoluminal imaging and minimally invasive therapy of the small bowel. Further technological developments continue to expand their indications and use. This brief review highlights the state-of-the-art in this arena and aims to summarise the current and potential future role of these technologies in clinical practice.

Primary small bowel anastomosis in generalised peritonitis

NARCIS (Netherlands)

deGraaf, JS; van Goor, Harry; Bleichrodt, RP

Objective: To find out if primary small bowel anastomosis of the bowel is safe in patients with generalised peritonitis who are treated by planned relaparotomies. Design: Retrospective study. Setting: University hospital, The Netherlands. Subjects. 10 Patients with generalised purulent peritonitis

Small-bowel neoplasms in patients undergoing video capsule endoscopy

DEFF Research Database (Denmark)

Rondonotti, E; Pennazio, M; Toth, E

2008-01-01

BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency......, clinical presentation, diagnostic/therapeutic work-up, and endoscopic appearance of small-bowel tumors in a large population of patients undergoing VCE. PATIENTS AND METHODS: Identification by a questionnaire of patients with VCE findings suggesting small-bowel tumors and histological confirmation...... of the neoplasm seen in 29 centers of 10 European Countries. RESULTS: Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm...

Axial torsion of meckel's diverticulum causing small bowel obstruction in adult: A case report

Energy Technology Data Exchange (ETDEWEB)

Youn, In Kyung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

2016-02-15

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is prevalent in 2–3% of the population. The lifetime risk of complications is estimated at 4%. Small bowel obstruction is the second most common complication of MD. Among the causes of bowel obstruction, axial torsion of MD is the rarest complication. Urgent surgical treatment is needed in cases of small bowel obstruction associated with torsion of MD. Pre-operative diagnosis of MD as a cause of small bowel obstruction is difficult, because the diagnosis can be made only if the diverticulum is delineated at the site of obstruction. We reported a case of axial torsion of MD with necrosis that caused proximal small bowel perforation in a 21 year old male.

US features of transient small bowel intussusception in pediatric patients

International Nuclear Information System (INIS)

Kim, Ji Hye

2004-01-01

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

International spinal cord injury bowel function basic data set (Version 2.0)

DEFF Research Database (Denmark)

Krogh, K; Emmanuel, A; Perrouin-Verbe, B

2017-01-01

: Working group appointed by the American Spinal injury association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: The draft prepared by the working group was reviewed by the International SCI Data Set Committee and later by members of the ISCoS Executive and Scientific Committees......STUDY DESIGN: International expert working group. OBJECTIVES: To revise the International Spinal Cord Injury (SCI) Bowel Function Basic Data Set as a standardized format for the collecting and reporting of a minimal amount of information on bowel function in clinical practice and research. SETTING...... and the ASIA board. The revised data set was posted on the ASIA and ISCoS websites for 1 month to allow further comments and suggestions. Changes resulting from a Delphi process among experts in children with SCI were included. Members of ISCoS Executive and Scientific Committees and the ASIA board made...

Treatment-time-dependence models of early and delayed radiation injury in rat small intestine

International Nuclear Information System (INIS)

Denham, James W.; Hauer-Jensen, Martin; Kron, Tomas; Langberg, Carl W.

2000-01-01

Background: The present study modeled data from a large series of experiments originally designed to investigate the influence of time, dose, and fractionation on early and late pathologic endpoints in rat small intestine after localized irradiation. The objective was to obtain satisfactory descriptions of the regenerative response to injury together with the possible relationships between early and late endpoints. Methods: Two- and 26-week pathologic radiation injury data in groups of Sprague-Dawley rats irradiated with 27 different fractionation schedules were modeled using the incomplete repair (IR) version of the linear-quadratic model with or without various time correction models. The following time correction models were tested: (1) No time correction; (2) A simple exponential (SE) regenerative response beginning at an arbitrary time after starting treatment; and (3) A bi-exponential response with its commencement linked to accumulated cellular depletion and fraction size (the 'intelligent response model' [INTR]). Goodness of fit of the various models was assessed by correlating the predicted biological effective dose for each dose group with the observed radiation injury score. Results: (1) The incomplete repair model without time correction did not provide a satisfactory description of either the 2- or 26-week data. (2) The models using SE time correction performed better, providing modest descriptions of the data. (3) The INTR model provided reasonable descriptions of both the 2- and 26-week data, confirming a treatment time dependence of both early and late pathological endpoints. (4) The most satisfactory descriptions of the data by the INTR model were obtained when the regenerative response was assumed to cease 2 weeks after irradiation rather than at the end of irradiation. A fraction-size-dependent delay of the regenerative response was also suggested in the best fitting models. (5) Late endpoints were associated with low-fractionation sensitivity

Consolidating duodenal and small bowel toxicity data via isoeffective dose calculations based on compiled clinical data.

Science.gov (United States)

Prior, Phillip; Tai, An; Erickson, Beth; Li, X Allen

2014-01-01

To consolidate duodenum and small bowel toxicity data from clinical studies with different dose fractionation schedules using the modified linear quadratic (MLQ) model. A methodology of adjusting the dose-volume (D,v) parameters to different levels of normal tissue complication probability (NTCP) was presented. A set of NTCP model parameters for duodenum toxicity were estimated by the χ(2) fitting method using literature-based tolerance dose and generalized equivalent uniform dose (gEUD) data. These model parameters were then used to convert (D,v) data into the isoeffective dose in 2 Gy per fraction, (D(MLQED2),v) and convert these parameters to an isoeffective dose at another NTCP (D(MLQED2'),v). The literature search yielded 5 reports useful in making estimates of duodenum and small bowel toxicity. The NTCP model parameters were found to be TD50(1)(model) = 60.9 ± 7.9 Gy, m = 0.21 ± 0.05, and δ = 0.09 ± 0.03 Gy(-1). Isoeffective dose calculations and toxicity rates associated with hypofractionated radiation therapy reports were found to be consistent with clinical data having different fractionation schedules. Values of (D(MLQED2'),v) between different NTCP levels remain consistent over a range of 5%-20%. MLQ-based isoeffective calculations of dose-response data corresponding to grade ≥2 duodenum toxicity were found to be consistent with one another within the calculation uncertainty. The (D(MLQED2),v) data could be used to determine duodenum and small bowel dose-volume constraints for new dose escalation strategies. Copyright © 2014 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

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

International Nuclear Information System (INIS)

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

2015-01-01

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

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.

Science.gov (United States)

Urgesi, R; Cianci, R; Bizzotto, A; Costamagna, G; Riccioni, M E

2013-05-01

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. 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. Thirty coeliac untreated patients and 30 age-, sex- and BMI-matched healthy controls underwent CE assessment of whole gut transit times. 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). 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.

Radiologic findings of small bowel rupture due to blunt abdominal trauma

International Nuclear Information System (INIS)

Ha, Hyeon Kweun; Bahk, Yong Whee

1987-01-01

Bowel rupture due to blunt abdominal trauma is no longer rare, and is among the most challenging problems that confront the physicians and radiologists. It is frequently difficult to diagnose because the symptoms may be trivial during the early stage and masked by more obvious, but less lethal injuries. It is well known that the roentgen examination of the abdomen is also of little value to exclude bowel rupture because of infrequency of positive findings and free gas. The plain films of 23 cases of jejunal rupture and 8 cases of ileal rupture were evaluated to sort and diagnostic features of small bowel rupture caused by blunt abdominal trauma. 1. Free intraperitoneal gas was noted in 6 cases of jejunal rupture (26%) and 1 case of ileal rupture (13%), and definite radiological evidence of free intraperitoneal fluid was present in 16 cases of patients (52%). 2. The contour change of bowel loops such as tapering or indentation were seen in 11 cases of patients (36%), and local opacity along the mesenteric root axis was demonstrated in 19 cases of patients (61%). 3. Paralytic ileus was localized to LUQ in jejunal rupture and to mid-abdomen in ileal rupture, and gastric and transverse-colon distension with gas was noticeable especially in jejunal rupture

Historical analysis of experience with small bowel capsule endoscopy in a spanish tertiary hospital.

Science.gov (United States)

Egea Valenzuela, Juan; Carrilero Zaragoza, Gabriel; Iglesias Jorquera, Elena; Tomás Pujante, Paula; Alberca de Las Parras, Fernando; Carballo Álvarez, Fernando

2017-02-01

Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004. We retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies. A total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group «other indications». No major complications were reported. Small bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease. Our experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

Abnormalities of small bowel and colon in systemic sclerosis

International Nuclear Information System (INIS)

Scutellari, P.N.; Cinotti, A.; Cavallari, L.; Orzincolo, C.; Dovigo, L.; Trotta, F.; Menegale, G.

1990-01-01

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

Small bowel ultrasound in patients with celiac disease

Energy Technology Data Exchange (ETDEWEB)

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

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.

Small bowel ultrasound in patients with celiac disease

International Nuclear Information System (INIS)

Bartusek, D.; Valek, V.; Husty, J.; Uteseny, J.

2007-01-01

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

[Volvulus of the small bowel due to ascaris lumbricoides package: about a case].

Science.gov (United States)

Diouf, Cheikh; Kane, Ahmed; Ndoye, Ndeye Aby; Ndour, Oumar; Faye-Fall, Aimé Lakh; Fall, Mbaye; Alumeti, Désiré Munyali; Ngom, Gabriel

2016-01-01

We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

Directory of Open Access Journals (Sweden)

Barbara Monard

2017-01-01

Full Text Available Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome.

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

Science.gov (United States)

Mottet, Nicolas; Ramanah, Rajeev; Riethmuller, Didier

2017-01-01

Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome. PMID:29230337

Small Bowel Obstruction due to Intestinal Xanthomatosis

Directory of Open Access Journals (Sweden)

L. E. Barrera-Herrera

2015-01-01

Full Text Available Vast majority of bowel obstruction is due to postoperative adhesions, malignancy, intestinal inflammatory disease, and hernias; however, knowledge of other uncommon causes is critical to establish a prompt treatment and decrease mortality. Xanthomatosis is produced by accumulation of cholesterol-rich foamy macrophages. Intestinal xanthomatosis is an uncommon nonneoplastic lesion that may cause small bowel obstruction and several cases have been reported in the English literature as obstruction in the jejunum. We report a case of small intestinal xanthomatosis occurring in a 51-year-old female who presented with one day of copious vomiting and intermittent abdominal pain. Radiologic images revealed jejunal loop thickening and inflammatory changes suggestive of foreign body obstruction, diagnostic laparoscopy found two strictures at the jejunum, and a pathologic examination confirmed a segmental small bowel xanthomatosis. This case illustrates that obstruction even without predisposing factors such as hyperlipidemia or lymphoproliferative disorders.

Surgical treatment of bowel occlusion as late radiation effect

International Nuclear Information System (INIS)

Moeschl, P.; Miholic, J.; Wolner, E.

1989-01-01

67 patients were operated for intestinal complications following radiotherapy. The lesions were located in the small bowel (n = 41) and in the sigmoid colon/rectum (n = 33). 98.5% of the patients were females, the most frequent cause for irradiation being ovarian cancer. Bowel stenosis with resultant chronic or acute ileus was the most frequent indication for operation. Percutaneous irradiation resulted in a significantly higher proportion of small bowel lesions (77%, p = 0.001), whilst endocavitary irradiation was followed in 67% of cases by colorectal lesions. Different application modality of irradiation also resulted in completely different symptoms for small and large bowel lesions. The operative mortality was 9.5%. Peritonitis following anastomotic leakage was the cause of death in 6 of 7 cases. In the treatment of small bowel ileus mortality following bowel resection (9%, one of 11 cases) was comparable to that of the bypass operation (6%, one of 18 cases). Both operation methods seem to be justified. Single-layer anastomosis resulted in zero mortality (21 cases) for ileus operation compared with 19% mortality (16 cases) in double-layer anastomosis and should be prefered for operations on the irradiated bowel. (author)

Has the incidence of radiation-induced bowel damage following treatment of uterine carcinoma changed in the last 20 years

International Nuclear Information System (INIS)

Allen-Mersh, T.C.; Wilson, E.J.; Hope-Stone, H.F.; Mann, C.V.

1986-01-01

Radiation-induced bowel damage occurred in 4.3% of patients treated primarily by irradiation for uterine carcinoma during the period 1962-1982. There has been a progressive rise in the incidence of radiation damage and radiation-induced rectovaginal fistula during this 20-year period. Radiation from intracavitary sources was a contributory factor in 92% of injured cases. The rising incidence of bowel damage in our patients may be due to an increase in the number of patients receiving a high rectal dose from the intracavitary source. There was a significantly (P<0.01) higher incidence of radiation injury in cases of cervical carcinoma compared to endometrical carcinoma. This was because cervical carcinoma tended to present at a more advanced stage than endometrial carcinoma and was more frequently treated with combined external and intracavitary irradiation. There was no significant increase in the incidence of complications among patients undergoing hysterectomy. (author)

Orazipone, a locally acting immunomodulator, ameliorates intestinal radiation injury: A preclinical study in a novel rat model

International Nuclear Information System (INIS)

Boerma, Marjan; Wang, Junru; Richter, Konrad K.; Hauer-Jensen, Martin

2006-01-01

Purpose: Intestinal radiation injury (radiation enteropathy) is relevant to cancer treatment, as well as to radiation accidents and radiation terrorism scenarios. This study assessed the protective efficacy of orazipone, a locally-acting small molecule immunomodulator. Methods and Materials: Male rats were orchiectomized, a 4-cm segment of small bowel was sutured to the inside of the scrotum, a proximal anteperistaltic ileostomy was created for intraluminal drug administration, and intestinal continuity was re-established by end-to-side anastomosis. After three weeks postoperative recovery, the intestine in the 'scrotal hernia' was exposed locally to single-dose or fractionated X-radiation. Orazipone (30 mg/kg/day) or vehicle was administered daily through the ileostomy, either during and after irradiation, or only after irradiation. Structural, cellular, and molecular aspects of intestinal radiation toxicity were assessed two weeks after irradiation. Results: Orazipone significantly ameliorated histologic injury and transforming growth factor-β immunoreactivity levels, both after single-dose and fractionated irradiation. Intestinal wall thickness was significantly reduced after single-dose and nonsignificantly after fractionated irradiation. Mucosal surface area and numbers of mast cells were partially restored by orazipone after single-dose irradiation. Conclusions: This work (1) demonstrates the utility of the ileostomy rat model for intraluminal administration of response modifiers in single-dose and fractionated radiation studies; (2) shows that mucosal immunomodulation during and/or after irradiation ameliorates intestinal toxicity; and (3) highlights important differences between single-dose and fractionated radiation regimens

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

Directory of Open Access Journals (Sweden)

Hiroaki Shiba

2009-11-01

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

Relation between radiation-induced tissue injury and its carcinogenesis of the rat small intestine

Energy Technology Data Exchange (ETDEWEB)

Tsubouchi, S [Aichi Cancer Center, Nagoya (Japan). Research Inst.; Matsuzawa, T

1975-06-01

This study was undertaken to make clear the relationships between radiation-induced tissue injury and its carcinogenesis in the rat small intestine. The abdomens of Wistar rats were irradiated locally with 1000 to 2000 rads. Approximately 2 months following irradiation, visible nodules were found in the intestines of the groups receiving irradiation. Nodule incidence was 80 to 100% in groups that received 1750 or 2000 rads, 50% in the 1500-rad groups, and 3% in the 1000-rad groups, respectively. The histology of the nodules within 70 days postirradiation, revealed adenomatous hyperplasia, including invasion of submucosa, muscle layers, and serosa of the small intestine accompanied by an area of fibrous tissue resulting from desmoplastic reaction by irradiation injury. The nodule within 140 to 300 days postirradiation induced advanced tissue injuried, that is, a polypoid lesion in histology and intestinal nodular adhesion in macroscopic anatomy. Running parallel with the advance of the above mentioned tissue injuries, the nodules in 3 out of 18 rat during 200 to 300 days postirradiation showed mucoid adenocarcinoma.

Relation between radiation-induced tissue injury and its carcinogenesis of the rat small intestine

International Nuclear Information System (INIS)

Tsubouchi, Susumu; Matsuzawa, Taiju.

1975-01-01

This study was undertaken to make clear the relationships between radiation-induced tissue injury and its carcinogenesis in the rat small intestine. The abdomens of Wistar rats were irradiated locally with 1000 to 2000 rads. Approximately 2 months following irradiation, visible nodules were found in the intestines of the groups receiving irradiation. Nodule incidence was 80 to 100% in groups that received 1750 or 2000 rads, 50% in the 1500-rad groups, and 3% in the 1000-rad groups, respectively. The histology of the nodules within 70 days postirradiation, revealed adenomatous hyperplasia, including invasion of submucosa, muscle layers, and serosa of the small intestine accompanied by an area of fibrous tissue resulting from desmoplastic reaction by irradiation injury. The nodule within 140-300 days postirradiation induced advanced tissue injuried, that is, a polypoid lesion in histology and intestinal nodular adhesion in macroscopic anatomy. Running parallel with the advance of the above mentioned tissue injuries, the nodules in 3 out of 18 rat during 200-300 days postirradiation showed mucoid adenocarcinoma. (author)

A case of small bowel injury induced by preoperative irradiation for rectal carcinoma

International Nuclear Information System (INIS)

Tanaka, Takayuki; Noguchi, Tomoyoshi; Akimoto, Shin

1988-01-01

A 54-year-old man underwent anterior resection with intraoperative radiation following preoperative irradiation for carcinoma of the rectum in August 1984, and subsequently was suffering from severe diarrhea and abdominal pain. One year and two months later he was admitted to our hospital with a sudden onset of lower abdominal pain, nausea and vomitting. The symptoms were so severe that emergency laparotomy was performed. There was no evidence of recurrent tumor, but the terminal ileum, from a point 30 cm. proximal to the cecum was found to be dark red, constricted and fixed to the urinary bladder. In addition, another two parts of the ileum from a point 50 cm. to that segment showed dark red. These damaged ileum were resected. Pathological examination revealed that there was thickness of the endothelium of arteriole and thromboses of the venule and mucosal damage (ie, ulceration, necroses). These vascular changes had resulted in radiation enteritis induced by preoperative radiotherapy. After the operation severe diarrhea continued until March 1986, when the granning diarrhea and pain became unbearable. At reoperation, another part of ileum was found to be dark red and constricted. There was a recurrent episode of radiation injury of small intestine. We report this case for the recognition of high-risk clinical factors and attention to careful selection or preparation of the patients with cancer for radiotherapy. (author)

Microscopic polyangiitis: Atypical presentation with extensive small bowel necrosis, diffuse alveolar hemorrhage, and renal failure

Directory of Open Access Journals (Sweden)

Justin M. Segraves, M.D.

2017-01-01

Full Text Available Microscopic polyangiitis is an uncommon systemic vasculitis of varying severity that is associated with myeloperoxidase (MPO and perinuclear antineutrophil cytoplasmic (p-ANCA antibodies. The most commonly affected organs are the lungs and kidneys. We report on a very unusual case of microscopic polyangiitis presenting with severe mesenteric ischemia in addition to diffuse alveolar hemorrhage and acute renal failure. The patient was initially diagnosed with acute pancreatitis at an outside facility given his severe abdominal pain and elevated pancreatic enzymes. Further investigations after transfer to our facility determined that the patient was actually suffering from a severe exacerbation of previously diagnosed microscopic polyangiitis. He quickly developed diffuse alveolar hemorrhage (DAH necessitating intubation and acute kidney injury (AKI requiring dialysis. He subsequently developed mesenteric ischemia and bowel necrosis resulting in emergent laparotomy and extensive small bowel resection. Physicians need to be aware that microscopic polyangiitis can very rarely present with severe involvement of the abdominal viscera and mesenteric vessels. Severe disease necessitates the use of high dose IV steroids, rituximab or cyclophosphamide, and plasma exchange (PLEX.

Microscopic polyangiitis: Atypical presentation with extensive small bowel necrosis, diffuse alveolar hemorrhage, and renal failure.

Science.gov (United States)

Segraves, Justin M; Iyer, Vivek N

2017-01-01

Microscopic polyangiitis is an uncommon systemic vasculitis of varying severity that is associated with myeloperoxidase (MPO) and perinuclear antineutrophil cytoplasmic (p-ANCA) antibodies. The most commonly affected organs are the lungs and kidneys. We report on a very unusual case of microscopic polyangiitis presenting with severe mesenteric ischemia in addition to diffuse alveolar hemorrhage and acute renal failure. The patient was initially diagnosed with acute pancreatitis at an outside facility given his severe abdominal pain and elevated pancreatic enzymes. Further investigations after transfer to our facility determined that the patient was actually suffering from a severe exacerbation of previously diagnosed microscopic polyangiitis. He quickly developed diffuse alveolar hemorrhage (DAH) necessitating intubation and acute kidney injury (AKI) requiring dialysis. He subsequently developed mesenteric ischemia and bowel necrosis resulting in emergent laparotomy and extensive small bowel resection. Physicians need to be aware that microscopic polyangiitis can very rarely present with severe involvement of the abdominal viscera and mesenteric vessels. Severe disease necessitates the use of high dose IV steroids, rituximab or cyclophosphamide, and plasma exchange (PLEX).

Work related injuries and associated factors among small scale ...

African Journals Online (AJOL)

Objective: This study aims to assess the magnitude of work related injury and associated factors among small scale industrial workers in Mizan-Aman town, Bench Maji Zone, Southwest Ethiopia. Method: A cross-sectional study design was conducted from February to May, 2016. Data was collected using a structured face to ...

Extensive small bowel intramural haematoma secondary to warfarin

OpenAIRE

Limmer, Alexandra M.; Clement, Zackariah

2017-01-01

Abstract Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in? 1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was ...

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

International Nuclear Information System (INIS)

Lee, Young Cheol; Kim, Young Tong; Bae, Won Kyung; Kim, Il Young

2007-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2007-12-15

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

SU-C-BRA-01: Interactive Auto-Segmentation for Bowel in Online Adaptive MRI-Guided Radiation Therapy by Using a Multi-Region Labeling Algorithm

International Nuclear Information System (INIS)

Lu, Y; Chen, I; Kashani, R; Wan, H; Maughan, N; Muccigrosso, D; Parikh, P

2016-01-01

Purpose: In MRI-guided online adaptive radiation therapy, re-contouring of bowel is time-consuming and can impact the overall time of patients on table. The study aims to auto-segment bowel on volumetric MR images by using an interactive multi-region labeling algorithm. Methods: 5 Patients with locally advanced pancreatic cancer underwent fractionated radiotherapy (18–25 fractions each, total 118 fractions) on an MRI-guided radiation therapy system with a 0.35 Tesla magnet and three Co-60 sources. At each fraction, a volumetric MR image of the patient was acquired when the patient was in the treatment position. An interactive two-dimensional multi-region labeling technique based on graph cut solver was applied on several typical MRI images to segment the large bowel and small bowel, followed by a shape based contour interpolation for generating entire bowel contours along all image slices. The resulted contours were compared with the physician’s manual contouring by using metrics of Dice coefficient and Hausdorff distance. Results: Image data sets from the first 5 fractions of each patient were selected (total of 25 image data sets) for the segmentation test. The algorithm segmented the large and small bowel effectively and efficiently. All bowel segments were successfully identified, auto-contoured and matched with manual contours. The time cost by the algorithm for each image slice was within 30 seconds. For large bowel, the calculated Dice coefficients and Hausdorff distances (mean±std) were 0.77±0.07 and 13.13±5.01mm, respectively; for small bowel, the corresponding metrics were 0.73±0.08and 14.15±4.72mm, respectively. Conclusion: The preliminary results demonstrated the potential of the proposed algorithm in auto-segmenting large and small bowel on low field MRI images in MRI-guided adaptive radiation therapy. Further work will be focused on improving its segmentation accuracy and lessening human interaction.

SU-C-BRA-01: Interactive Auto-Segmentation for Bowel in Online Adaptive MRI-Guided Radiation Therapy by Using a Multi-Region Labeling Algorithm

Energy Technology Data Exchange (ETDEWEB)

Lu, Y; Chen, I; Kashani, R; Wan, H; Maughan, N; Muccigrosso, D; Parikh, P [Washington University School of Medicine, Saint Louis, MO (United States)

2016-06-15

Purpose: In MRI-guided online adaptive radiation therapy, re-contouring of bowel is time-consuming and can impact the overall time of patients on table. The study aims to auto-segment bowel on volumetric MR images by using an interactive multi-region labeling algorithm. Methods: 5 Patients with locally advanced pancreatic cancer underwent fractionated radiotherapy (18–25 fractions each, total 118 fractions) on an MRI-guided radiation therapy system with a 0.35 Tesla magnet and three Co-60 sources. At each fraction, a volumetric MR image of the patient was acquired when the patient was in the treatment position. An interactive two-dimensional multi-region labeling technique based on graph cut solver was applied on several typical MRI images to segment the large bowel and small bowel, followed by a shape based contour interpolation for generating entire bowel contours along all image slices. The resulted contours were compared with the physician’s manual contouring by using metrics of Dice coefficient and Hausdorff distance. Results: Image data sets from the first 5 fractions of each patient were selected (total of 25 image data sets) for the segmentation test. The algorithm segmented the large and small bowel effectively and efficiently. All bowel segments were successfully identified, auto-contoured and matched with manual contours. The time cost by the algorithm for each image slice was within 30 seconds. For large bowel, the calculated Dice coefficients and Hausdorff distances (mean±std) were 0.77±0.07 and 13.13±5.01mm, respectively; for small bowel, the corresponding metrics were 0.73±0.08and 14.15±4.72mm, respectively. Conclusion: The preliminary results demonstrated the potential of the proposed algorithm in auto-segmenting large and small bowel on low field MRI images in MRI-guided adaptive radiation therapy. Further work will be focused on improving its segmentation accuracy and lessening human interaction.

Modern MRI of the small bowell; Moderne MRT des Duenndarms

Energy Technology Data Exchange (ETDEWEB)

Scharitzer, M.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

2015-12-15

The radiological diagnostics of diseases of the small intestine have undergone a great change in the last two decades. Through rapid progress with new treatments and an increasing therapeutic focus on transmural healing, a complete evaluation of the gastrointestinal tract is now crucial. With the introduction of endoscopy, gastrointestinal imaging with a relatively high radiation exposure had only limited applications. The development of cross-sectional imaging allowed a much broader radiological evaluation of abdominal diseases. Due to rapid investigation techniques, excellent soft tissue contrast and the distinct advantage of eliminating exposure to radiation, magnetic resonance imaging (MRI) of the gastrointestinal tract has gained increasing importance. With sufficient filling of the intestinal lumen, simultaneous imaging of all the intestinal wall layers, the perienteric structures and associated abdominal pathologies is now possible. New MR sequences, such as diffusion-weighted sequences, dynamic contrast-enhanced sequences and MR fluoroscopy, enable the detection of morphological changes, with additional characterization of affected bowel loops as well as the assessment of functional pathologies with dynamic information about intestinal motility disturbances. Recent guidelines of European radiological and gastroenterological organizations have confirmed the importance of cross-sectional imaging and particularly of MRI for diagnostics and follow-up in patients with Crohn's disease. Due to the possibility of assessment of all the layers of the intestinal wall and the presence of extramural complications, MRI has a significant impact on further therapeutic treatment in patients with inflammatory bowel disease. Especially in patients with inflammatory bowel disease, MR enterography and MR enteroclysis should be the methods of choice for the evaluation of small bowel pathologies because of radiation issues and the great diagnostic value they provide. A

Central nervous system radiation injury in small animal models

International Nuclear Information System (INIS)

Kogel, A.J. van der

1991-01-01

Experimental studies on radiation injury in the central nervous system have been carried out in many species ranging from mouse to monkey. This review is restricted to studies in rodents irradiated with low linear energy transfer (LET) radiation. In this paper, the various rodent models of brain and spinal cord injury are described with particular emphasis on the pathology of different types of lesions and theories of their pathogenesis. Many of the initial studies were limited to relatively high single doses, but in later work more clinically relevant fractionated irradiation schemes were employed. This has led to the recognition of various types of early and late delayed injury that are analogous to the syndromes observed in humans. Two main pathways have been suggested for the pathogenesis, one involving predominantly the progressive loss of glial cells and the other involving vascular injury. The relative importance of both mechanisms will be discussed with respect to treatment conditions and to dose level in particular. An hypothesis is presented concerning the possible role of different cell types in the development of specific syndromes

Scintigraphic pattern of small bowel bleeding

International Nuclear Information System (INIS)

Anshu Rajnish Sharma; Charan, S.; Silva, I.

2004-01-01

Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

Portal venous air in an adult patient with obstructive small bowel volvulus

NARCIS (Netherlands)

Tan, ECTH; Jager, GJ; Bleeker, WA; van Goor, Harry

2002-01-01

Background. Diagnosis of small bowel volvulus is frequently delayed often resulting in bowel ischaemia and infarction and impairing clinical outcome. Instant and correct diagnosis and subsequent adequate surgery may improve the outcome. Methods: We describe a 19-year-old female with small bowel

Gastrointestinal Motility, Part 2: Small-Bowel and Colon Transit.

Science.gov (United States)

Maurer, Alan H

2016-03-01

Because of the difficulty often encountered in deciding whether a patient's symptoms originate in the upper or lower gastrointestinal tract, gastrointestinal transit scintigraphy is a uniquely suited noninvasive, quantitative, and physiologic method of determining whether there is a motility disorder affecting the stomach, small bowel, or colon. Small-bowel and colon transit studies can be performed alone or together with gastric emptying studies after oral administration of an appropriately radiolabeled meal. It is hoped that newly published standards for performing these studies and the anticipated arrival of new Current Procedural Terminology codes in the United States for small-bowel and colon transit studies will increase their availability and use. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Extensive small bowel intramural haematoma secondary to warfarin.

Science.gov (United States)

Limmer, Alexandra M; Clement, Zackariah

2017-03-01

Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in  1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was successfully managed non-operatively with fluid resuscitation, INR reversal, bowel rest and nasogastric decompression. The patient's presentation was atypical with a lack of classic symptoms such as abdominal pain. This highlights the importance of considering intramural haematoma as a differential diagnosis for gastrointestinal symptoms in anticoagulated patients.

Open table-top device positioning technique to reduce small bowel obstruction. Positioning accuracy and impact on conformal radiation therapy techniques

International Nuclear Information System (INIS)

Rudat, V.; Flentje, M.; Engenhart, R.; Metzger, M.; Wannenmacher, M.

1995-01-01

The immobilization error of patients positioned on the opern table-top device in prone prosition as well as the movement of the small bowel out of the pelvis by this positioning technique was determined. The positioning error is of special importance for the 3-dimensional treatment planning for conformal radiotherapy. The positioning error was determined by superposing 106 portal films with the corresponding simultor films from 21 patients with carcinoma of the rectum who received 3D-planned conformal radiotherapy (o-field technique with irregular blocks). The movement of the small bowel out of the pelvis was studied by comparing simulator films after barium swallow in supine and open table-top position as well with 3D-treatment plans of the same patient in both positions in 3 cases. The positioning error along the medio-lateral, dorso-ventral und cranio-caudal axis was 1.4/-0.6/1.8 mm and the standard deviation 4.4/6.8/6.3 mm, respectively. In comparison to the supine position more rotation errors in the sagittal view were observed (37% and 9% respectively) with a media of 5.1 . Six out of 22 patients showed no adhesions of the small bowel and a complete movement out of the tratment field was achieved. 14 out of 16 Patients with adhesions revealed a partial movement of the small bowel out of the treatment field. Comparing 3D-treatment plans in both positions again demonstrated a marked reduction of the irradiated small bowel volume with the use of the open table-top decive. (orig.) [de

Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease

Institute of Scientific and Technical Information of China (English)

Richard A Awad

2011-01-01

Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel

Small bowel perforation due to fish bone: A case report

Directory of Open Access Journals (Sweden)

Huseyin Pulat

2015-09-01

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

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

Directory of Open Access Journals (Sweden)

H. Hoffmann

2010-01-01

Full Text Available Blunt traumatic diaphragmatic rupture (BTDR is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

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

International Nuclear Information System (INIS)

Alexopoulou, Efthymia; Loggitsi, Dimitra; Economopoulos, Nikos; Papakonstantinou, Olympia; Kelekis, Nikolaos L.; Roma, Eleftheria; Panagiotou, Ioanna; Pahoula, Ioanna

2009-01-01

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 Τ2-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.)

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

Energy Technology Data Exchange (ETDEWEB)

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

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.)

Rapunzel Syndrome: a rare cause of acute small bowel obstruction ...

African Journals Online (AJOL)

The Rapunzel syndrome is a very rare condition where trichobezoar has extended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was ...

Small-bowel carcinoid with no liver metastases.

Science.gov (United States)

Juniku-Shkololli, Argjira; Haziri, Adem

2009-01-01

Carcinoid is a slowly-growing tumor from the group of neuroendocrine or APUD tumors. Characteristic of these tumors is the production of biogene amins & polypeptide hormones. 90% of all carcinoids are located in the GI system. A female patient, 68 years old, comes for a visit with signs of diffuse abdominal pain, diarrhea, irregular bowel movements, weakness, dyspnea and pretibial edemas. The gastroenterologist gives her only symptomatic therapy at first, and starts the examinations after her hospitalization (initial dg: Enterocolitis). One month later she visits again with the same complains. CT scan result shows steatosis hepatica and lots of liquids in the small bowel and colon. She underwent operation--resection of 20 cm of the small bowel with tumor masses and part-time ileostoma. The biopsy of the resected segment of the bowel shows multiple carcinoids. Our patient had no flushing of the skin and therefore couldn't be suspected clinically for this diagnosis. The intestinal carcinoid does not usually produce the carcionid syndrome unless hepatic metastases have occurred. The infiltration of the mesentery provokes an intense fibrotic reaction resulting in kinking of the bowel segments, which causes intestinal obstruction as it happened in this patient. As long as in our clinic we don't have this technique, it is much harder to make an early diagnosis. Fortunately our patient was diagnosed before liver metastases occurred, and therefore her treatment was successful.

Strangulated small bowel gangrene due to torsioned gangrenous appendix in an old man: a case report

Directory of Open Access Journals (Sweden)

Ardavan Shahbazi

2016-11-01

Full Text Available Background: Torsion of the appendix is a rare entity and divided into two categories: primary and secondary. The primary mode is due to an abnormality in either appendix anatomy or its meso or both and is more common in children. The secondary forms happen in adults which can be associated with appendiceal tumor, appendiceal mucocele, fecal impaction, volvulus of ovarian cyctadenoma. Adynamic small bowel obstruction or ileus is seen frequently with all forms of peritoneal inflammation. However, Anatomical small intestinal obstruction or gangrene due to torsioned appendix is a rare condition and few cases reported in the literature. Method: Here we have a 83-year-old man patient with small bowel obstruction and localized right lower quadrant peritonitis who undergo emergency laparotomy to eliminate small bowel obstruction and peritonitis. Preoperative abdominal radiography showed multiple dilated small bowel loops with empty colon. Results: During exploration necrosis of the terminal 40cm of the ileum due to a twisted and gangrenous appendix was discovered. Other parts were normal. Conclusion: it may be useful to recommend early midline exploratory laparotomy for patients with small bowel obstruction even in the presence symptoms of local appendicitis. This operation can be both diagnostic and therapeutic.

Bowel function and quality of life after colostomy in individuals with spinal cord injury

DEFF Research Database (Denmark)

Bølling Hansen, Rikke; Staun, Michael; Kalhauge, Anna

2016-01-01

OBJECTIVE: To evaluate the effect of colostomy on bowel function and quality of life (QoL) in individuals with spinal cord injury (SCI). DESIGN: Cross-sectional descriptive study. SETTING: Department for Spinal Cord Injuries and Departments of Gastroenterology and Radiology, Rigshospitalet....... PARTICIPANTS: Eighteen individuals with SCI and a colostomy performed post injury, 12 males, 6 females, 8 with tetraplegia and 10 with paraplegia. Median age at time of study was 49.9 years, years since lesion was 3-56 years, and time since colostomy was performed 0.5 to 20 years. INTERVENTIONS: Questionnaires...... and measurement of gastrointestinal transit time (GITT). OUTCOME MEASURES: Retrospective data collection from patient records, a questionnaire on bowel management pre and post colostomy, quality of life (QoL) by SF-36, and GITT. RESULTS: Seventy-two percent significantly reduced their use of time on bowel...

A combination of small bowel imaging methods: conventional enteroclysis with complementary magnetic resonance enteroclysis

Energy Technology Data Exchange (ETDEWEB)

Akman, C. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Korman, U. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey)]. E-mail: ugurk9@istanbul.edu.tr; Oguet, G. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Kurugoglu, S. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Urger, E. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Ulus, S. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Esen, G. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Tasci, I. [Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey)

2005-07-01

AIM: The aim of this prospective study was to evaluate the overall findings of conventional enteroclysis (CE) with complementary magnetic resonance enteroclysis (MRE) in small bowel disease. METHODS: The study included 32 patients referred from various clinical departments, with known or suspected small bowel disease and abnormalities on CE. Immediately after CE, true fast imaging with steady-state precession (true FISP), and unenhanced and gadolinium-enhanced T1-weighted fast low-angle shot (FLASH) sequences with fat saturation were obtained. Mucosal, mural and luminal changes of the small bowel were evaluated by each technique. In addition, bowel wall thickening, bowel wall enhancement and perienteric changes were assessed by MRE. The radiological findings obtained were evaluated together as a combination, and the role of MRE in the determination of the activity and complications of the small bowel disease was assessed. Radiological findings were correlated with clinical evaluation and follow-up in all cases, including endoscopy in 14 cases and surgery in 5 cases. RESULTS: MRE provided important supplementary mural and extramural information, including degree of pathological wall thickness, mural enhancement pattern associated with disease activity, perivisceral collection, abscess formation, mesenteric fibrofatty proliferation, lymphadenopathy and increase in perienteric vascularity. Short strictures were not revealed on MRE; however, for patients with a history of abdominal malignancy, MRE helped characterize the level of any obstruction and the extent of the disease. CONCLUSION: We recommend MRE for patients who have findings of advanced inflammatory bowel disease or neoplasm on CE examination. The combination of these two techniques can provide important information on the degree and extent of the disorder.

Small Bowel Review: Part II

Directory of Open Access Journals (Sweden)

ABR Thomson

1999-01-01

Full Text Available In the past year there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 500 papers were assessed; some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist.

Small Bowel Review: Part I

Directory of Open Access Journals (Sweden)

ABR Thomson

1998-01-01

Full Text Available In the past year there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 500 papers were assessed, and some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist.

CT Findings of Small Bowel Anisakiasis: Analysis of Four Cases

International Nuclear Information System (INIS)

Kim, Wee Kyoung; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jung, Woo Kyoung; Kim, Min Yeong

2011-01-01

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

CT Findings of Small Bowel Anisakiasis: Analysis of Four Cases

Energy Technology Data Exchange (ETDEWEB)

Kim, Wee Kyoung; Song, Soon Young; Cho, On Koo; Koh, Byung Hee [Hanyang University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Soo; Jung, Woo Kyoung; Kim, Min Yeong [Hanyang University Guri Hospital, College of Medicine, Guri (Korea, Republic of)

2011-02-15

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

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

Science.gov (United States)

Watanabe, K; Yagi, T; Iwagaki, H; Kimura, Y; Mitsuoka, N; Inagaki, M; Tanaka, S; Tanaka, N

2001-01-01

To study graft-versus-host reaction (GVHR) in small-bowel transplantation and its underlying mechanisms and to find methods for circumventing GVHR, we used an unidirectional GVHR model in which F1 Lewis (LEW) x Wistar King A (WKA) hybrid rats received small-bowel transplants from either LEW or WKA parent rats. The survival time of F1 hybrid rats that received full-length small-bowel transplantation from LEW and WKA was 16.3+/-2.1 days and 18.2+/-3.4 days, respectively. When one-quarter of LEW small bowel was transplanted to an F1 hybrid recipient, the survival time was significantly longer at 44.0+/-23.4 days compared with rats that had received full-length LEW small-bowel transplantation. The survival time of F1 hybrid rats which received an injection of high-dose (5 x 10(8) cells) LEW or WKA spleen cells was 11.9+/-4.0 days and 13.1+/-3.6 days, respectively. However, when an injection containing a low dose (1 x 108 cells) of LEW spleen cells was used, survival was > 100 days, showing significance compared with the survival of rats receiving the higher dose LEW spleen-cell injection. Both small-bowel transplantation and spleen-cell injection were compared for the effective period of recipient resistance to donor cell or small-bowel transplantation as second challenge. When the F1 rats given a quarter LEW small-bowel transplant as first challenge were treated with a high-dose of spleen cells 30 days after transplantation, they survived for > 30 days without GVHR. F1 rats that were treated with a low-dose LEW spleen-cell injection, followed 30 days later by full LEW small-bowel transplantation, had a survival time of > 100 days. These results indicate that segmental small-bowel transplantation and spleen-cell injection as first challenge may facilitate the prevention of GVHR, resulting in resistance to subsequent immunological challenge.

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

Science.gov (United States)

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

2013-07-01

Fetal primary small bowel volvulus without atresia or malrotation is an extremely rare but life-threatening surgical emergency. We report a case of primary small bowel volvulus that presented as sudden fetal distress and was diagnosed on the basis of the 'whirl-pool sign' of fetal sonography. This diagnosis led to emergency operation after birth at the third trimester with a good outcome. Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology. Copyright © 2013 Elsevier Inc. All rights reserved.

The effect on the small bowel of 5-FU and oxaliplatin in combination with radiation using a microcolony survival assay

Directory of Open Access Journals (Sweden)

Kjellén Elisabeth

2009-12-01

Full Text Available Abstract Background In locally advanced rectal cancer, 5-Fluorouracil (5-FU-based chemoradiation is the standard treatment. The main acute toxicity of this treatment is enteritis. Due to its potential radiosensitizing properties, oxaliplatin has recently been incorporated in many clinical chemoradiation protocols. The aim of this study was to investigate to what extent 5-FU and oxaliplatin influence the radiation (RT induced small bowel mucosal damage when given in conjunction with single or split dose RT. Methods Immune competent balb-c mice were treated with varying doses of 5-FU, oxaliplatin (given intraperitoneally and total body RT, alone or in different combinations in a series of experiments. The small bowel damage was studied by a microcolony survival assay. The treatment effect was evaluated using the inverse of the slope (D0 of the exponential part of the dose-response curve. Results In two separate experiments the dose-response relations were determined for single doses of RT alone, yielding D0 values of 2.79 Gy (95% CI: 2.65 - 2.95 and 2.98 Gy (2.66 - 3.39, for doses in the intervals of 5-17 Gy and 5-10 Gy, respectively. Equitoxic low doses (IC5 of the two drugs in combination with RT caused a decrease in jejunal crypt count with significantly lower D0: 2.30 Gy (2.10 - 2.56 for RT+5-FU and 2.27 Gy (2.08 - 2.49 for RT+oxaliplatin. Adding both drugs to RT did not further decrease D0: 2.28 Gy (1.97 - 2.71 for RT+5-FU+oxaliplatin. A clearly higher crypt survival was noted for split course radiation (3 × 2.5 Gy compared to a single fraction of 7.5 Gy. The same difference was seen when 5-FU and/or oxaliplatin were added. Conclusion Combining 5-FU or oxaliplatin with RT lead to an increase in mucosal damage as compared to RT alone in our experimental setting. No additional reduction of jejunal crypt counts was noted when both drugs were combined with single dose RT. The higher crypt survival with split dose radiation indicates a

Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report

Directory of Open Access Journals (Sweden)

Mutahir A. Tunio

2014-01-01

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

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

International Nuclear Information System (INIS)

Torigian, Drew A.; Levine, Marc S.; Rubesin, Stephen E.; Laufer, Igor

2001-01-01

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

Diagnosis of pediatric gastric, small-bowel and colonic volvulus.

Science.gov (United States)

Garel, Charles; Blouet, Marie; Belloy, Frederique; Petit, Thierry; Pelage, Jean-Pierre

2016-01-01

Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

Women's experiences of living with neurogenic bladder and bowel after spinal cord injury: life controlled by bladder and bowel.

Science.gov (United States)

Nevedal, Andrea; Kratz, Anna L; Tate, Denise G

2016-01-01

Neurogenic bladder and bowel (NBB) is a chronic condition hindering the functioning and quality of life (QOL) of people with spinal cord injury (SCI). NBB research has focused on men with SCI leaving unanswered questions about women's experiences of living with NBB. The purpose of this study was to identify and describe women's experiences of living with SCI and NBB. Secondary analysis of semi-structured interviews from a larger qualitative study of women with SCI (N = 50) was carried out. Transcripts were coded for bowel and bladder content. Pile-sorting techniques were used to identify emergent themes related to NBB. Meta-themes were categorized under the International Classification of Functioning, Disability and Health. Bladder and bowel topics were spontaneously discussed by 46 out of 50 study participants suggesting the salience of this issue for women with SCI. We identified 6 meta-themes: life controlled by bladder and bowel, bladder and bowel accidents, women's specific challenges, life course disruption, bladder and bowel medical management, and finding independence. Findings describe concerns, strategies, and the detrimental impact of NBB in the lives of women with SCI. Findings inform policy makers, health care and rehabilitation professionals to improve accessibility and quality of life for women with NBB. Women with spinal cord injury (SCI) reported gender specific challenges to living with neurogenic bladder and bowel (NBB). Interventions designed for women with SCI can address these problems and provide recommendations for prevention and treatment. Women described the detrimental impact of NBB on life course expectations, emotional, social, physical health, and quality of life domains. Psychosocial and educational programs can be developed to address these challenges and improve overall quality of life. Recommendations for special treatment and policy considerations are needed to maximize women's independence and health while living with NBB

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

Directory of Open Access Journals (Sweden)

Rauf Fozia

2011-09-01

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.

Pathophysiology and surgical treatment for radiation enteritis

International Nuclear Information System (INIS)

Onodera, Hisashi; Park, Tae Bun; Hasegawa, Masato

1993-01-01

We analyzed 23 patients (5 males and 18 females, mean age 60) who had been operated on in our department for radiation enteritis. 1) These patients were divided into two types according to the time of surgery. Sixteen of 23 (79%) patients were operated on a median of 12 months after radiotherapy, while 7 (30%) underwent surgery more than 10 years later. 2) They were also divided according to the dominant symptoms. Fourteen of 23 (60%) complained of nausea and abdominal distension suggestive of small bowel injury, whereas 7 (30%) had tenesmus and anal bleeding indicating proctitis. Two patients developed perforative peritonitis. 3) The operations performed were as follows: extensive intestinal resection and anastomosis (13), pull-through procedure (3), rectal excision (2), ileostomy (3), by-pass operation (2). Two patients with peritonitis died despite open drainage. Nineteen intestinal anastomoses were all successfully performed. Patients who underwent extensive small bowel resection could resume ordinary daily life without symptoms. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowels followed by anastomosis of the disease-free ends, while rectal lesions are best dealt with by restorative proctectomy. This may provide a good quality of life and minimize major postoperative complications such as leakage. (author)

Pathophysiology and surgical treatment for radiation enteritis

Energy Technology Data Exchange (ETDEWEB)

Onodera, Hisashi; Park, Tae Bun; Hasegawa, Masato (Kyoto Univ. (Japan). Faculty of Medicine) (and others)

1993-12-01

We analyzed 23 patients (5 males and 18 females, mean age 60) who had been operated on in our department for radiation enteritis. (1) These patients were divided into two types according to the time of surgery. Sixteen of 23 (79%) patients were operated on a median of 12 months after radiotherapy, while 7 (30%) underwent surgery more than 10 years later. (2) They were also divided according to the dominant symptoms. Fourteen of 23 (60%) complained of nausea and abdominal distension suggestive of small bowel injury, whereas 7 (30%) had tenesmus and anal bleeding indicating proctitis. Two patients developed perforative peritonitis. (3) The operations performed were as follows: extensive intestinal resection and anastomosis (13), pull-through procedure (3), rectal excision (2), ileostomy (3), by-pass operation (2). Two patients with peritonitis died despite open drainage. Nineteen intestinal anastomoses were all successfully performed. Patients who underwent extensive small bowel resection could resume ordinary daily life without symptoms. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowels followed by anastomosis of the disease-free ends, while rectal lesions are best dealt with by restorative proctectomy. This may provide a good quality of life and minimize major postoperative complications such as leakage. (author).

Combined small and large bowel MR imaging in patients with Crohn's disease: a feasibility study

International Nuclear Information System (INIS)

Narin, Burcu; Ajaj, Waleed; Goehde, Susanne; Lauenstein, Thomas C.; Langhorst, Jost; Gerken, Guido; Akgoez, Haldun; Ruehm, Stefan G.

2004-01-01

MRI of the small bowel is a new method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both the small and large bowel. Therefore, our goal was to assess the feasibility of displaying the small bowel and colon simultaneously by MR imaging. Eighteen patients with inflammatory bowel disease were studied. For small bowel distension, patients ingested a solution containing mannitol and locust bean gum. Furthermore, the colon was rectally filled with water. MR examinations were performed on a 1.5-T system. Before and after intravenous gadolinium administration, a T1w data set was collected. All patients underwent conventional colonoscopy as a standard of reference. The oral ingestion and the rectal application of water allowed an assessment of the small bowel and colon in all patients. By means of MRI (endoscopy), 19 (13) inflamed bowel segments in the colon and terminal ileum were detected. Furthermore, eight additional inflammatory lesions in the jejunum and proximal ileum that had not been endoscopically accessible were found by MRI. The simultaneous display of the small and large bowel by MRI is feasible. Major advantages of the proposed MR concept are related to its non-invasive character as well as to the potential to visualize parts of the small bowel that cannot be reached by endoscopy. (orig.)

Development of a new method for small bowel transit study

International Nuclear Information System (INIS)

Hung, Guang-Uei; Tsai, Chien-Chung; Lin, Wan-Yu

2006-01-01

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)

Bowel function and quality of life after colostomy in individuals with spinal cord injury.

Science.gov (United States)

Bølling Hansen, Rikke; Staun, Michael; Kalhauge, Anna; Langholz, Ebbe; Biering-Sørensen, Fin

2016-05-01

To evaluate the effect of colostomy on bowel function and quality of life (QoL) in individuals with spinal cord injury (SCI). Cross-sectional descriptive study. Department for Spinal Cord Injuries and Departments of Gastroenterology and Radiology, Rigshospitalet. Eighteen individuals with SCI and a colostomy performed post injury, 12 males, 6 females, 8 with tetraplegia and 10 with paraplegia. Median age at time of study was 49.9 years, years since lesion was 3-56 years, and time since colostomy was performed 0.5 to 20 years. Questionnaires and measurement of gastrointestinal transit time (GITT). Retrospective data collection from patient records, a questionnaire on bowel management pre and post colostomy, quality of life (QoL) by SF-36, and GITT. Seventy-two percent significantly reduced their use of time on bowel emptying after the colostomy. All but one reported being content with the colostomy. Thirty-nine percent reported one or more problems related to the colostomy. Seventy-five percent had a GITT within normal range for able-bodied populations. When disregarding the physical component, QoL was not significantly lower in the total study group compared to a Danish norm group, but significantly lower when compared the subgroup of persons with tetraplegia. A colostomy reduces the time necessary for bowel management. The majority of individuals with SCI and a colostomy did not perceive bowel management as being a problem. The results indicate that colostomy is a favourable option for individuals with SCI, who spend long hours on bowel management and for whom non-invasive procedures did not improve the situation enough.

Small-bowel cancer in Lynch syndrome : is it time for surveillance?

NARCIS (Netherlands)

Koornstra, Jan J.; Kleibeuker, Jan H.; Vasen, Hans F. A.

Small-bowel cancer is part of the tumour spectrum of Lynch syndrome. Lynch syndrome, or hereditary non-polyposis colorectal cancer, is caused by germline mutations in one of the mismatch repair genes. Mutation carriers have an estimated lifetime risk for the development of small-bowel cancer of

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

Directory of Open Access Journals (Sweden)

M. Simadibrata

2002-09-01

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

Spectrum of small-bowel mucosal abnormalities identified by capsule endoscopy in patients with portal hypertension of varied etiology.

Science.gov (United States)

Chandrasekar, T S; Janakan, Gokul Bollu; Chandrasekar, Viveksandeep Thoguluva; Kalamegam, Raja Yogesh; Suriyanarayanan, Sathiamoorthy; Sanjeevaraya, Prasad Menta

2017-01-01

Bleeding from small intestinal ectopic varices and persistent anemia caused by portal hypertensive enteropathy (PHE) can be very challenging. Capsule endoscopy (CE) is one of the best noninvasive modalities in identifying such lesions. The aims of this study are to study the prevalence of small-bowel changes related to portal hypertension (PHT) and to correlate them with the observations related to the effects of portal hypertension in the esophagus, stomach, and colon. Thirty-two patients with various etiologies of PHT with either anemia or gastrointestinal bleed were included along with age- and sex-matched controls without PHT. All patients underwent blood tests, gastroscopy, colonoscopy, and CE. The small-bowel findings by CE were categorized as inflammatory-like and vascular lesions. The small-bowel changes were analyzed to find out any association with various demographic, clinical, and endoscopic variables. Thirty-one out of 32 patients with PHT (96.8%) had PHE identified by CE. Of them, 31 (96.8%) had inflammatory-like appearance, 11 (34.4%) had vascular lesions, and 2 (6.2%) had small-bowel varices. Inflammatory-like appearance was noted in eight (25%) and angiodysplastic lesions in two (6.2%) controls. Findings compatible with PHE were detected in 96.8% of the patients and 25% of the controls (X 2 =34.72, p=0.000).The presence of PHE was not associated with any of the above-mentioned variables. Small-bowel mucosal changes were seen in significantly higher number of patients with PHT with anemia.

Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

Science.gov (United States)

Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J; Hoffmann, Matthew; McKay, Michael J; Shakespeare, Thomas P

2014-02-01

Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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

Energy Technology Data Exchange (ETDEWEB)

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

2004-02-01

Small bowel diverticulitis is a rare cause of an acute abdomen. Originating from acquired diverticula of the jejunum, less often of the ileum, or Meckel diverticulum, the symptoms are non-specific, simulating other acute inflammatory disorders, such as appendicitis, cholecystitis or colonic diverticulitis. The diagnosis of small bowel diverticulitis is solely based on radiologic findings, with computed tomography (CT) regarded as the method of choice. In recent years, a number of case reports have described the spectrum of the CT features in acute small bowel diverticulitis and its dependence on the severity of the inflammatory process. Typical findings are an inflamed diverticulum, inflammatory mesenteric infiltration, extraluminal gas collection and mural edema of adjacent small bowel loops with resultant separation of bowel loops. An enterolith is rarely found in an inflamed diverticulum. Complications include abscesses, fistulae, small bowel obstruction and free perforation with peritonitis. Small bowel diverticulitis can be a diagnostic problem if it involves the terminal ileum or Meckel's diverticulum. For preoperative confirmation of the presumed diagnosis of small bowel diverticulitis on CT, an enteroclysis for acquired diverticula or a technetium scan for Meckel's diverticulum should be performed. We present the CT findings in three patients of acute small bowel diverticulitis, two affecting the jejunum and one a Meckel's diverticulum. (orig.) [German] Die akute Duenndarmdivertikulitis ist eine seltene Ursache eines akuten Abdomens. Ausgehend von den erworbenen Divertikeln des Jejunums, seltener des Ileums, oder von einem Meckel-Divertikel, manifestiert sich die Divertikulitis klinisch durch eine unspezifische Symptomatik, die zuerst an die haeufigeren, akutentzuendlichen Erkrankungen des Abdomens wie z. B. Appendizitis, Cholezystitis oder Kolondivertikulitis denken laesst. Die Duenndarmdivertikulitis kann praeoperativ nur durch

Gastrointestinal Traumatic Injuries: Gastrointestinal Perforation.

Science.gov (United States)

Revell, Maria A; Pugh, Marcia A; McGhee, Melanie

2018-03-01

The abdomen is a big place even in a small person. Gastrointestinal trauma can result in injury to the stomach, small bowel, colon, or rectum. Traumatic causes include blunt or penetrating trauma, such as gunshot wounds, stabbings, motor vehicle collisions, and crush injuries. Nontraumatic causes include appendicitis, Crohn disease, cancer, diverticulitis, ulcerative colitis, blockage of the bowel, and chemotherapy. The mechanism of injury will affect both the nature and severity of any resulting injuries. Treatment must address the critical and emergent nature of these injuries as well as issues that affect all trauma situations, which include management of hemodynamic instability. Copyright © 2017 Elsevier Inc. All rights reserved.

Anatomy and Physiology of the Small Bowel.

Science.gov (United States)

Volk, Neil; Lacy, Brian

2017-01-01

Comprehension of small intestine physiology and function provides a framework for the understanding of several important disease pathways of the gastrointestinal system. This article reviews the development, anatomy and histology of the small bowel in addition to physiology and digestion of key nutrients. Copyright © 2016 Elsevier Inc. All rights reserved.

Capsule endoscopy: Beyond small bowel

Directory of Open Access Journals (Sweden)

Samuel N Adler

2012-01-01

Full Text Available In this article the brief and dramatic history of capsule endoscopy of the digestive tract is reviewed. Capsule endoscopy offers a non invasive method to diagnose diseases that affect the esophagus, small bowel and colon. Technological improvements relating to optics, software, data recorders with two way communication have revolutionized this field. These advancements have produced better diagnostic performance.

Merkel cell carcinoma metastatic to the small bowel mesentery

Directory of Open Access Journals (Sweden)

Guang-Yu Yang

2011-03-01

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

Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn's disease

DEFF Research Database (Denmark)

Almen, Sven; Granerus, Göran; Ström, Magnus

2007-01-01

Background: Leukocyte scintigraphy is a noninvasive investigation to assess inflammation. We evaluated the utility of labeled leukocytes to detect small bowel inflammation and disease complications in Crohn's disease and compared it to whole small bowel enteroscopy and laparotomy findings. Methods......: Scintigraphy with technetium-99m exametazime-labeled leukocytes was prospectively performed in 48 patients with Crohn's disease a few days before laparotomy; 41 also had an intraoperative small bowel enteroscopy. The same procedures were performed in 8 control patients. Independent grading of scans...... was compared with the results of enteroscopy and with surgical, histopathologic, and clinical data. Results: In the 8 control patients leukocyte scan, endoscopy, and histopathology were all negative for the small bowel. In patients with Crohn's disease and small bowel inflammation seen at enteroscopy and...

Ruptured Jejunal Diverticulum Due to a Single-Band Small Bowel Obstruction

Directory of Open Access Journals (Sweden)

Rajaraman Durai

2008-01-01

Full Text Available Jejunal diverticulosis is rare and often goes unnoticed until complications occur. The diverticula are true, acquired diverticula and often asymptomatic. Jejunal diverticulosis can be associated with diverticulosis of the duodenum, ileum, and colon. Here we describe a patient with known severe diverticular disease of the large bowel, who presented acutely with abdominal pain and signs of generalised peritonitis. Laparotomy showed ruptured jejunal diverticulosis with a single band over the terminal ileum, causing small bowel obstruction. Spontaneous perforation of a jejunal diverticulum is rare and is usually an intraoperative finding. One should exclude a precipitating cause, such as coexisting distal obstruction, stricture, or a foreign body.

Radiation injuries/ionizing radiation

International Nuclear Information System (INIS)

Gooden, D.S.

1991-01-01

This book was written to aid trial attorneys involved in radiation litigation. Radiologists and medical physicists will also find it helpful as they prepare for trial, either as a litigant or an expert witness. Two chapters present checklists to guide attorneys for both plaintiffs and defendants. Gooden titles these checklists Elements of Damages and Elements of Proof and leads the reader to conclusions about each of these. One section that will be particularly helpful to attorneys contains sample interrogatories associated with a case of alleged radiation exposure resulting in a late radiation injury. There are interrogatories for the plaintiff to ask the defendant and for the defendant to ask the plaintiff

Injury by ionizing radiations

International Nuclear Information System (INIS)

Upton, A.C.

1985-01-01

In view of the vast amount of effort devoted to the study of radiation injury during the past century, it may be concluded that the effects of radiation are better understood than those of any other physical or chemical agent. To this extent, it is useful to review our experience with radiation in addressing health problems associated with other environmental agents

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

Science.gov (United States)

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

2014-01-01

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

Acute small bowel obstruction due to chicken bone bezoar

Directory of Open Access Journals (Sweden)

Vetpillai P

2012-12-01

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

Small bowel obstruction in percutaneous fixation of traumatic pelvic fractures

Directory of Open Access Journals (Sweden)

Roberto Bini

2013-01-01

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

Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding.

Science.gov (United States)

Lewis, B S; Wenger, J S; Waye, J D

1991-02-01

Intraoperative endoscopy (IOE) is accepted as the ultimate diagnostic procedure for completely evaluating the small bowel in patients with obscure gastrointestinal (GI) bleeding. Small bowel enteroscopy (SBE) has been reported useful in the nonsurgical evaluation of the small intestine in these patients, but findings may be limited because of incomplete small bowel intubation and a lack of tip deflection. Twenty-three patients underwent 25 SBE exams and subsequently had 25 IOE exams during surgical exploration for continued bleeding. Patients' bleeding histories averaged 2 yr, with an average transfusion requirement of 27 units. Findings on IOE were the same as with SBE in 17/22 (77%) of examinations. We conclude that SBE and IOE are comparable in depth of insertion and ability to detect small vascular ectasias. Both procedures missed pathology due to limited visibility and the evanescent nature of ectasias. Long-term success in abolishing bleeding with these combined techniques can be expected in 55% of these patients. SBE should precede surgery, since the finding of diffuse ectasias precludes any benefit from operative intervention.

Assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction using cine-MRI.

Science.gov (United States)

Ohkubo, Hidenori; Kessoku, Takaomi; Fuyuki, Akiko; Iida, Hiroshi; Inamori, Masahiko; Fujii, Tetsuro; Kawamura, Harunobu; Hata, Yasuo; Manabe, Noriaki; Chiba, Toshimi; Kwee, Thomas C; Haruma, Ken; Matsuhashi, Nobuyuki; Nakajima, Atsushi; Takahara, Taro

2013-07-01

Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays in the diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluate the motility of the entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluated the usefulness of cine-MRI as a novel diagnostic method for CIPO. Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared between the groups. Cine-MRI provided sufficient dynamic images to assess the motility of the entire small bowel. Luminal diameter (mean±s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4±14.1, 11.1±1.5, and 10.9±1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1±11.0%, 73.0±9.3%, and 74.6±9.4%, respectively). No significant differences were observed in the contraction cycle. This study is the first to assess the clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluate the entire small bowel peristalsis, and can detect the affected loops at a glance; therefore, it might be extremely useful for the diagnosis and follow-up of CIPO patients in clinical practice.

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

Directory of Open Access Journals (Sweden)

Hyun Seok Lee

2016-01-01

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

Role of luminal nutrients and endogenous GLP-2 in intestinal adaptation to mid-small bowel resection

DEFF Research Database (Denmark)

Dahly, Elizabeth M; Gillingham, Melanie B; Guo, Ziwen

2003-01-01

To elucidate the role of luminal nutrients and glucagon-like peptide-2 (GLP-2) in intestinal adaptation, rats were subjected to 70% midjejunoileal resection or ileal transection and were maintained with total parenteral nutrition (TPN) or oral feeding. TPN rats showed small bowel mucosal hyperpla......To elucidate the role of luminal nutrients and glucagon-like peptide-2 (GLP-2) in intestinal adaptation, rats were subjected to 70% midjejunoileal resection or ileal transection and were maintained with total parenteral nutrition (TPN) or oral feeding. TPN rats showed small bowel mucosal...... rats was associated with a significant positive correlation between increases in plasma bioactive GLP-2 and proglucagon mRNA expression in the colon of TPN rats and ileum of orally fed rats. These data support a significant role for endogenous GLP-2 in the adaptive response to mid-small bowel resection...

Is “pelvic radiation disease” always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

International Nuclear Information System (INIS)

Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J.; Hoffmann, Matthew; McKay, Michael J.; Shakespeare, Thomas P.

2014-01-01

Background: Pelvic radiation disease (PRD) also widely known as “radiation proctopathy” is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. Methods and materials: A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Results: Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Conclusions: Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines

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

Science.gov (United States)

Chen, Hong-bin; Huang, Yue; Chen, Su-yu; Song, Hui-wen; Li, Xiao-lin; Dai, Dong-lin; Xie, Jia-tia; He, Song; Zhao, Yuan-yuan; Huang, Chun; Zhang, Sheng-jun; Yang, Lin-na

2011-04-01

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. 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. 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. 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.

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

Energy Technology Data Exchange (ETDEWEB)

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

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.)

Quality of Life after Post-Prostatectomy Intensity Modulated Radiation Therapy: Pelvic Nodal Irradiation Is Not Associated with Worse Bladder, Bowel, or Sexual Outcomes.

Directory of Open Access Journals (Sweden)

James M Melotek

Full Text Available Limited data exist regarding toxicity and quality of life (QOL after post-prostatectomy intensity modulated radiation therapy (IMRT and whether pelvic nodal RT influences these outcomes.118 men were treated with curative-intent RT after radical prostatectomy. 69 men (58% received pelvic nodal RT. QOL data and physician-assigned toxicity were prospectively collected. Changes in QOL from baseline were assessed with Wilcoxon signed-rank tests and risk factors associated with each domain were identified with generalized estimating equation (GEE models. Late freedom from (FF toxicity was estimated by the Kaplan-Meier method and comparisons were tested using the log-rank test.Urinary irritation/obstruction, bowel, and sexual domain scores declined at 2 months (all P ≤ 0.01 but were no different than baseline at subsequent visits through 4 years of follow-up. At 4 years, FF grade 2+ GI toxicity was 90% and FF grade 2+ GU toxicity was 89%. On GEE analysis, pelvic nodal RT was associated with decreased bowel function (P = 0.09 and sexual function (P = 0.01. On multivariate analysis, however, there was no significant association with either decreased bowel (P = 0.31 or sexual (P = 0.84 function. There was also no association with either FF grade 2+ GI toxicity (P = 0.24 or grade 2+ GU toxicity (P = 0.51.Receipt of pelvic nodal RT was not associated with inferior QOL or toxicity compared to prostate bed alone RT. For the entire cohort, RT was associated with only temporary declines in patient-reported urinary, bowel, or sexual QOL.

The effect of barium infusion rate on the diagnostic value of small bowel enteroclysis

International Nuclear Information System (INIS)

Oudkerk, M.; Rijke, A.M.

1988-01-01

Although enteroclysis may have many advantages over the conventional methods of small bowel examination, the contrast material is not always infused at a rate appropriate to gain maximum diagnostic information. In this study, 190 patients were examined by small bowell enteroclysis at five contrast infusion rates ranging from 50 to 150 ml/min using a newly designed infusion pump system. The results show that at rates above 75 ml/min, motility disturbances are masked by small bowel dilatation and paralysis, transit times are extended and morphological detail is obscured. At rates below 75 ml/min, incomplete filling of the loops renders optimal diagnostic evaluation impossible. An infusion rate of 75 ml/min was found to be optimal for initiating small bowel studies. This rate can be adjusted for individual cases when pathology or drugs affect the motility of the small bowel. 13 refs.; 5 figs.; 1 table

Progress ill Small-Bowel Physiology and Disease

African Journals Online (AJOL)

1971-10-23

Oct 23, 1971 ... The epithelial cell of the small-bowel mucosa is second ... an important part in the entrapment of fat micelles before absorption at the .... died with a gastric carcinoma. ... termed 'Mediterranean' because of its frequency in.

Small Bowel Review: Part I

Directory of Open Access Journals (Sweden)

ABR Thomson

1996-01-01

Full Text Available Major scientific advances have been made over the past few years in the areas of small bowel physiology, pathology, microbiology and clinical sciences. Over 1000 papers have been reviewed and a selective number are considered here. Wherever possible, the clinical relevance of these advances have been identified. There have been a number of important and/or interesting developments in the past year that have clinical significance.

Ataxia Telangiectasia–Mutated Gene Polymorphisms and Acute Normal Tissue Injuries in Cancer Patients After Radiation Therapy: A Systematic Review and Meta-analysis

International Nuclear Information System (INIS)

Dong, Lihua; Cui, Jingkun; Tang, Fengjiao; Cong, Xiaofeng; Han, Fujun

2015-01-01

Purpose: Studies of the association between ataxia telangiectasia–mutated (ATM) gene polymorphisms and acute radiation injuries are often small in sample size, and the results are inconsistent. We conducted the first meta-analysis to provide a systematic review of published findings. Methods and Materials: Publications were identified by searching PubMed up to April 25, 2014. Primary meta-analysis was performed for all acute radiation injuries, and subgroup meta-analyses were based on clinical endpoint. The influence of sample size and radiation injury incidence on genetic effects was estimated in sensitivity analyses. Power calculations were also conducted. Results: The meta-analysis was conducted on the ATM polymorphism rs1801516, including 5 studies with 1588 participants. For all studies, the cut-off for differentiating cases from controls was grade 2 acute radiation injuries. The primary meta-analysis showed a significant association with overall acute radiation injuries (allelic model: odds ratio = 1.33, 95% confidence interval: 1.04-1.71). Subgroup analyses detected an association between the rs1801516 polymorphism and a significant increase in urinary and lower gastrointestinal injuries and an increase in skin injury that was not statistically significant. There was no between-study heterogeneity in any meta-analyses. In the sensitivity analyses, small studies did not show larger effects than large studies. In addition, studies with high incidence of acute radiation injuries showed larger effects than studies with low incidence. Power calculations revealed that the statistical power of the primary meta-analysis was borderline, whereas there was adequate power for the subgroup analysis of studies with high incidence of acute radiation injuries. Conclusions: Our meta-analysis showed a consistency of the results from the overall and subgroup analyses. We also showed that the genetic effect of the rs1801516 polymorphism on acute radiation injuries was

Small bowel volvulus in pregnancy with associated superior mesenteric artery occlusion.

Science.gov (United States)

Esterson, Yonah B; Villani, Robert; Dela Cruz, Ronald A; Friedman, Barak; Grimaldi, Gregory M

Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA. Copyright © 2017 Elsevier Inc. All rights reserved.

Radiation, an ideal cytotoxic for the study of cell biology in the small intestine

International Nuclear Information System (INIS)

Potten, C.

2003-01-01

Epithelial tissues are highly polarised with the proliferative compartment sometimes subdivided into units of proliferation in many instances. My interests have been in trying to understand how many cellular constituents exist, what their function is and intercommunicants are that ensure appropriate steady state cell replacement rates. Radiation has proved to be a valuable tool to induce cell death, reproductive sterilisation, and regenerative proliferation in these systems, the responses to which can provide information on the number of regenerative cells (a function associated with stem cells). Such studies have helped define the epidermal proliferative units and the structurally similar units on the dorsal surface of the tongue. The radiation responses considered in conjunction with a wide range of cell kinetic lineage tracking and somatic mutation studies with complex mathematical modelling, provide insights into the functioning of the poliferative units (crypts) of the small intestine. Comparative studies have then been undertaken with the crypts in the large bowel. In the small intestine, which rarely develops cancer, various protective mechanisms have evolved to ensure the genetic integrity of the stem cell compartment. Stem cells in the small intestinal crypts have an intolerance of genotoxic damage (including that induced by very low doses of radiation), they do not undergo cell cycle arrest and repair but commit an altruistic p53 dependent cell suicide (apoptosis). This process is compromised in the large bowel by bcl-2 expression. Recent studies have suggested a second genome protection mechanism operating in the stem cells of the small intestinal crypts that may also have a p53 dependence. Such studies have allowed the cell lineages and genome protection mechanisms operating in the small intestinal crypts to be defined

Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

Institute of Scientific and Technical Information of China (English)

Faisal Aziz; Srinivasulu Conjeevaram; Than Phan

2006-01-01

Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed.Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents,and small bowel obstruction was treated with bypass.To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

Software-assisted quantitative analysis of small bowel motility compared to manual measurements

International Nuclear Information System (INIS)

Bickelhaupt, S.; Froehlich, J.M.; Cattin, R.; Raible, S.; Bouquet, H.; Bill, U.; Patak, M.A.

2014-01-01

Aim: To validate a newly developed software prototype that automatically analyses small bowel motility by comparing it directly with manual measurement. Material and methods: Forty-five patients with clinical indication for small bowel magnetic resonance imaging (MRI) were retrospectively included in this institutional review board-approved study. MRI was performed using a 1.5 T system following a standard MR-enterography protocol. Small bowel motility parameters (contractions-per-minute, luminal diameter, amplitude) were measured three times each in identical segments using the manual and the semiautomatic software-assisted method. The methods were compared for agreement, repeatability, and time needed for each measurement. All parameters were compared between the methods. Results: A total of 91 small-bowel segments were analysed. No significant intra-individual difference (p > 0.05) was found for peristaltic frequencies between the methods (mean: 4.14/min manual; 4.22/min software-assisted). Amplitudes (5.14 mm; 5.57 mm) and mean lumen diameters (17.39 mm; 14.68) differed due to systematic differences in the definition of the bowel wall. Mean duration of single measurement was significantly (p < 0.01) shorter with the software (6.25 min; 1.30 min). The scattering of repeated measurements was significantly (p < 0.05) lower using the software. Conclusion: The software-assisted method accomplished highly reliable, fast and accurate measurement of small bowel motility. Measurement precision and duration differed significantly between the two methods in favour of the software-assisted technique

Imaging findings of hepatoid adenocarcinoma of the small bowel: A case report

Energy Technology Data Exchange (ETDEWEB)

Park, Jong Won; Kim, Kyoung Ah; Jung, Sang Geun [CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of)

2016-12-15

Hepatoid adenocarcinoma is a rare extrahepatic tumor defined as having a morphologic and immunohistochemical similarity to hepatocellular carcinoma. In this case report, we describe a patient with hepatoid adenocarcinoma of the jejunum with multiple liver metastases that developed in the absence of risk factors. We describe the radiologic findings including those of dynamic computed tomography and small bowel follow-through. To the best of our knowledge, only two cases of hepatoid adenocarcinoma of the small bowel have been reported in patients with inflammatory bowel disease.

Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy

International Nuclear Information System (INIS)

Green, Sheryl; Stock, Richard; Greenstein, Adrian

1995-01-01

4 gastro-intestinal toxicity. Two patients (13%) developed small bowel obstruction at 2 and 4 months, respectively, post-irradiation which were managed conservatively. There were no long term complications in patients irradiated. CONCLUSION: Treatment results are comparable to those historically reported for non-inflammatory bowel disease related rectal cancer although the subset of high risk patients appeared to have a poorer outcome. In light of this finding and the ability of patients with inflammatory bowel disease to tolerate pelvic irradiation, high risk patients should be treated aggressively with chemotherapy and radiation therapy

Accelerating the transit time of barium sulphate suspensions in small bowel examinations

International Nuclear Information System (INIS)

Summers, David S.; Roger, Mark D.; Allan, Paul L.; Murchison, John T.

2007-01-01

Purpose: To determine whether hyperosmolar and effervescent agents proven individually to accelerate transit time in the barium small bowel examination have an additive effect when combined, surpassing that of either agent alone. Materials and methods: One hundred and forty-nine patients were randomised to four groups. Three hundred milliliters of barium sulphate alone was given to the first group. Fifteen milliliters of iodinated hyperosmolar contrast agent (Gastrografin, meglumine/sodium diatrizoate, Schering) was given in addition to barium sulphate to the second group while six packets of effervescent granules (Carbex, Ferring) were added for the third group. The final group was given a combination of both additives and barium sulphate. The time taken following ingestion for the contrast column to reach the caecum, as assessed by frequent interval fluoroscopy, was recorded. A subgroup of 32 patients were selected randomly from the four groups, 8 from each and assessed for quality of examination. Statistical assessments were made using Kruskal-Wallis and Mann-Whitney tests. Results: One hundred and nineteen patients were analysed after exclusions. The addition of accelerant to barium sulphate, both individually and in combination significantly reduced the small bowel transit time (p < 0.001). No significant difference existed between the additives when used with barium alone. The combined group had significantly faster transit times compared to the hyperosmolar group (p = 0.02). Differences between combined and effervescent groups tended towards significance (p = 0.09). No significant difference existed between groups when examination quality was assessed. Conclusion: These results suggest that the addition of combined effervescent and hyperosmolar agents to the barium suspension may significantly shorten the small bowel transit time without adversely affecting examination quality. This has implications for patient acceptability of the examination as well as

The effects of erythromycin in small-bowel follow-through

Energy Technology Data Exchange (ETDEWEB)

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

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.

Fractionation schedule affects transforming growth factor β expression in chronic radiation enteropathy

International Nuclear Information System (INIS)

Hauer-Jensen, Martin; Richter, Konrad K.; Sung, C.-C.; Langberg, Carl W.

1995-01-01

Purpose/Objective: The risk of intestinal obstruction from fibrotic strictures is a major dose limiting factor in abdominal radiation therapy. We have shown that chronic intestinal radiation injury (radiation enteropathy) is associated with sustained over-expression of the fibrogenic cytokine, transforming growth factor beta (TGF-β). This study used quantitative computerized image analysis to examine the relationship between TGF-β expression and specific histopathologic alterations as a function of fractionation schedule. Materials and Methods: Localized fractionated small bowel irradiation was performed in a rat model developed in our laboratory: 49 male rats were orchiectomized and a loop of small bowel was sutured to the inside of the scrotum. After 3 weeks recovery, the intestine within the artificial 'scrotal hernia' was sham-irradiated (Controls) or exposed to a total dose of 50.4 Gy orthovoltage radiation, given either as 18 daily fractions of 2.8 Gy (Group I) or as 9 daily fractions of 5.6 Gy (Group II). Groups of animals were euthanized at 2 weeks (early injury) and 26 weeks (chronic injury). Specimens were prepared for immunohistochemistry and histopathology. Extracellular TGF-β was detected with a polyclonal antibody, and protein expression was quantified by computerized image analysis. Twenty separate 40X fields per specimen were digitized, and the average number of stained pixels relative to total pixels was determined. Histopathologic injury was assessed in H+E sections with a previously validated Radiation Injury Score (RIS). Results: Irradiated animals had significantly higher levels of extracellular TGF-β immunoreactivity at both 2 weeks and 26 weeks (p<0.01). TGF-β expression correlated with RIS at both time points (p<0.001). Group II had significantly greater RIS and TGF-β expression than group I (p<0.01). TGF-β expression at 2 weeks correlated with epithelial atypia, mucosal ulceration, and subserosal thickening (p<0.01). At 26 weeks, TGF

Whirl sign as CT finding in small-bowel volvulus

International Nuclear Information System (INIS)

Fujimoto, K.; Nakamura, K.; Nishio, H.; Takashima, S.; Minakuchi, K.; Onoyama, Y.; Nomura, K.; Hayata, S.

1995-01-01

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

Whirl sign as CT finding in small-bowel volvulus

Energy Technology Data Exchange (ETDEWEB)

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

1995-12-31

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

Injury Profiles Associated with Artisanal and Small-Scale Gold Mining in Tarkwa, Ghana.

Science.gov (United States)

Calys-Tagoe, Benedict N L; Ovadje, Lauretta; Clarke, Edith; Basu, Niladri; Robins, Thomas

2015-07-10

Artisanal and small-scale gold mining (ASGM) is inherently risky, but little is known about mining-associated hazards and injuries despite the tremendous growth worldwide of ASGM and the benefits it offers. The current study aimed to characterize the physical injuries associated with ASGM in Ghana to guide policy formulation. A cross-sectional survey was carried out in the Tarkwa mining district of the Western Region of Ghana in 2014. A total of 404 small-scale miners were recruited and interviewed regarding their occupational injury experiences over the preceding 10 years using a paper-based structured questionnaire. Nearly one-quarter (23.5%) of the miners interviewed reported getting injured over the previous 10 years, and the overall injury rate was calculated to be 5.39 per 100 person years. The rate was significantly higher for women (11.93 per 100 person years) and those with little mining experience (e.g., 25.31 per 100 person years for those with less than one year of work experience). The most injury-prone mining activities were excavation (58.7%) and crushing (23.1%), and over 70% of the injuries were reported to be due to miners being hit by an object. The majority of the injuries (57%) were lacerations, and nearly 70% of the injuries were to the upper or lower limbs. Approximately one-third (34.7%) of the injuries resulted in miners missing more than two weeks of work. One-quarter of the injured workers believed that abnormal work pressure played a role in their injuries, and nearly two-fifths believed that their injuries could have been prevented, with many citing personal protective equipment as a solution. About one-quarter of the employees reported that their employers never seemed to be interested in the welfare or safety of their employees. These findings greatly advance our understanding of occupational hazards and injuries amongst ASGM workers and help identify several intervention points.

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

Energy Technology Data Exchange (ETDEWEB)

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

1986-12-01

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

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

International Nuclear Information System (INIS)

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

1986-01-01

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

Detection of high-grade small bowel obstruction on conventional radiography with convolutional neural networks.

Science.gov (United States)

Cheng, Phillip M; Tejura, Tapas K; Tran, Khoa N; Whang, Gilbert

2018-05-01

The purpose of this pilot study is to determine whether a deep convolutional neural network can be trained with limited image data to detect high-grade small bowel obstruction patterns on supine abdominal radiographs. Grayscale images from 3663 clinical supine abdominal radiographs were categorized into obstructive and non-obstructive categories independently by three abdominal radiologists, and the majority classification was used as ground truth; 74 images were found to be consistent with small bowel obstruction. Images were rescaled and randomized, with 2210 images constituting the training set (39 with small bowel obstruction) and 1453 images constituting the test set (35 with small bowel obstruction). Weight parameters for the final classification layer of the Inception v3 convolutional neural network, previously trained on the 2014 Large Scale Visual Recognition Challenge dataset, were retrained on the training set. After training, the neural network achieved an AUC of 0.84 on the test set (95% CI 0.78-0.89). At the maximum Youden index (sensitivity + specificity-1), the sensitivity of the system for small bowel obstruction is 83.8%, with a specificity of 68.1%. The results demonstrate that transfer learning with convolutional neural networks, even with limited training data, may be used to train a detector for high-grade small bowel obstruction gas patterns on supine radiographs.

Wireless capsule endoscopy of the small bowel: development, testing, and first human trials

Science.gov (United States)

Swain, Paul; Iddan, Gavriel J.; Meron, Gavriel; Glukhovsky, Arkady

2001-01-01

Small bowel endoscopy with existing endoscopes is limited by problems of discomfort and the technical difficulty of advancing far into the small-bowel. Our aim has been to develop and test wireless capsule endoscopy. Wireless endoscopes, in the form of capsules (11 x 33 mm), were constructed by Given Imaging. These were powered by silver oxide batteries and each contained a CMOS imaging chip and miniature processor, white light emitting diodes (LEDs), a short focal length lens, and a miniature transmitter and antenna. Two video frames per second were transmitted, using radio-frequency (approx. 410 MHz), to an array of aerials attached to the body. The array of aerials can also be used to calculate the position of the capsule in the body. The images were stored on a portable recorder carried on a belt and subsequently downloaded for analysis. The batteries allow more than 5 hours of recording, although the capsule generally passes through the whole small bowel in under two hours. Clear video images of the human bowel were recorded from the pylorus to the caecum. Wireless endoscopy, for the first time, allows painless optical imaging of the whole of the small bowel.

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

Energy Technology Data Exchange (ETDEWEB)

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

1972-12-15

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

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

International Nuclear Information System (INIS)

Kim, Hong Soo; Kang, Hee Woong; Bahk, Yong Whee

1972-01-01

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

Adhesive small bowel obstruction due to pelvic inflammatory disease: A case report

Directory of Open Access Journals (Sweden)

Razan A Al-Ghassab

2018-01-01

Full Text Available We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.

Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass.

Science.gov (United States)

Naef, Markus; Mouton, Wolfgang G; Wagner, Hans E

2010-12-01

Internal hernias are a specific cause of acute abdominal pain and are a well-known complication after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Although internal hernias are a rare cause of intestinal obstruction, they may evolve towards serious complications, such as extensive bowel ischemia and gangrene, with the need for bowel resection and sometimes for a challenging reconstruction of intestinal continuity. The antecolic position of the Roux limb is associated with a decrease in the incidence of small-bowel obstruction and internal hernias. The best prevention of the formation of these hernias is probably by closure of potential mesenteric defects at the initial operation with a non-absorbable running suture. We present a patient in late pregnancy with a small-bowel volvulus following laparoscopic Roux-en-Y gastric bypass for morbid obesity and discuss the available literature. For a favorable obstetric and neonatal outcome, it is crucial not to delay surgical exploration and an emergency operation usually is mandatory.

Radiation-associated ischemic coloproctitis. Report of two cases

Energy Technology Data Exchange (ETDEWEB)

Tomori, Hirofumi; Yasuda, Takashi; Shiraishi, Masayuki; Isa, Tsutomu; Muto, Yoshihiro; Egawa, Haruhiko [Ryukyus Univ., Nishihara, Okinawa (Japan). Faculty of Medicine

1999-10-01

Radiation-associated ischemic coloproctitis is a rare clinical entity caused by vascular insufficiency to the rectosigmoid colon. It most commonly occurs after radiotherapy for gynecological cancer. We present herein the cases of two patients who developed radiation-associated coloproctitis with transmural necrosis and eventual perforation. Perforation of the rectosigmoid colon occurred 3.5 years after radiotherapy in case 1, a 46-year-old woman, and presented as a well-defined small area of transmural necrosis. Conversely, in case 2, a 55-year-old woman, it occurred 1.5 years after radiotherapy, and presented as segmental, diffuse transmural necrosis. The lesion in case 1 had been caused by intramural vascular obliteration due to marked fibrosis of the bowel wall, while that in case 2 had been caused by occlusion of the mesenteric artery with thrombosis. Both patients underwent Hartmann's resection without rectal excision, and survived the perforative event. (author)

Radiation-associated ischemic coloproctitis. Report of two cases

International Nuclear Information System (INIS)

Tomori, Hirofumi; Yasuda, Takashi; Shiraishi, Masayuki; Isa, Tsutomu; Muto, Yoshihiro; Egawa, Haruhiko

1999-01-01

Radiation-associated ischemic coloproctitis is a rare clinical entity caused by vascular insufficiency to the rectosigmoid colon. It most commonly occurs after radiotherapy for gynecological cancer. We present herein the cases of two patients who developed radiation-associated coloproctitis with transmural necrosis and eventual perforation. Perforation of the rectosigmoid colon occurred 3.5 years after radiotherapy in case 1, a 46-year-old woman, and presented as a well-defined small area of transmural necrosis. Conversely, in case 2, a 55-year-old woman, it occurred 1.5 years after radiotherapy, and presented as segmental, diffuse transmural necrosis. The lesion in case 1 had been caused by intramural vascular obliteration due to marked fibrosis of the bowel wall, while that in case 2 had been caused by occlusion of the mesenteric artery with thrombosis. Both patients underwent Hartmann's resection without rectal excision, and survived the perforative event. (author)

High-resolution array comparative genomic hybridization in sporadic and celiac disease-related small bowel adenocarcinomas.

NARCIS (Netherlands)

Diosdado, B.; Buffart, T.E.; Watkins, R.; Carvalho, B.; Ylstra, B.; Tijssen, M.; Bolijn, A.S.; Lewis, F.; Maude, K.; Verbeke, C.; Nagtegaal, I.D.; Grabsch, H.; Mulder, C.J.; Quirke, P.; Howdle, P.; Meijer, G.A.

2010-01-01

PURPOSE: The molecular pathogenesis of small intestinal adenocarcinomas is not well understood. Understanding the molecular characteristics of small bowel adenocarcinoma may lead to more effective patient treatment. EXPERIMENTAL DESIGN: Forty-eight small bowel adenocarcinomas (33 non-celiac disease

Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury.

Directory of Open Access Journals (Sweden)

Charles H Hubscher

Full Text Available Locomotor training (LT as a therapeutic intervention following spinal cord injury (SCI is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs' pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury.Prospective cohort study; pilot trial with small sample size.Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart.Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants.These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively

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

Energy Technology Data Exchange (ETDEWEB)

Hwang, Su Yeon; Jang, Kyung Mi; Kim, Min Jeong; Koh, Sung Hye; Jeon, Eui Yong; Min, Kwang Seon; Seo, Jin Won; Park, Hyoung Chul [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

2009-09-15

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

Chemical and radiation injuries

International Nuclear Information System (INIS)

Hugo, M.J.

1981-01-01

The paper is a discussion of radiation injuries and the treatment thereof. Radiation injuries are mainly caused as a result of nuclear leaks or nuclear bomb explosions. Such an explosion is usually accompanied by a light flash, noise, heat radiation and nuclear radiation which can all caurse various types of injuries. The general effect of radioactive radiation is discussed. The seriousness of the situation where the whole body was exposed to nuclear radiation, depends on the total radiation dose received and varies from person to person. The progress of radiation sickness is described. Mention is also made of long term radiation effects. The emergency treatment of the injured before specialised aid is available, is discussed. The primary aim of treatment is to save life and to prevent further injuries and complications. Injured people must be removed as far as possible from the point of maximum radiation. Attention must also be given to decontamination

Acquired Epidermodysplasia Verruciformis Associated with Human Papilloma Virus Type 14 in a Small Bowel Transplanted Child--A Case Report.

Science.gov (United States)

Hirschman, Derek; Tacastacas, Joselin; Rady, Peter L; Tyring, Stephen K; Cooper, Kevin; Honda, Kord

2016-01-01

A 3-year-old African American girl taking sirolimus and tacrolimus for a small bowel transplantation presented with hypopigmented macules and papules throughout her trunk. A biopsy diagnosed epidermodysplasia verruciformis (EV) that was found to be associated with human papillomavirus (HPV) type 14 according to polymerase chain reaction analysis. There are few cases of acquired EV in the setting of organ transplantation. Although there is no standardized treatment for acquired EV, prevention and surveillance for transformation to squamous cell carcinoma are primary concerns. © 2015 Wiley Periodicals, Inc.

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

International Nuclear Information System (INIS)

Barbiera, F.; Ciraulo, R.; Cusma', S.

1999-01-01

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

Small Bowel Review: Part I

Directory of Open Access Journals (Sweden)

ABR Thomson

2000-01-01

Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. More than 1500 papers were assessed in preparation for this review. Some were selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope, and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

Small Bowel Review: Part II

Directory of Open Access Journals (Sweden)

ABR Thomson

2001-01-01

Full Text Available In the past year, there have been many advances in the area of small bowel physiology and pathology. In preparation for this review, over 1500 papers were assessed. Some have been selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.

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

Science.gov (United States)

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

2015-03-01

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

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

International Nuclear Information System (INIS)

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

2014-01-01

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

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

International Nuclear Information System (INIS)

Asbach, P.; Breitwieser, C.; Diederichs, G.; Eisele, S.; Kivelitz, D.; Taupitz, M.; Zeitz, M.; Hamm, B.; Klessen, C.

2006-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2006-11-15

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

Bedside Ultrasound for the Diagnosis of Small Bowel Obstruction

Directory of Open Access Journals (Sweden)

Alexander Anshus

2017-09-01

Full Text Available History of present illness: An elderly female with no history of prior abdominal surgeries presented to the emergency department (ED with acute onset of abdominal pain and distention. Upon arrival, she began having large volume bilious emesis. While waiting for a computed tomography (CT scan of her abdomen and pelvis, a point of care ultrasound (POCUS was performed which showed evidence of a small bowel obstruction (SBO. The patient had a nasogastric tube placed that put out over two liters of bilious contents. A subsequent CT scan confirmed the diagnosis of SBO from a left inguinal hernia and the patient was admitted to the surgical service. Significant findings: The POCUS utilizing the low frequency curvilinear probe demonstrates fluid-filled, dilated bowel loops greater than 2.5cm with to-and-fro peristalsis, and thickened bowel walls greater than 3mm, concerning for SBO. Discussion: Gastrointestinal obstruction is a common diagnosis in the ED, accounting for approximately 15% of all ED visits for acute abdominal pain.1 SBO accounts for approximately 80% of all obstructions.2 In the diagnosis of SBO, studies show that abdominal x-rays have a sensitivity of 66-77% and specificity of 50-57%,3 CT scans have a sensitivity of 92% and specificity of 93%,4 and ultrasound has a sensitivity of 88% and specificity of 96%.5 While CT scan remains a widely accepted modality for diagnosing SBO, ultrasound is more cost effective, well tolerated, does not involve ionizing radiation, and can be done in a timely manner at the patient’s bedside. Ultrasound can also identify transition points as well as distinguish between functional and mechanical obstruction.6 In addition to SBO, ultrasound can be used to diagnose external hernias, intussusception, tumors, superior mesenteric artery (SMA syndrome, foreign bodies, bezoars, and ascariasis.7

Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen

Directory of Open Access Journals (Sweden)

Michael P. O’Leary

2016-01-01

Full Text Available Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

Large bowel resection

Science.gov (United States)

... blockage in the intestine due to scar tissue Colon cancer Diverticular disease (disease of the large bowel) Other reasons for bowel resection are: Familial polyposis (polyps are growths on the lining of the colon or rectum) Injuries that damage the large bowel ...

Auxiliary en-bloc liver-small bowel transplantation with partial pancreas preservation in pigs

Institute of Scientific and Technical Information of China (English)

Zhen-Yu Yin; Xiao-Dong Ni; Feng Jiang; Ning Li; You-Sheng Li; Xiao-Ming Wang; Jie-Shou Li

2004-01-01

AIM: The aim of this study was to describe an auxiliary combined liver-small bowel transplantation model with the preservation of duodenum, head of pancreas and hepatic biliary system in pigs. The technique, feasibility, security and immunosuppression were commented.METHODS: Forty outbred long-white pigs were randomized into two groups, and the auxiliary composite liver/small bowel allotransplantations were undertaken in 10 long-white pigs in each group with the recipient liver preserved.Group A was not treated with immunosuppressive drugs while group B was treated with cyclosporine A and methylprednisolone after operation. The hemodynamic changes and amylase of body fluid (including blood, urine and abdominal drain) were analyzed.RESULTS: The average survival time of the animals was 10±1.929 d (6 to 25 d) in group A while more than 30 d in group B. The pigs could tolerate the hemodynamic fluctuation during operation and the hemodynamic parameters recovered to normal 2 h after blood reperfusion. The transient high amylase level was decreased to normal one week after operation and autopsy showed no pancreatitis.CONCLUSION: Auxiliary en-bloc liver-small bowel transplantation with partial pancreas preservation is a feasible and safe model with simplified surgical techniques for composite liver/small bowel transplantation. This model may be used as a preclinical training model for clinical transplantation method, clinical liver-small bowel transplantation related complication research, basic research including immunosuppressive treatment, organ preservation, acute rejection, chronic rejection, immuno-tolerance and xenotransplantation.

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

International Nuclear Information System (INIS)

Ai Songtao; Wang Xiaolin; Gong Gaoquan; Chen Yi; Lin Genlai; Zhang Feng; Li Guoping; Liu Lingxiao

2005-01-01

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(P 0.05) 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)

Advanced imaging techniques for small bowel Crohn's disease: what does the future hold?

Science.gov (United States)

Pita, Inês; Magro, Fernando

2018-01-01

Treatment of Crohn's disease (CD) is intrinsically reliant on imaging techniques, due to the preponderance of small bowel disease and its transmural pattern of inflammation. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most widely employed imaging methods and have excellent diagnostic accuracy in most instances. Some limitations persist, perhaps the most clinically relevant being the distinction between inflammatory and fibrotic strictures. In this regard, several methodologies have recently been tested in animal models and human patients, namely US strain elastography, shear wave elastography, contrast-enhanced US, magnetization transfer MRI and contrast dynamics in standard MRI. Technical advances in each of the imaging methods may expand their indications. The addition of oral contrast to abdominal US appears to substantially improve its diagnostic capabilities compared to standard US. Ionizing dose-reduction methods in CT can decrease concern about cumulative radiation exposure in CD patients and diffusion-weighted MRI may reduce the need for gadolinium contrast. Clinical indexes of disease activity and severity are also increasingly relying on imaging scores, such as the recently developed Lémann Index. In this review we summarize some of the recent advances in small bowel CD imaging and how they might affect clinical practice in the near future.

Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury.

Science.gov (United States)

Hocevar, Barbara; Gray, Mikel

2008-01-01

Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when

Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy. A preliminary study

International Nuclear Information System (INIS)

Dohan, Anthony; Boudiaf, Mourad; Dautry, Raphael; Dray, Xavier; Samaha, Elia; Cellier, Christophe; Camus, Marine; Eveno, Clarisse; Soyer, Philippe

2018-01-01

The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505 mGy.cm; p = 0.002). With VE, a total of 25 polyps >5 mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. (orig.)

Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy. A preliminary study

Energy Technology Data Exchange (ETDEWEB)

Dohan, Anthony [Hopital Lariboisiere - Assistance Publique-Hopitaux de Paris, Department of Body and Interventional Imaging, Paris (France); Universite Sorbonne Paris Cite, Paris Diderot, INSERM UMR 965, Paris (France); Boudiaf, Mourad; Dautry, Raphael [Hopital Lariboisiere - Assistance Publique-Hopitaux de Paris, Department of Body and Interventional Imaging, Paris (France); Dray, Xavier [Department of Digestive Diseases, Hopital Saint-Antoine, Assistance Publique-Hopitaux de Paris, Paris (France); Sorbonne Universite, Paris (France); Samaha, Elia [European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris, Gastroenterology and Endoscopy Unit, Paris (France); Cellier, Christophe [European Georges Pompidou Hospital, Assistance Publique-Hopitaux de Paris, Gastroenterology and Endoscopy Unit, Paris (France); Universite Sorbonne Paris Cite, Paris Descartes, Paris (France); Camus, Marine [Universite Sorbonne Paris Cite, Paris Descartes, Paris (France); Hopital Cochin - Assistance Publique-Hopitaux de Paris, Department of Gastroenterology, Paris (France); Eveno, Clarisse [Universite Sorbonne Paris Cite, Paris Diderot, INSERM UMR 965, Paris (France); Hopital Lariboisiere - Assistance Publique-Hopitaux de Paris, Department of Surgical Oncologic and Digestive Unit, Paris (France); Soyer, Philippe [Universite Sorbonne Paris Cite, Paris Diderot, INSERM UMR 965, Paris (France); Hopital Cochin - Assistance Publique-Hopitaux de Paris, Department of Body and Interventional Imaging, Paris (France)

2018-01-15

The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505 mGy.cm; p = 0.002). With VE, a total of 25 polyps >5 mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. (orig.)

[Microflora of the upper part of the small bowel in healthy Peruvian subjects].

Science.gov (United States)

Vidal-Neira, L; Yi-Chu, A; León Barúa, R

1983-01-01

In 20 healthy Peruvians aerobic cultures were done of upper small bowel contents, obtained following the method of the string capsule or Enterotest, and of faringeal material, obtained doing gargles with sterilized water. In 15 (75%) of the 20 subjects cultures of small bowel contents either were sterile (in 5 subjects, or 25% of the total) or revealed only diverse aerobic germs (in 10 subjects, or 50% of the total), the germs more frequently found being: negative coagulase staphylococcus albus (in 7 subjects, or 35% of the total), alpha hemolytic streptococcus (in 4 subjects, or 20% of the total) and Neisseria catarrhalis (in 4 subjects, or 20% of the total). In 5 (25%) of the 20 subjects, coliform bacteria were found in the upper small bowel (Klebsiella pneumonia in 2, and Escherichia coli in the remaining 3). Of those 5 subjects, only 2 (10% or the total of 20) had the microorganisms exclusively in the bowel, and in both the concentration of germs was 10(4)/ml. On the contrary, the 3 remaining subjects (15% of the total) had coliforms also in the pharynx; in 2 of the 3 subjects the concentration of germs found in the bowel was 10(3)/ml, and, in the remaining one, 10/ml; only one of the 3 subjects presented germs in the pharynx in a greater concentration than in the bowel, while another presented germs in the same concentration in both localizations, and the remaining one presented germs in the bowel in a concentration lower than in the pharynx.(ABSTRACT TRUNCATED AT 250 WORDS)

Supra-transumbilical laparotomy (STL) approach for small bowel ...

African Journals Online (AJOL)

Background: Supra-Transumbilical Laparotomy (STL) has been used in paediatric surgery for a broad spectrum of abdominal procedures. We report our experience with STL approach for small bowel atresia repair in newborns and review previous published series on the topic. Patients and Methods: Fourteen patients with ...

Circulating Zonulin Correlates with Density of Enteroviruses and Tolerogenic Dendritic Cells in the Small Bowel Mucosa of Celiac Disease Patients.

Science.gov (United States)

Vorobjova, Tamara; Raikkerus, Helerin; Kadaja, Lumme; Talja, Ija; Uibo, Oivi; Heilman, Kaire; Uibo, Raivo

2017-02-01

Impaired intestinal integrity, including increased permeability of the small bowel mucosa, has been shown in patients with celiac disease (CD) as well as with type 1 diabetes (T1D). Zonulin (ZO, pre-haptoglobin), a tight junction regulator, plays a particular role in the regulation of intestinal barrier function and in the pathogenesis of the above-mentioned diseases. To investigate whether enteroviruses (EVs) and immunoregulatory cells are associated with intestinal permeability in patients with CD alone and with coexistent T1D. Altogether 80 patients (mean age 10.68 ± 6.69 years) who had undergone small bowel biopsy were studied. Forty patients with functional dyspepsia and normal small bowel mucosa formed the control group. The circulating ZO level in sera was evaluated using ELISA. The densities of EV, FOXP3+ regulatory T cells (Tregs), indoleamine 2,3-dioxygenase (IDO+) dendritic cells (DCs) and glutamic acid dexarboxylase (GAD)65+ cells in small bowel mucosa were investigated by immunohistochemistry. The expression analysis of FOXP3, tight junction protein 1 (TJP1), gap junction (GJA1), IDO and CD103 genes was evaluated by real-time PCR. The ZO level was higher in CD patients compared to subjects with a normal small bowel mucosa, particularly in those with Marsh IIIc atrophy (p = 0.01), and correlated with the density of EV (r = 0.63; p = 0.0003) and IDO+ DCs (r = 0.58; p = 0.01) in the small bowel mucosa. The density of GAD65+ epithelial cells was correlated with the density of EV (r = 0.59; p = 0.03) and IDO+ DCs (r = 0.78; p = 0.004) in CD patients. The relative expression of FOXP3 mRNA in the small bowel mucosa tissue was significantly higher in patients with CD, compared to subjects with a normal mucosa, and correlated with the density of EV (r = 0.62; p = 0.017) as well as with the relative expression of IDO mRNA (r = 0.54; p = 0.019). The CD is associated with elevation of the circulating ZO level, the value of which

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

DEFF Research Database (Denmark)

Halling, Morten Lee; Nathan, Torben; Kjeldsen, Jens

2014-01-01

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

Unusual causes of mechanical small bowel obstruction

International Nuclear Information System (INIS)

Shatnawi, Nawaf J.; Bani-Hani, Kamal E.

2005-01-01

We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients (5 resections were due to bowel strangulation). Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause. (author)

Effects of a 5-HT(3) antagonist, ondansetron, on fasting and postprandial small bowel water content assessed by magnetic resonance imaging.

Science.gov (United States)

Marciani, L; Wright, J; Foley, S; Hoad, C L; Totman, J J; Bush, D; Hartley, C; Armstrong, A; Manby, P; Blackshaw, E; Perkins, A C; Gowland, P A; Spiller, R C

2010-09-01

5-HT(3) antagonists have been shown to be effective in relieving the symptoms of irritable bowel syndrome with diarrhoea (IBS-D). Using a recently validated magnetic resonance imaging (MRI) method, we have demonstrated reduced fasting small bowel water content (SBWC) in IBS-D associated with accelerated small bowel transit. We hypothesized that slowing of transit with ondansetron would lead to an increase in SBWC by inhibiting fasting motility. To assess the effects of ondansetron compared with placebo in healthy volunteers on SBWC and motility in two different groups of subjects, one studied using MRI and another using manometry. Healthy volunteers were given either a placebo or ondansetron on the day prior to and on the study day. Sixteen volunteers underwent baseline fasting and postprandial MRI scans for 270 min. In a second study, a separate group of n = 18 volunteers were intubated and overnight migrating motor complex (MMC) recorded. Baseline MRI scans were carried out after the tube was removed. Fasting SBWC was markedly increased by ondansetron (P fasting SBWC (P fasting small bowel water. This was associated with reduced fasting antroduodenal Motility Index which may explain the clinical benefit of such drugs. 2010 Blackwell Publishing Ltd.

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

International Nuclear Information System (INIS)

Zhang Shizheng; Ren Xiaojun; Zhang Qiaowei

2004-01-01

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

Multifocal small bowel stromal tumours presenting with peritonitis in an HIV positive patient.

Science.gov (United States)

Mansoor, Ebrahim

2014-01-01

The most common mesenchymal tumour of the gastrointestinal tract is stromal tumours (GISTs). Symptomatic GISTs can present with complications such as haemorrhage, obstruction and perforation. Complete surgical resection with negative margins is the mainstay of treatment but may be imprudent on emergent occasion. Tyrosine-kinase inhibitors (TKIs) have been revolutionary in the treatment of GISTs and have resulted in improved outcomes. A 41 year old HIV positive male presented with an acute history of abdominal pain and obstructive symptoms. Clinical examination revealed sepsis and peritonitis. One of the several small bowel tumours discovered at exploratory laparotomy was necrotic and perforated. The perforated tumour alone was resected and a small bowel internal hernia reduced. The patient made an uneventful recovery and will be considered for TKI therapy with a view to later re-operation. GISTs very rarely perforate. The pathophysiology of stromal tumour necrosis is poorly understood. Multifocality and small bowel location are poor prognosticators and may occur in the setting of familial GISTs, specific syndromes and sporadic cases. There is no established association between HIV and GISTs. Perforation occurs infrequently in ≤8% of symptomatic cases and poses increased risk of local recurrence. The surgical management of perforation takes precedence in an emergency. The surgeon must however take cognisance of the adherence to ideal oncologic principles where feasible. TKI therapy is invaluable if a re-exploration is to be later considered. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

Blunt gastric injuries.

Science.gov (United States)

Oncel, Didem; Malinoski, Darren; Brown, Carlos; Demetriades, Demetrios; Salim, Ali

2007-09-01

Gastric rupture after blunt abdominal trauma is a rare injury with few reports in the literature. The purpose of this study was to review our experience with blunt gastric injuries and compare outcomes with small bowel or colon injuries. All patients with hollow viscus perforations after blunt abdominal trauma from 1992 to 2005 at our level I trauma center were reviewed. Of 35,033 blunt trauma admissions, there were 268 (0.7%) patients with a total of 319 perforating hollow viscus injuries, 25 (0.07%) of which were blunt gastric injuries. When compared with the small bowel or colon injuries, the blunt gastric injury group had a higher Injury Severity Score (22 versus 17, P = 0.04), more patients with a chest Abbreviated Injury Score greater than 2 (36% versus 12%, P < 0.01), and a shorter interval from injury to laparotomy (221 versus 366 minutes, P = 0.017). Multivariate analysis identified five independent risk factors for mortality: age older than 55 years, head Abbreviated Injury Score greater than 2, chest Abbreviated Injury Score greater than 2, the presence of hypotension on admission, and Glasgow Coma Scale 8 or less. The results of this study suggest that mortality in patients with blunt hollow viscus injuries can be attributed to concurrent head and chest injuries, but not the specific hollow viscus organ that is injured.

Small bowel volvulus due to torsion of pedunculated uterine leiomyoma: CT findings.

Science.gov (United States)

Guglielmo, Nicola; Malgras, Brice; Place, Vinciane; Guerrache, Youcef; Pautrat, Karine; Pocard, Marc; Soyer, Philippe

Torsion of a uterine leiomyoma is a rare complication that can be life threatening because of ischemia or necrosis. This condition may also lead to gastrointestinal complications such as obstruction or, more rarely, small bowel volvulus. Its diagnosis is difficult and can be facilitated with the use of computed tomography or magnetic resonance imaging. Treatment is based on emergency surgical resection of the twisted uterine leiomyoma and detorsion of the small bowel volvulus. Copyright © 2016 Elsevier Inc. All rights reserved.

Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

Science.gov (United States)

Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

2016-10-01

Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

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

LENUS (Irish Health Repository)

Medani, Mekki

2009-01-01

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

Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses

Science.gov (United States)

Holzner, Philipp Anton; Kulemann, Birte; Kuesters, Simon; Timme, Sylvia; Hoeppner, Jens; Hopt, Ulrich Theodor; Marjanovic, Goran

2011-01-01

AIM: To investigate the influence of remote ischemic preconditioning (RIPC) on anastomotic integrity. METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10) had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34) varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9). On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range). RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg) in the control group. The experimental groups did not show a statistically significant difference (P > 0.05). Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group. CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning. PMID:21455330

Application of small intestine decompression combined with oral feeding in middle and late period of malignant small bowel obstruction.

Science.gov (United States)

Li, Dechun; Du, Hongtao; Shao, Guoqing; Guo, Yongtuan; Lu, Wan; Li, Ruihong

2017-07-01

The application value of small intestine decompression combined with oral feeding in the middle and late period of malignant small bowel obstruction was examined. A total of 22 patients with advanced malignant small bowel obstruction were included in the present study. An ileus tube was inserted via the nose under fluoroscopy into the obstructed small intestine of each patient. At the same time, the insertion depth the of the catheter was adjusted. When the catheter was blocked, small bowel selective angiography was performed to determine the location and cause of the obstruction and the extent of the obstruction, and to determine the length of the small intestine in the site of obstruction, and to select the variety and tolerance of enteral nutrition. We observed the decompression tube flow and ease of intestinal obstruction. In total, 20 patients were treated with oral enteral nutrition after abdominal distension, and 22 cases were treated by the nose to observe the drainage and the relief of intestinal obstruction. The distal end of the catheter was placed in a predetermined position. The symptoms of intestinal obstruction were relieved 1-4 days after decompression. The 22 patients with selective angiography of the small intestine showed positive X-ray signs: 18 patients with oral enteral nutrition therapy had improved the nutritional situation 2 weeks later. In 12 cases, where there was anal defecation exhaust, 2 had transient removal of intestinal obstruction catheter. In conclusion, this comprehensive treatment based on small intestine decompression combined with enteral nutrition is expected to become a new therapeutic approach and method for the treatment of patients with advanced tumor small bowel obstruction.

Late radiation injuries of the gastrointestinal tract in het H2 and H5 EORTC Hodgkin's disease trials

International Nuclear Information System (INIS)

Cosset, J.M.; Henry-Amar, M.; Burgers, J.M.V.; Noordijk, E.Ml.; Van der Schueren, E.

1988-01-01

Out of 516 patients who entered in the two succesive EORTC trials H2 and H5 for supra-diaphragmatic stages I and II Hodgkin's disease (HD), and who received an infra-diaphragmatic irradiation, 36 (7%) developed the late radiation injuries of the gastrointestinal tract (GIT). Twenty-five patients presented with ulcers (stomach or duodenum), 2 with severe gastritis, 6 with small bowel obstruction or perforation and 3 patients had both un ulcer and bowel obstruction. A previous laparotomy played an important role. While the complication rate was 2.7% without any previous abdominal surgery, it was 11.5% after laparotomy (p < 0.001). Fractionation was also found to be of importance in the occurrence of complications: three different weekly schedules were used - 5 x 2 Gy, 4 x 2.5 Gy and 3 x 3.3 Gy; the GIT complication rates were 4, 9 and 22%, respectively (p < 0.001). These data provide new arguments: (1) against the systematic use of laparotomy and splenectomy in the management of HD; (2) against the use of large fraction sizes (superior to 2 Gy) when irradiating those patients

Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

International Nuclear Information System (INIS)

Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I.; Badillo, Andrea T.

2017-01-01

Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

Prenatal magnetic resonance and ultrasonographic findings in small-bowel obstruction: imaging clues and postnatal outcomes

Energy Technology Data Exchange (ETDEWEB)

Rubio, Eva I.; Blask, Anna R.; Bulas, Dorothy I. [Children' s National Medical System, Division of Diagnostic Imaging and Radiology, Washington, DC (United States); Badillo, Andrea T. [Children' s National Medical System, Division of General and Thoracic Surgery, Washington, DC (United States)

2017-04-15

Prenatal small-bowel obstruction can result from single or multiple atresias, and it can be an isolated abnormality or part of a syndrome. It is sometimes the first manifestation of cystic fibrosis. Accurate prediction of the level of obstruction and length of bowel affected can be difficult, presenting a challenge for counseling families and planning perinatal management. To review the prenatal US and MRI findings of small-bowel obstruction and to assess whether fetal MRI adds information that could improve prenatal counseling and perinatal management. We retrospectively reviewed 12 prenatally diagnosed cases of small-bowel obstruction evaluated by both US and MRI from 2005 to 2015. We analyzed gestational age at evaluation, US and MRI findings, gestational age at delivery and postnatal outcomes. The final diagnoses were jejunal atresia (7), ileal atresia (1), cystic fibrosis (3) and combined jejunal and anal atresia (1). Four of the eight with jejunal atresia were found to have multiple small-bowel atresias. Prenatal perforation was noted in three. We identified a trend of increasing complexity of bowel contents corresponding to progressively distal level of obstruction, as indicated by increasing US echogenicity and high T1 signal on MRI. Seven cases of jejunal atresia and one case of ileal atresia demonstrated small ascending, transverse and descending colon (microcolon) with filling of a normal-diameter rectum. In contrast, all three fetuses with cystic fibrosis and the fetus with jejunal-anal atresia demonstrated microcolon as well as abnormal paucity or absence of rectal meconium. Polyhydramnios was present in nine. Eight were delivered prematurely, of whom seven had polyhydramnios. The fetus with jejunal and anal atresia died in utero. Postnatally, three had short gut syndrome, all resulting from multiple jejunal atresias; these three were among a subset of four fetuses whose bowel diameter measured more than 3 cm. Eight infants had no further

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

Directory of Open Access Journals (Sweden)

Amanda D. Rice

2016-01-01

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

Tc-99m sucralfate scanning for inflammatory bowel disease

International Nuclear Information System (INIS)

Lieberman, L.M.; Becker, S.; Mekhmandarov, S.; Steinmetz, A.

1987-01-01

The authors investigated 14 patients with idiopathic inflammatory bowel disease (IBD) by administering Tc-99m sucralfate (TcS) orally and imaging the abdomen 4 and 24 hours after dose. All patients had either barium radiographic studies or colonoscopy before the scan. The scan identified seven of nine patients who had radiologically demonstrated small-bowel lesions and four of five patients with colonic disease. The authors' preliminary experience suggests that TcS maybe a useful procedure to document location and extent of active disease. It provides information about both small and large bowel in one procedure, is noninvasive, easy to perform, and has low radiation absorbed dose

Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury

Science.gov (United States)

Williams, Carolyn S.; Montgomery, Lynnette R.; Willhite, Andrea M.; Angeli, Claudia A.; Harkema, Susan J.

2018-01-01

Objective Locomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs’ pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury). Study design Prospective cohort study; pilot trial with small sample size. Methods Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart. Results Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants. Conclusions These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task

The role of multidetector computed tomography in evaluation of small bowel obstructions

Directory of Open Access Journals (Sweden)

Mehmet Fatih İnci

2013-03-01

Full Text Available Objective: The purpose of the study was to evaluate therole and additional diagnostic contribution of multi-detectorcomputed tomography (MDCT in patients with acuteabdominal pain caused by small bowel obstruction.Materials and methods: A total of 48 patients who admittedto our hospital with acute abdominal pain and underwentMDCT on suspicion of intestinal obstruction and hadabdominal surgery between January 2012 and October2012 were included to our study. MDCT images were interpretedby two experienced radiologist retrospectively.All clinical data and surgery notes also were evaluated.Patients had surgery due to penetrating or blunt abdominalinjury were excluded.Results: Of these 48 patients, 26 (54.1% were male and22 (45.9% were female. Patients’ ages ranged 25 to 71and mean age was 52±5.4 years. The causes of intestinalobstruction of patients were adhesions for 12 (46.1% patients,tumors for 7 (26.9% patients, external hernias for5 (19.2% patients, internal hernia for 1 (3.9% patient andintussusception for 1 (3.9% patient. A total concordancebetween the MDCT findings and definitive diagnosis wasfound in 26 of 23 cases and the sensitivity and specifityof MDCT in the diagnosis of small bowel obstruction werefound to be 88.5% and 90%, respectively.Conclusion: MDCT is a fast, effective and reliable imagingmethod for preoperative diagnosing small bowel obstructioncauses acute abdominal pain with the advantagesof MDCT such as multi-planar and three-dimensionalreformatted imaging.Key words: Acute abdominal pain, multi-detector computed tomography, small bowel obstruction

Small bowel obstruction and perforation after Essure sterilization: a case report.

Science.gov (United States)

Mantel, Hendrik T J; Wijma, Jacobus; Stael, Adrianus P M

2013-01-01

We present a rare but serious complication of Essure microinsert sterilization. Case report. A 42-year-old woman presented with nausea, vomiting, abdominal pain and abdominal distension 1 month after uncomplicated Essure sterilization. Abdominal X-ray showed small bowel obstruction. At subsequent laparotomy, a stretched Essure device was found ensnaring the terminal ileum. It had caused strangulation and local perforation of the bowel wall. The device was removed and an ileocecal resection with side-to-side ileocolostomy was performed. In retrospect, the aberrant location of the right Essure device near the ileocecal junction was noticed on the abdominal X-ray. This case illustrates that perforation of an Essure device can result in a serious complication leading to ileocecal resection. An abdominal X-ray with specific attention to the correct location of the Essure coils is advisable for patients presenting with small bowel obstruction after Essure sterilization. Copyright © 2013 Elsevier Inc. All rights reserved.

Small bowel volvulus in the adult populace of the United States: results from a population-based study.

Science.gov (United States)

Coe, Taylor M; Chang, David C; Sicklick, Jason K

2015-08-01

Small bowel volvulus is a rare entity in Western adults. Greater insight into epidemiology and outcomes may be gained from a national database inquiry. The Nationwide Inpatient Sample (1998 to 2010), a 20% stratified sample of United States hospitals, was retrospectively reviewed for small bowel volvulus cases (International Classification of Diseases, 9th Edition [ICD-9] code 560.2 excluding gastric/colonic procedures) in patients greater than or equal to 18 years old. There were 2,065,599 hospitalizations for bowel obstruction (ICD-9 560.x). Of those, there were 20,680 (1.00%) small bowel volvulus cases; 169 were attributable to intestinal malrotation. Most cases presented emergently (89.24%) and operative management was employed more frequently than nonoperative (65.21% vs 34.79%, P volvulus, our findings provide a robust representation of this rare cause of small bowel obstruction in American adults. Copyright © 2015 Elsevier Inc. All rights reserved.

Bowel Angioedema Associated With Iodinated Contrast Media: Incidence and Predisposing Factors.

Science.gov (United States)

Seo, Nieun; Chung, Yong Eun; Lim, Joon Seok; Song, Mi Kyung; Kim, Myeong-Jin; Kim, Ki Whang

2017-09-01

Bowel angioedema is an acute adverse reaction to iodinated contrast media (CM) that involves the gastrointestinal tract. We aimed to investigate the incidence and predisposing factors of iodinated CM-associated bowel angioedema during computed tomography (CT) examinations. This study was approved by our institutional review board, and informed consent was waived due to its retrospective design. From July 2013 to July 2015, adult patients with a history of adverse reactions to iodinated CM during CT (group A, n = 427) and patients without adverse reactions matched for age and sex with the propensity-score matching method (group B, n = 427) were studied. Contrast media-associated bowel angioedema was determined when bowel wall thickness increased after contrast enhancement compared with the precontrast scan. Potential predisposing factors including patient demographics, symptoms and time of adverse reactions, and CM-related factors were compared between patients with and without angioedema in group A. In addition, the incidence of bowel angioedema was compared between groups A and B. The incidence of CM-associated bowel angioedema in group A was 3.3% (14/427) in the per-patient analysis and 2.6% (15/578) in the per-examination analysis. The CM-associated bowel angioedema involved the distal duodenum and/or proximal jejunum and showed long-segmental circumferential bowel wall thickening on CT. None of the studied predisposing factors was different between patients with and without bowel angioedema (P > 0.05). The incidence of CM-associated bowel angioedema in group B was 1.9% (8/427) and 1.7% (8/458) for per-patient and per-examination analyses, respectively, and these rates were not significantly different between groups A and B (P = 0.346 and P = 0.370, respectively). The incidence of CM-associated bowel angioedema during CT was 1.7% to 3.3%, and none of the studied predisposing factors was associated with bowel angioedema.

Gastric and small intestinal dysfunction in spinal cord injury patients.

Science.gov (United States)

Fynne, L; Worsøe, J; Gregersen, T; Schlageter, V; Laurberg, S; Krogh, K

2012-02-01

Many patients with spinal cord injury (SCI) suffer from constipation, abdominal pain, nausea, or bloating, and colonic transit times are prolonged in most. Gastric and small intestinal dysfunction could contribute to symptoms but remain to be described in detail. Also, it is obscure whether the level of SCI affects gastric and small intestinal function. To study orocecal transit time and gastric emptying (GE) in patients with SCI. Nineteen patients with SCI (7 ♀, median age 54 years) and 15 healthy volunteers (9 ♀, median age 32 years) were included. All were referred because of neurogenic bowel problems. Eleven patients had low SCI (located at conus medullaris or cauda equina) affecting only the parasympathetic nerves to the left colon and eight had high SCI (above Th6) affecting parasympathetic and sympathetic innervation. Subjects ingested a small magnetic pill that subsequently was tracked by the Motility Tracking System - MTS-1 (Motilis, Lausanne, Switzerland). Orocecal transit time was longer than normal both in individuals with high lesions (P < 0.01) and in individuals with low lesions (P < 0.01). Individuals with high lesions had slower GE than those with conal/cauda equina lesions (P < 0.05). Basic contractile frequencies of the stomach and small intestine were unaffected by SCI. Surprisingly, upper gastrointestinal transit is prolonged in subjects with SCI suffering from bowel problems, not only in subjects with cervical or high thoracic lesions but also in subjects with conal/cauda equina lesions. We speculate that this is secondary to colonic dysfunction and constipation. © 2011 John Wiley & Sons A/S.

Rectal cancer and inflammatory bowel disease: natural history and implications for radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Green, Sheryl; Stock, Richard; Greenstein, Adrian

1995-07-01

compared to 0% for patients with N1 - N3 disease (P < 0.0001). An analysis of high risk patients (30) with T3-T4 or N1 - N3 disease revealed at 5 years on OS of 9%, a DFS of 10%, a PC rate of 26% and FFDF of 20%. In this subset of patients, there was a trend toward improved pelvic control in patients receiving radiation therapy (14) with a 5 year PC of 60% compared to a rate of 23% for those patients not irradiated (16) (p=0.59). Acute complications (grade 3 or >) were noted in 3 patients (20%) receiving radiation therapy and these included two cases of grade 3 skin reactions and one case of grade 4 gastro-intestinal toxicity. Two patients (13%) developed small bowel obstruction at 2 and 4 months, respectively, post-irradiation which were managed conservatively. There were no long term complications in patients irradiated. CONCLUSION: Treatment results are comparable to those historically reported for non-inflammatory bowel disease related rectal cancer although the subset of high risk patients appeared to have a poorer outcome. In light of this finding and the ability of patients with inflammatory bowel disease to tolerate pelvic irradiation, high risk patients should be treated aggressively with chemotherapy and radiation therapy.

Reduction of acute rejection by bone marrow mesenchymal stem cells during rat small bowel transplantation.

Directory of Open Access Journals (Sweden)

Yang Yang

Full Text Available Bone marrow mesenchymal stem cells (BMMSCs have shown immunosuppressive activity in transplantation. This study was designed to determine whether BMMSCs could improve outcomes of small bowel transplantation in rats.Heterotopic small bowel transplantation was performed from Brown Norway to Lewis rats, followed by infusion of BMMSCs through the superficial dorsal veins of the penis. Controls included rats infused with normal saline (allogeneic control, isogeneically transplanted rats (BN-BN and nontransplanted animals. The animals were sacrificed after 1, 5, 7 or 10 days. Small bowel histology and apoptosis, cytokine concentrations in serum and intestinal grafts, and numbers of T regulatory (Treg cells were assessed at each time point.Acute cellular rejection occurred soon after transplantation and became aggravated over time in the allogeneic control rats, with increase in apoptosis, inflammatory response, and T helper (Th1/Th2 and Th17/Treg-related cytokines. BMMSCs significantly attenuated acute cellular rejection, reduced apoptosis and suppressed the concentrations of interleukin (IL-2, IL-6, IL-17, IL-23, tumor necrosis factor (TNF-α, and interferon (IFN-γ while upregulating IL-10 and transforming growth factor (TGF-β expression and increasing Treg levels.BMMSCs improve the outcomes of allogeneic small bowel transplantation by attenuating the inflammatory response and acute cellular rejection. Treatment with BMMSCs may overcome acute cellular rejection in small bowel transplantation.

Seat belt injuries and sigmoid colon trauma.

OpenAIRE

Eltahir, E M; Hamilton, D

1997-01-01

Colonic seat belt injuries are rare but carry higher mortality rates than small bowel injuries. The case of a 44 year old man is described who had severe sigmoid colon compression injury from his seat belt a few days after a road traffic accident.

Sequential stenotic strictures of the small bowel leading to obstruction

Institute of Scientific and Technical Information of China (English)

无

2007-01-01

Small bowel obstructions (SBOs) are primarily caused by adhesions, hernias, neoplasms, or inflammatory strictures. Intraluminal strictures are an uncommon cause of SBO. This report describes our findings in a unique case of sequential, stenotic intraluminal strictures of the small intestine, discusses the differential diagnosis of intraluminal intestinal strictures, and reviews the literature regarding intraluminal pathology.

Successful Mitigation of Delayed Intestinal Radiation Injury Using Pravastatin is not Associated with Acute Injury Improvement or Tumor Protection

International Nuclear Information System (INIS)

Haydont, Valerie; Gilliot, Olivier; Rivera, Sofia; Bourgier, Celine; Francois, Agnes; Aigueperse, Jocelyne; Bourhis, Jean; Vozenin-Brotons, Marie-Catherine

2007-01-01

Purpose: To investigate whether pravastatin mitigates delayed radiation-induced enteropathy in rats, by focusing on the effects of pravastatin on acute cell death and fibrosis according to connective tissue growth factor (CTGF) expression and collagen inhibition. Methods and Materials: Mitigation of delayed radiation-induced enteropathy was investigated in rats using pravastatin administered in drinking water (30 mg/kg/day) 3 days before and 14 days after irradiation. The ileum was irradiated locally after surgical exteriorization (X-rays, 19 Gy). Acute apoptosis, acute and late histologic alterations, and late CTGF and collagen deposition were monitored by semiquantitative immunohistochemistry and colorimetric staining (6 h, 3 days, 14 days, 15 weeks, and 26 weeks after irradiation). Pravastatin antitumor action was studied in HT-29, HeLa, and PC-3 cells by clonogenic cell survival assays and tumor growth delay experiments. Results: Pravastatin improved delayed radiation enteropathy in rats, whereas its benefit in acute and subacute injury remained limited (6 h, 3 days, and 14 days after irradiation). Delayed structural improvement was associated with decreased CTGF and collagen deposition but seemed unrelated to acute damage. Indeed, the early apoptotic index increased, and severe subacute structural damage occurred. Pravastatin elicited a differential effect, protecting normal intestine but not tumors from radiation injury. Conclusion: Pravastatin provides effective protection against delayed radiation enteropathy without interfering with the primary antitumor action of radiotherapy, suggesting that clinical transfer is feasible

Prevention of ionizing radiation injuries

International Nuclear Information System (INIS)

Suzuki, Masashi

1976-01-01

In the first age (1895 - 1940), radiation injuries of skin (75% of death caused by RI injury) and chronic radiation injury of heamatopoietic organs (almost remains) appeared in radiologist and people engaged in RI treatment for medical use, and Ra poisoning appeared in workers who treated aluminous paint. As prevention of radiation injuries in this age, measurement of radiation dose, shelter effect and finding of injuries were studied, and internal radiation allowed level was determined. From 1942 to 1960, acute RI injuries due to exposure of large amount of RI by an accident and secondary leukemia appeared to workers of atomic-bomb industries and researcher of atomic energy. U and Pu poisoning accompanied with development of nuclear fuel industry appeared. This expanded industrial hygiene of this age together with epidemiological data of atomic-bomb exposed people. From 1960 onward, it is an age of industry for peaceful use of atomic energy, and manifestation of various kinds of delayed injuries, especially malignant tumor due to RI exposure, is recognized. Labourer has many opportunity to encounter dangerously with pollution and injuries by RI, and regional examination of RI enterprise and countermeasure to decrease exposure dose were mentioned as future theme from a viewpoint of exposure dose of nation. (Kanao, N.)

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

International Nuclear Information System (INIS)

Lepage-Saucier, Marianne; Tang, An; Billiard, Jean-Sebastien; Murphy-Lavallee, Jessica; Lepanto, Luigi

2010-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2010-04-15

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

Long-term bladder and bowel management after spinal cord injury: a 20-year longitudinal study.

Science.gov (United States)

Savic, Gordana; Frankel, Hans L; Jamous, Mohamed Ali; Soni, Bakulesh M; Charlifue, Susan

2018-02-16

Prospective observational. The aim of this study was to analyse changes in bladder and bowel management methods in persons with long-standing spinal cord injury (SCI). Two spinal centres in UK. Data were collected through interviews and examinations between 1990 and 2010 in a sample of persons injured more than 20 years prior to 1990. For the 85 participants who completed the 2010 follow-up, the mean age was 67.7 years and the mean duration of injury was 46.3 years, 80% were male, 37.7% had tetraplegia AIS grade A, B, or C, 44.7% paraplegia AIS A, B, or C, and 17.6% an AIS D grade regardless of level. In all, 50.6% reported having changed their bladder method, 63.1% their bowel method, and 40.5% both methods since they enroled in the study. The reasons for change were a combination of medical and practical. In men, condom drainage remained the most frequent bladder method, and in women, suprapubic catheter replaced straining/expressing as the most frequent method. The use of condom drainage and straining/expressing bladder methods decreased, whereas the use of suprapubic and intermittent catheters increased. Manual evacuation remained the most frequent bowel management method. The percentage of participants on spontaneous/voluntary bowel emptying, straining and medications alone decreased, whereas the use of colostomy and transanal irrigation increased over time. More than half the sample, all living with SCI for more than 40 years, required change in their bladder and bowel management methods, for either medical or practical reasons. Regular follow-ups ensure adequate change of method if/when needed.

Small bowel obstruction following perforation of the uterus at ...

African Journals Online (AJOL)

BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had ...

A radiologist's guide to small bowel and multivisceral transplantation

International Nuclear Information System (INIS)

Godfrey, E.M.; Upponi, S.S.; See, T.C.; Cheow, H.K.; Sivaprakasam, R.; Butler, A.J.; Whitley, S.

2013-01-01

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

Gallstone Ileus: An Unlikely Cause of Mechanical Small Bowel Obstruction

Directory of Open Access Journals (Sweden)

Estela Abich

2017-06-01

Full Text Available Gallstone ileus is a rare disease that accounts for 1–4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal fistula, pneumobilia, and small bowel obstruction. Emergent laparotomy with a one-stage procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. The postoperative course was uneventful until postoperative day 4 when the patient was found tachycardic, lethargic, and unresponsive. We reviewed the literature on the diagnosis and treatment of gallstone ileus.

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

Directory of Open Access Journals (Sweden)

Awad Al Qahtani

2012-06-01

Full Text Available Small bowel obstruction is a known complication of Crohn’s disease. Determining need for operation is a demanding task. The aim of this study was to fine tune the decision-making process by evaluating standard clinical and laboratory parameters in small bowel obstruction of any cause and compare etiologies. Consecutive patients with Crohn’s disease and small bowel obstruction were selected retrospectively and compared to a randomly selected group of non Crohn’s patients with obstruction over a 9 year period. Twenty-two clinical, laboratory and radiological variables were assessed for the following outcomes: i diagnosis of Crohn’s; ii operative or non operative treatment in Crohn’s; iii operative or non operative treatment without Crohn’s; iv exacerbation or adhesions causing obstruction among Crohn’s patients. Multivariable models were developed for each outcome using logistic regression. Age less than 50, history of smoking, Jewish ethnicity, white count >11x10E9, neutrophils >7.5x10E9 and platelet volume <9.9 fL, supported the diagnosis of Crohn’s disease. Operation in Crohn’s disease within the same admission was associated with a history of smoking, temperature >38˚, high pulse >100, leukocytosis (>11x10E9 and obstruction on abdominal scan, while operation in patients without Crohn’s in the sentinel admission, was associated with temperature >38˚, tachycardia, leukocytosis (>11x10E9 and previous operation. Confirmation of these predictive patterns in a validation group could help in clinical decisions regarding therapeutic options in an emergency setting.

A study of diagnosis and manegement of mechanical small-bowel obstruction

International Nuclear Information System (INIS)

Kawasaki, Masayasu; Kurumi, Yoshimasa; Naitoh, Hiroyuki

2007-01-01

We tried to clarify the most appropriate management for simple bowel obstruction and effective methods for diagnosis of strangulated bowel obstruction. Consecutive 252 cases of mechanical small-bowel obstruction treated in the hospital from 2000 to 2005 were assessed retrospectively. There were 219 cases of simple obstructions and 33 cases of strangulated obstruction. Seventy-eight percent of simple obstruction cases were treated conservatively (fasting in 82, decompression tube treatment in 88 and operation in 49). The average duration for indwelling the decompression tube was 5.2 days and the amount of discharge from the tube decreased day by day. In the cases of operation, the operation was performed on the 4.5th day after admission on the average, and the average amount of tube discharge before the operation was more than 450 ml/day. On the other hand, strangulation was most frequently diagnosed by enhanced abdominal CT scan, followed by physical examination, and the properties of decompression tube discharge in this order, and the blood data were only used for reference. Simple small-bowel obstruction should be treated by surgical therapy if symptomatic remission could not be gained by five days after beginning of the treatment. Enhanced abdominal CT scan is the most useful method for diagnosis of strangulation in an early stage of ischemia. (author)

The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

International Nuclear Information System (INIS)

Grassi, Roberto; Romano, Stefania; D'Amario, Fenesia; Giorgio Rossi, Antonio; Romano, Luigia; Pinto, Fabio; Di Mizio, Roberto

2004-01-01

Introduction: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. Materials and methods: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. Results: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid

The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults

Energy Technology Data Exchange (ETDEWEB)

Grassi, Roberto; Romano, Stefania E-mail: stefromano@libero.it; D' Amario, Fenesia; Giorgio Rossi, Antonio; Romano, Luigia; Pinto, Fabio; Di Mizio, Roberto

2004-04-01

Introduction: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation of the intestinal loops, however recently some Authors attested the increasing important role of sonography in the acute abdominal disease. Aim of our report is to demonstrate the value of free fluid detected by US in differentiating between low and high-grade small bowel obstruction. Materials and methods: The study is based on 742 consecutive patients who presented symptoms of the acute abdomen; all patients had undergone initial serial abdominal plain film and US examinations prior to any medical intervention. We reviewed the imaging findings of 150 cases in whom small bowel obstruction was clinically suspected and confirmed at surgery. We consider the following radiographic and US findings: dilatation of small bowel loops; bowel wall thickness; presence of air-fluid levels; thickness of valvulae conniventes; evidence of peristalsis; presence and echogenicity of extraluminal fluid. We looked at the value of extraluminal peritoneal fluid at US examination in differentiating low and high-grade small bowel obstruction based on the surgical outcome. Results: In 46 patients altered peristaltic activity, thin bowel walls, fluid filled loops with hyperechoic spots in the bowel segment proximal to obstruction were noted at US, whereas radiographic features were: moderate dilatation of small bowel loops, with thin bowel wall and evidence of numerous and subtle valvulae conniventes; presence of air-fluid levels was also noted. In 70 other patients, US examination revealed all the findings described in the precedent cases and also the presence of free extraluminal fluid

Imaging of small bowel-related complications following major abdominal surgery

International Nuclear Information System (INIS)

Sandrasegaran, Kumaresan; Maglinte, Dean D.T.

2005-01-01

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

Radiation injury to the nervous system

International Nuclear Information System (INIS)

Gutin, P.H.; Leibel, S.A.; Sneline, G.E.

1991-01-01

This book is designed to describe to the radiation biologist, radiation oncologist, neurologist, neurosurgeon, medical oncologist, and neuro-oncologist, the current state of knowledge about the tolerance of the nervous system to various kinds of radiation, the mechanisms of radiation injury, and how nervous system tolerance and injury are related to the more general problem of radiation damage to normal tissue of all types. The information collected here should stimulate interest in and facilitate the growing research effort into radiation injury to the nervous system

Radiation-induced heart injury

International Nuclear Information System (INIS)

Suzuki, Yoshihiko; Niibe, Hideo

1975-01-01

In order to identify radiation-induced heart injury and to differentiate it from heart disease, an attempt was made to clarify post-irradiation heart injury by investigating the histological changes which occur during the internal between the irradiation and the time of demonstrable histological changes. A study was made of 83 autopsies in which most of the primary neoplasms were breast cancers, lung cancers and mediastinal tumors. In 43 of these autopsies the heart had been irradiated. Sixty eight dd-strain mice were also used for microautoradiographic study. Histological changes in the heart were observed in 27 of the 43 cases receiving irradiation. The limit of the tolerance dose to the heart for indicating histological changes was 1220 ret in humans. The latent period without histological changes was 2.7 months after initiation of radiation therapy. Greater heart injury was observed after re-irradiation or after the combined therapy of radiation and chemotherapy especially mitomycin (MMC). The histological findings after treatment with MMC were similar to those of radiation-induced heart injury. Results of the study indicate that the damage is secondary to radiation-induced changes of the vascula connective tissue. (Evans, G.)

Epidemiology of small-bowel obstruction beyond the neonatal period

African Journals Online (AJOL)

Background The aim of this study was to evaluate the etiologies causing intestinal obstruction beyond the neonatal period. Patients and methods An observational study was conducted on children between 1 month and 17 years of age who underwent surgery for small-bowel obstruction. (SBO) at this tertiary referral center ...

Radiation enteritis

International Nuclear Information System (INIS)

Ochsner, S.F.; Head, L.H.

1973-01-01

A comprehensive review of radiation enteritis is presented. Experience in clinical radiation therapy has indicated that the small bowel is the segment of the alimentary tract that is most susceptible to radiation damage. (U.S.)

Fetal small bowel volvulus without malrotation: the whirlpool & coffee bean signs.

Science.gov (United States)

Jakhere, S G; Saifi, S A; Ranwaka, A A

2014-01-01

Intestinal volvulus is a common condition seen in infancy and adulthood, but small bowel volvulus is a rare condition affecting the fetus in utero. Very few cases have been reported describing the ultrasound findings of the same. We present a case report of a case of intestinal volvulus which was diagnosed prenatally based on the ultrasound features of whirlpool sign and coffee bean sign. An emergency caesarian section was performed, small bowel volvulus was confirmed on post-natal ultrasound, and the neonate was subsequently operated. Although these signs have been separately described previously in the literature, in our case both these signs were seen in the same patient. Our case is a rare presentation with the occurrence of volvulus without malrotation, the contrary being more common.

Radiation Injury to the Brain

Science.gov (United States)

... Hits since January 2003 RADIATION INJURY TO THE BRAIN Radiation treatments affect all cells that are targeted. ... fractions, duration of therapy, and volume of [healthy brain] nervous tissue irradiated influence the likelihood of injury. ...

Radiation injuries in atomic bomb survivors, chapter 2

International Nuclear Information System (INIS)

Anon.

1979-01-01

Atomic bombs, for the first time in human history, were dropped on Hiroshima in August 6, and on Nagasaki on August 9, 1945. Though the powers of these bombs were small as compared with those of present day nuclear weapons, the atomic bombs claimed many lives instantaneously, damaged human bodies, and destroyed all objects, annihilating the urban areas. Even today, the dreadful consequences of the bombings still remain in both body and mind of the victims. Meanwhile, the experiences of atomic bomb disasters are fading constantly. In order to maintain the vivid information, in Part 2 ''Bodily injuries'', the following matters are described: early bodily injuries such as burns, (blast) external wounds, radiation injuries, and pathology in bodily injuries; later bodily injuries such as keloids, injuries to blood and eyes, injuries in exposed women, injuries in growth, aging and life, injuries in mental/nervous system, malignant tumors, and changes in chromosomes; and genetic effects. (J.P.N.)

Increased Expression of Toll-Like Receptors 4, 5, and 9 in Small Bowel Mucosa from Patients with Irritable Bowel Syndrome

Directory of Open Access Journals (Sweden)

Aldona Dlugosz

2017-01-01

Full Text Available The aim of our study was to compare patients with irritable bowel syndrome (IBS and healthy controls regarding the expression of toll-like receptors 2, 4, 5, and 9 (TLR2, TLR4, TLR5, and TLR9, the primary mucosal receptors of bacterial components, in small and large bowel mucosa. Methods. We analysed biopsies from jejunum and sigmoid colon of 22 patients (17 females with IBS aged 18–66 (median: 39 years and 14 healthy volunteers (12 females aged 22–61 (median: 42 years. Eight patients had constipation-predominant IBS (C-IBS, 7 had diarrhoea-predominant IBS (D-IBS, and 7 had IBS without predominance of constipation or diarrhoea. We analysed mRNA levels for TLRs using quantitative PCR and distribution of TLRs in mucosa using immunohistochemistry. Results. We found increased mRNA expression of TLR4 (mean fold change 1.85±0.31 versus 1.0±0.20; p<0.05, TLR5 (1.96±0.36 versus 1.0±0.20; p<0.05 and TLR9 (2.00±0.24 versus 1.0±0.25; p<0.01 but not of TLR2 in the small bowel mucosa from patients with IBS compared to the controls. There was no significant difference in mRNA levels for TLRs in colon mucosa between patients and controls. Conclusion. Upregulation of TLR4, TLR5, and TLR9 suggests the involvement of bacteria or dysregulation of the immune response to commensal flora in small bowel mucosa in IBS patients.

[Experimental model of severe local radiation injuries of the skin after X-rays].

Science.gov (United States)

Kotenko, K V; Moroz, B B; Nasonova, T A; Dobrynina, O A; LIpengolz, A A; Gimadova, T I; Deshevoy, Yu B; Lebedev, V G; Lyrschikova, A V; Eremin, I I

2013-01-01

The experimental model of severe local radiation injuries skin under the influence of a relatively soft X-rays on a modified device RAP 100-10 produced by "Diagnostica-M" (Russia) was proposed. The model can be used as pre-clinical studies in small experimental animals in order to improve the treatment of local radiation injuries, especially in the conditions of application of cellular therapy.

Ageing with neurogenic bowel dysfunction

DEFF Research Database (Denmark)

Nielsen, S D; Faaborg, Pia Møller; Finnerup, Nanna Brix

2017-01-01

The aim of this longitudinal study with postal survey was to describe changes in the patterns of neurogenic bowel dysfunction and bowel management in a population of people with spinal cord injury (SCI) followed for two decades. In 1996, a validated questionnaire on bowel function was sent to the...

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

International Nuclear Information System (INIS)

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

1986-01-01

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

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

Directory of Open Access Journals (Sweden)

Mohamed Moftah

2012-08-01

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.

Unusual Case Report of Thrombotic Microangiopathy of the Small Bowel Following Liver Transplantation, a Possible Immunosuppressant-Induced Disease with Histological and Ultrastructural Findings

Directory of Open Access Journals (Sweden)

Domenico Piscitelli

2009-01-01

Full Text Available Cyclosporin-A (CsA and tacrolimus (FK-506 are immunomodulating agents used to prevent rejection in organ transplantation. They are both associated with several side effects, including nephrotoxicity and severe hypertension due to vascular injury, which often appears as a microvascular occlusive disorder (thrombotic microangiopathy, TMA. We report the first case of a microvascular occlusive disorder with the features of TMA in the small bowel of an orthotopic liver transplant (OLT patient after immunosuppressive therapy with CsA and FK506. The patient presented with severe recurrent abdominal colics and distal subocclusion, requiring aggressive surgical treatment. Histological and ultrastructural analysis of the resected specimen disclosed intestinal TMA. Although rare, such a complication should be considered in the differential diagnosis of abdominal colics in patients undergoing immunosuppressant therapy after OLT.

Blind bedside insertion of small bowel feeding tubes.

LENUS (Irish Health Repository)

Duggan, SN

2009-12-01

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

Changing aspects of radiation enteropathy

International Nuclear Information System (INIS)

Morgenstern, L.; Hart, M.; Lugo, D.; Friedman, N.B.

1985-01-01

Fifty-two patients with radiation enteropathy secondary to radiation for abdominal or pelvic malignant neoplasms are described. This series (1977 to 1984) is compared with a series of 50 patients from the same institution over an earlier period (1961 to 1977). Intestinal obstruction was the principal complication in both series; 96% of the patients underwent either intestinal resection or anastomotic bypass of the affected segment. Changes that have occurred since the last report are as follows: changes in source of radiation energy (linear accelerator); less evidence of mucosal damage; increased serosal reaction (''serosal peel''); and increased use of elemental diets, parenteral nutrition, and long intestinal tubes in surgical management. Since postoperative radiation injury occurs most frequently in the pelvis, new developments for the exclusion of small bowel from the pelvis during radiation are reviewed. Changes in fractionation of radiation dosage should also be considered in patients with enteric symptoms during radiation therapy

Multiphasic MDCT in small bowel volvulus

International Nuclear Information System (INIS)

Feng Shiting; Chan Tao; Sun Canhui; Li Ziping; Guo Huanyi; Yang Guangqi; Peng Zhenpeng; Meng Quanfei

2010-01-01

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.

Multiphasic MDCT in small bowel volvulus

Energy Technology Data Exchange (ETDEWEB)

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

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.

Effect of prolonged general anesthesia with sevoflurane and laparoscopic surgery on gastric and small bowel propulsive motility and pH in dogs.

Science.gov (United States)

Boscan, Pedro; Cochran, Shannon; Monnet, Eric; Webb, Craig; Twedt, David

2014-01-01

To determine if general anesthesia with sevoflurane and laparoscopic surgery changed gastric and small bowel propulsive motility or pH in dogs. Prospective, controlled trial. Twelve, 19-24 months old, female, Treeing Walker Hound dogs, weighing 23-30 kg. Dogs were anesthetized for a median of 8.5 hours during another study to determine the minimum alveolar concentration of sevoflurane using a visceral stimulus. Gastric and small bowel motility were determined using a sensor capsule that measures pressure, pH and temperature. Gastric transit time and motility index were calculated. For 8/12 dogs, gastric motility, pH and transit time were measured. In 4/12 dogs, small bowel motility and pH were measured. Anesthesia decreased gastric and small bowel motility but did not change luminal pH. Mean gastric contraction force decreased from median (range) 11 (8-20) to 3 (1-10) mmHg (p < 0.01) and gastric motility index decreased from 0.63 (0-1.58) to 0 (0-0.31; p = 0.01). Frequency of contractions did not change, 3.7 (1.6-4.4) versus 2.8 (0.1-5.1) contractions minute(-1) (p = 0.1). Gastric motility returned to normal 12-15 hours following anesthesia. Gastric emptying was prolonged from 12 (5.3-16) to 49 (9.75-56.25) hours (p < 0.01). Mean small bowel contraction force decreased from 34 (24-37) to 3 (0.9-17) mmHg (p < 0.02) and motility index decreased from 3.75 (1-4.56) to 0 (0-1.53; p = 0.02). Frequency of contractions did not change, 0.5 (0.3-1.4) versus 1.4 (0.3-4.6) contractions minute(-1) (p = 0.11). Small bowel motility returned within 2 hours after anesthesia. Laparoscopy did not result in changes to gastric or small bowel parameters beyond those produced by general anesthesia. The force of gastric and small bowel contractions decreased during sevoflurane anesthesia for laparoscopy. Although gastric motility returned to normal within 12-15 hours the impairment of gastric emptying lasted 30-40 hours, predisposing dogs to postoperative ileus. �

Transient angioedema of small bowel secondary to intravenous iodinated contrast medium

Directory of Open Access Journals (Sweden)

Kirankumar N Kulkarni

2014-01-01

Full Text Available We report the clinical details and imaging findings of a case of transient angioedema of the small bowel following intravenous administration of non-ionic iodinated contrast material in a 17 year old female with no predisposing risk factors. Findings included long segment, symmetric, circumferential, low-density, bowel wall thickening involving the duodenum, jejunum, and most of the ileum on computed tomography scan obtained at 7 min following intravenous contrast material injection. This entity is self-limiting with a favourable clinical outcome and requires no specific treatment but only aggressive clinical monitoring.

Carcinoma of the large bowel after a single massive dose of radiation in healthy teenagers

International Nuclear Information System (INIS)

Rotmensch, S.; Avigad, I.; Soffer, E.E.; Horowitz, A.; Bar-Meir, S.; Confino, R.; Czerniak, A.; Wolfstein, I.

1986-01-01

Three healthy teenagers were exposed to a single pelvic x-ray irradiation as part of sterilization experiments performed in the Auschwitz concentration camp in 1943. Single and multiple carcinomas of the colon and rectum developed 40 years later in the radiation field. Histologic examination of surgical specimens revealed severe radiation-induced changes in all layers of tumor-adjacent areas. In contrast to previous reports of radiation-induced large bowel cancers, these women had not undergone repeated courses of radiation, had no known co-existing disease that might raise the risk for colonic and rectal malignancies, and had an extremely long and remarkably similar latency period. These cases emphasize the need for long-term surveillance in previously radiated patients. Since thousands of teenagers were subjected to similar sterilization experiments, awareness of this association might help in the early diagnosis of additional cases

Radiation injury in the digestive system after radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Horie, Y; Mishima, Y; Hara, K; Tomiyama, J; Nakano, H [Tokyo Univ. (Japan). Faculty of Medicine

1975-03-01

This paper described the investigation of 18 patients with injury in the digestive system who received surgical procedure after radiotherapy of cancer for the past ten years. The patients consisted of 6 males and 12 females with the age ranging 21 to 66 years old. Primary diseases were 9 cancers of the cervix of the uterus, seminoma and cancer of the ovary, the rectum and the other regions. Radiotherapy was applicable to each of the diseases, and more than 3,000 rads of irradiation given for over a month. Symptoms developed 3 months to 4 and a half years after irradiation and the mean period was about a year except one patient in whom cancer of the colon occurred after 13 years. Operation was performed about several months after the onset of disease in the average. Of 18 patients who received operation, cancer was suspected at preoperative diagnosis in all of 3 patients in whom gastric lesion was resected, 3 of 4 in whom the colon was resected, 1 with small intestine lesion and 1 of 4 with rectum lesion. It was characteristic of these lesions that recurrence of cancer was preoperatively suspected in most of the patients. In the patient with rectum lesion, steroids suppository was given postoperatively. In addition, historical background of radiation injury, difference in period of the occurrence of radiation injury, local injury in delayed period, predisposing cause, classification, symptoms, diagnosis and treatment of radiation injury were also mentioned.

Radiation injury in the digestive system after radiotherapy

International Nuclear Information System (INIS)

Horie, Yoshiaki; Mishima, Yoshio; Hara, Kosuke; Tomiyama, Jiro; Nakano, Haruo

1975-01-01

This paper described the investigation of 18 patients with injury in the digestive system who received surgical procedure after radiotherapy of cancer for the past ten years. The patients consisted of 6 males and 12 females with the age ranging 21 to 66 years old. Primary diseases were 9 cancers of the cervix of the uterus, seminoma and cancer of the ovary, the rectum and the other regions. Radiotherapy was applicable to each of the diseases, and more than 3,000 rads of irradiation given for over a month. Symptoms developed 3 months to 4 and a half years after irradiation and the mean period was about a year except one patient in whom cancer of the colon occurred after 13 years. Operation was performed about several months after the onset of disease in the average. Of 18 patients who received operation, cancer was suspected at preoperative diagnosis in all of 3 patients in whom gastric lesion was resected, 3 of 4 in whom the colon was resected, 1 with small intestine lesion and 1 of 4 with rectum lesion. It was characteristic of these lesions that recurrence of cancer was preoperatively suspected in most of the patients. In the patient with rectum lesion, steroids suppository was given postoperatively. In addition, historical background of radiation injury, difference in period of the occurrence of radiation injury, local injury in delayed period, predisposing cause, classification, symptoms, diagnosis and treatment of radiation injury were also mentioned. (Kanao, N.)

High-output stoma after small-bowel resections for Crohn's disease.

Science.gov (United States)

Tsao, Stephen K K; Baker, Melanie; Nightingale, Jeremy M D

2005-12-01

A 56-year-old Caucasian woman with a history of Crohn's disease and multiple bowel resections resulting in a loop jejunostomy was referred to our Nutritional Unit from a neighboring district general hospital for further management. She was first seen in October 2001, and initial assessment indicated that she was malnourished with fluid depletion, evidenced by the high volume of stomal fluid produced. There had been no sudden change in her medication, her Crohn's disease was quiescent and there was no evidence of any intra-abdominal sepsis. Despite a high calorific intake through her diet, she continued to lose weight. Serum urea and electrolytes; magnesium; C-reactive protein; full blood count; urinary spot sodium; anthropometric measurements. High-output stoma with malabsorption as a consequence of repeated small-bowel surgery. The patient was treated with oral hypotonic fluid restriction (0.5 l/day), 2 l of oral glucose-saline solution per day, high-dose oral antimotility agents (loperamide and codeine phosphate), a proton-pump inhibitor (omeprazole) and oral magnesium replacement. A year later, the patient's loop jejunostomy was closed and an end ileostomy fashioned, bringing an additional 35 cm of small bowel into continuity; macronutrient absorption improved but her problem of dehydration was only slightly reduced. She was stabilized on a twice-weekly subcutaneous magnesium and saline infusion and daily oral 1alpha-hydroxycholecalciferol.

Radiation injury

International Nuclear Information System (INIS)

Hubner, K.F.

1988-01-01

Radiation accidents and incidents continue to be of great interest and concern to the public. Issues such as the threat of nuclear war, the Chernobyl reactor accident, or reports of sporadic incidences of accidental radiation exposure keep this interest up and maintain a high level of fear among the public. In this climate of real concern and radiation phobia, physicians should not only be prepared to answer questions about acute or late effects of ionizing radiation, but also be able to participate in the initial assessment and management of individuals who have been exposed to ionizing radiation or contaminated with radioactive material. Some of the key facts about radiation injury and its medical treatment are discussed by the author

New Evidence on the Impact of Antithrombotics in Patients Submitted to Small Bowel Capsule Endoscopy for the Evaluation of Obscure Gastrointestinal Bleeding

Directory of Open Access Journals (Sweden)

Pedro Boal Carvalho

2014-01-01

Full Text Available Objectives. Small bowel capsule endoscopy (SBCE plays a decisive role in the obscure gastrointestinal bleeding (OGIB diagnosis. Antithrombotics may increase bleeding risk in patients with preexistent lesions or through direct mucosal aggression. We aimed to correlate antithrombotics usage with lesions with bleeding potential found in SBCE. Methods. Retrospective single-center study including 274 consecutive SBCE performed over 7 years for OGIB. The lesions were classified as P0 (no bleeding potential, P1 (uncertain bleeding potential: erosions, and P2 (high bleeding potential: angioectasias, ulcers, and tumors. We assessed antiplatelet and anticoagulant drug use during the 60 days preceding SBCE. Results. One-third of the patients were under antithrombotic therapy. The diagnostic yield of SBCE for P2 lesions was 30.0%. Angioectasias (20.4% were the most frequently observed lesions. There was a significant correlation between anticoagulant drug use and a higher incidence of P2 lesions in the small bowel (43.2% versus 26.5%; OR = 2.11, P=0.026. We found no significant correlation between antiplatelets and lesions with bleeding potential in SBCE. Conclusions. Small bowel lesions with high bleeding potential were more frequently detected when the patient was on anticoagulant drugs, resulting in a twofold risk. Antiplatelet drugs were not associated with small bowel lesions.

Adult small bowel obstruction.

Science.gov (United States)

Taylor, Mark R; Lalani, Nadim

2013-06-01

Small bowel obstruction (SBO) is a clinical condition that is often initially diagnosed and managed in the emergency department (ED). The high rates of potential complications that are associated with an SBO make it essential for the emergency physician (EP) to make a timely and accurate diagnosis. The primary objective was to perform a systematic review and meta-analysis of the history, physical examination, and imaging modalities associated with the diagnosis of SBO. The secondary objectives were to identify the prevalence of SBO in prospective ED-based studies of adult abdominal pain and to apply Pauker and Kassirer's threshold approach to clinical decision-making to the diagnosis and management of SBO. MEDLINE, EMBASE, major emergency medicine (EM) textbooks, and the bibliographies of selected articles were scanned for studies that assessed one or more components of the history, physical examination, or diagnostic imaging modalities used for the diagnosis of SBO. The selected articles underwent a quality assessment by two of the authors using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Data used to compile sensitivities and specificities were obtained from these studies and a meta-analysis was performed on those that examined the same historical component, physical examination technique, or diagnostic test. Separate information on the prevalence and management of SBO was used in conjunction with the meta-analysis findings of computed tomography (CT) to determine the test and treatment threshold. The prevalence of SBO in the ED was determined to be approximately 2% of all patients who present with abdominal pain. Having a previous history of abdominal surgery, constipation, abnormal bowel sounds, and/or abdominal distention on examination were the best history and physical examination predictors of SBO. X-ray was determined to be the least useful imaging modality for the diagnosis of SBO, with a pooled positive likelihood ratio (+LR

Disturbances in small bowel motility.

LENUS (Irish Health Repository)

Quigley, E M

2012-02-03

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

Emergency department patients with small bowel obstruction: What is the anticipated clinical course?

Institute of Scientific and Technical Information of China (English)

Sarah E Frasure; Amy Hildreth; Sukhjit Takhar; Michael B Stone

2016-01-01

BACKGROUND:Emergency physicians(EPs)often care for patients with acute small bowel obstruction.While some patients require exploratory laparotomy,others are managed successfully with supportive care.We aimed to determine features that predict the need for operative management in emergency department(ED)patients with small bowel obstruction(SBO).METHODS:We performed a retrospective chart review of 370 consecutive patients admitted to a large urban academic teaching hospital with a diagnosis of SBO over a two-year period.We evaluated demographic characters(prior SBO,prior abdominal surgery,active malignancy)and clinical findings(leukocytosis and lactic acid)to determine features associated with the need for urgent operative intervention.RESULTS:Patients with a prior SBO were less likely to undergo operative intervention[20.3%(42/207)]compared to those without a prior SBO[35.2%(57/162)].Abnormal bloodwork was not associated with need for operative intervention.68%of patients with CT scan findings of both an SBO and a hernia,however,were operatively managed.CONCLUSIONS:Patients with a history of SBO were less likely to require operative intervention at any point during their hospitalization.Abnormal bloodwork was not associated with operative intervention.The CT finding of a hernia,however,predicted the need for operative intervention,while other findings(ascites,duodenal thickening)did not.Further research would be helpful to construct a prediction rule,which could help community EPs determine which patients may benefit from expedited transfer for operative management,and which patients could be safely managed conservatively as an initial treatment strategy.

Effects of radiation, burn and combined radiation-burn injury on hemodynamics

International Nuclear Information System (INIS)

Ye Benlan; Cheng Tianming; Xiao Jiasi

1996-01-01

Changes in hemodynamics after radiation, burn and combined radiation burn injury within eight hours post injury were studied. The results indicate: (1) Shock of rats in the combined injury group is more severe than that in the burn group. One of the reasons is that the blood volume in the combined injury group is less than that in the burn group. Radiation injury plays an important role in this effect, which enhances the increase in vascular permeability and causes the loss of plasma. (2) Decrease in cardiac output and stroke work and increase in vascular resistance in the combined radiation burn group are more drastic than those in the burn group, which may cause and enhance shock. Replenishing fluid is useful for recovery of hemodynamics. (3) Rb uptake is increased in the radiation group which indicates that compensated increase of myocardial nutritional blood flow may take place before the changes of hemodynamics and shock. Changes of Rb uptake in the combined injury group is different from that in the radiation groups and in the burn group. The results also suggest that changes of ion channel activities may occur to a different extent after injury. (4) Verapamil is helpful to the recovery of hemodynamics post injury. It is better to combine verapamil with replenishing fluid

Acute and delayed radiation injuries in the small intestine and colon

International Nuclear Information System (INIS)

Heiss, H.

1981-01-01

The group of patients with severe actinic intestinal injuries consists of 67 patients, 46 female and 21 male. The main indication of irradiation were gynaecologic tumours with 67%. The irradiation was carried out with a telekobalt unit combined with radium. From the pathogenetic point of view, acute inflammation and necrobiotic processes in the intestinal mucosa and a restriction of the ability to regenerate are the main radiation-induced acute injuries; delayed injuries are mainly the narrowing and rarefaction of the vessels with lacking capillary budding. The cause of the completely different intervals of up to 26 years until the manifestation of the delayed injury remained unclear. The majority of the delayed symptoms were unspecific; therefore, the danger of misinterpretation was pointed out. A resection with primary anastomosis of the ends of the intestines is the goal to be reached operation-technically. The postoperative complication rate was 45.0%. The most frequent complications were the recurrence of a fistula and the formation of a new fistula, respectively, followed by anastomotic and wound insufficiency, and gastrointestinal bleedings. The postoperative lethality was 18.3%. The causes of death were, according to their frequency, peritonitis, acute failure of the coronary circulation, pneumonia, and massive bleedings. (orig./MG) [de

Small bowel involvement documented by capsule endoscopy in Churg-Strauss syndrome.

Science.gov (United States)

Beye, Birane; Lesur, Gilles; Claude, Pierre; Martzolf, Lionel; Kieffer, Pierre; Sondag, Daniel

2015-01-01

Churg-Strauss syndrome is a small and medium vessel vasculitis and is also known as allergic granulomatous angiitis. Gastrointestinal involvement is common in patients with Churg-Strauss syndrome (20-50%). The most common symptoms are abdominal pain, diarrhoea and occasionally gastrointestinal bleeding and perforation. We present a case of Churg-Strauss syndrome with small bowel lesions documented by video capsule endoscopy.

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

Directory of Open Access Journals (Sweden)

Amanda D. Rice

2013-02-01

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

CT findings of primary undifferentiated pleomorphic sarcoma in the small bowel: A case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Youe Ree; Lee, Young Hwan; Yoon, Kwon Ha; Yun, Ki Jung [Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan (Korea, Republic of)

2015-11-15

Undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma, is a soft tissue sarcoma arising from mesenchymal tissue of the body. UPS of the gastrointestinal tract is known to be rare and only a few cases have been reported in the literature. Based on our case and review of the other relevant literature, the CT findings of primary UPS of the small bowel included nodular bowel wall thickening with homogeneous enhancement. It presents as a rapidly growing tumor without bowel obstruction, and it may be accompanied by distant metastasis.

Increased Bowel Toxicity in Patients Treated With a Vascular Endothelial Growth Factor Inhibitor (VEGFI) After Stereotactic Body Radiation Therapy (SBRT)

Energy Technology Data Exchange (ETDEWEB)

Barney, Brandon M., E-mail: barney.brandon@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Markovic, Svetomir N. [Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota (United States); Laack, Nadia N.; Miller, Robert C.; Sarkaria, Jann N. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Macdonald, O. Kenneth [Therapeutic Radiologists Incorporated, Kansas City, Kansas (United States); Bauer, Heather J.; Olivier, Kenneth R. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

2013-09-01

Purpose: Gastrointestinal injury occurs rarely with agents that affect the vascular endothelial growth factor receptor and with abdominal stereotactic body radiation therapy (SBRT). We explored the incidence of serious bowel injury (SBI) in patients treated with SBRT with or without vascular endothelial growth factor inhibitor (VEGFI) therapy. Methods and Materials: Seventy-six patients with 84 primary or metastatic intra-abdominal lesions underwent SBRT (median dose, 50 Gy in 5 fractions). Of the patients, 20 (26%) received VEGFI within 2 years after SBRT (bevacizumab, n=14; sorafenib, n=4; pazopanib, n=1; sunitinib, n=1). The incidence of SBI (Common Terminology Criteria for Adverse Events, version 4.0, grade 3-5 ulceration or perforation) after SBRT was obtained, and the relationship between SBI and VEGFI was examined. Results: In the combined population, 7 patients (9%) had SBI at a median of 4.6 months (range, 3-17 months) from SBRT. All 7 had received VEGFI before SBI and within 13 months of completing SBRT, and 5 received VEGFI within 3 months of SBRT. The 6-month estimate of SBI in the 26 patients receiving VEGFI within 3 months of SBRT was 38%. No SBIs were noted in the 63 patients not receiving VEGFI. The log–rank test showed a significant correlation between SBI and VEGFI within 3 months of SBRT (P=.0006) but not between SBI and radiation therapy bowel dose (P=.20). Conclusions: The combination of SBRT and VEGFI results in a higher risk of SBI than would be expected with either treatment independently. Local therapies other than SBRT may be considered if a patient is likely to receive a VEGFI in the near future.

Radiation risk in the context of liability for injury

International Nuclear Information System (INIS)

Riley, Peter

2003-01-01

It is perceived by the man in the street that low-level radiation from a nuclear facility is more dangerous than that from other practices. The radiation protection system, in particular the ALARA principle, leads to concerns that even the smallest exposure to radiation is abnormal and dangerous. Public perception of the radiation risk leads to fear in the minds of the public. A consequence of this fear itself may be damage to health in the form of psychological damage or nervous shock. The paper draws attention to the liability for damages by radiation, in particular under the common law of the UK and US, and how liability, determined by the court, is not necessarily influenced by scientific rationality. A natural conclusion may be that a claimant suffering injury of the type caused by radiation and who had been exposed to radiation, no matter how small a dose, that could be shown to come from a nuclear installation would be awarded damages against the licensee of the site of the installation unless it could be shown that the injury was predominantly caused by another source (radioactive or otherwise)

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

International Nuclear Information System (INIS)

Weichselbaum, R.C.; Feeney, D.A.; Hayden, D.W.

1994-01-01

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

Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations

International Nuclear Information System (INIS)

Herbert, Christopher; Moiseenko, Vitali; McKenzie, Michael; Redekop, Gary; Hsu, Fred; Gete, Ermias; Gill, Brad; Lee, Richard; Luchka, Kurt; Haw, Charles; Lee, Andrew; Toyota, Brian; Martin, Montgomery

2012-01-01

Purpose: To investigate predictive factors in the development of symptomatic radiation injury after treatment with linear accelerator–based stereotactic radiosurgery for intracerebral arteriovenous malformations and relate the findings to the conclusions drawn by Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC). Methods and Materials: Archived plans for 73 patients who were treated at the British Columbia Cancer Agency were studied. Actuarial estimates of freedom from radiation injury were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of radiation injury. Log–rank test was used to search for dosimetric parameters associated with freedom from radiation injury. Results: Symptomatic radiation injury was exhibited by 14 of 73 patients (19.2%). Actuarial rate of symptomatic radiation injury was 23.0% at 4 years. Most patients (78.5%) had mild to moderate deficits according to Common Terminology Criteria for Adverse Events, version 4.0. On univariate analysis, lesion volume and diameter, dose to isocenter, and a V x for doses ≥8 Gy showed statistical significance. Only lesion diameter showed statistical significance (p 5 cm 3 and diameters >30 mm were significantly associated with the risk of radiation injury (p 12 also showed strong association with the incidence of radiation injury. Actuarial incidence of radiation injury was 16.8% if V 12 was 3 and 53.2% if >28 cm 3 (log–rank test, p = 0.001). Conclusions: This study confirms that the risk of developing symptomatic radiation injury after radiosurgery is related to lesion diameter and volume and irradiated volume. Results suggest a higher tolerance than proposed by QUANTEC. The widely differing findings reported in the literature, however, raise considerable uncertainties.

Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations

Energy Technology Data Exchange (ETDEWEB)

Herbert, Christopher, E-mail: cherbert@bccancer.bc.ca [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC (Canada); Moiseenko, Vitali [Department of Medical Physics, British Columbia Cancer Agency, Vancouver, BC (Canada); McKenzie, Michael [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC (Canada); Redekop, Gary [Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada); Hsu, Fred [Department of Radiation Oncology, British Columbia Cancer Agency, Abbotsford, BC (Canada); Gete, Ermias; Gill, Brad; Lee, Richard; Luchka, Kurt [Department of Medical Physics, British Columbia Cancer Agency, Vancouver, BC (Canada); Haw, Charles [Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada); Lee, Andrew [Department of Neurosurgery, Royal Columbian Hospital, New Westminster, BC (Canada); Toyota, Brian [Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada); Martin, Montgomery [Department of Medical Imaging, British Columbia Cancer Agency, Vancouver, BC (Canada)

2012-07-01

Purpose: To investigate predictive factors in the development of symptomatic radiation injury after treatment with linear accelerator-based stereotactic radiosurgery for intracerebral arteriovenous malformations and relate the findings to the conclusions drawn by Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC). Methods and Materials: Archived plans for 73 patients who were treated at the British Columbia Cancer Agency were studied. Actuarial estimates of freedom from radiation injury were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of radiation injury. Log-rank test was used to search for dosimetric parameters associated with freedom from radiation injury. Results: Symptomatic radiation injury was exhibited by 14 of 73 patients (19.2%). Actuarial rate of symptomatic radiation injury was 23.0% at 4 years. Most patients (78.5%) had mild to moderate deficits according to Common Terminology Criteria for Adverse Events, version 4.0. On univariate analysis, lesion volume and diameter, dose to isocenter, and a V{sub x} for doses {>=}8 Gy showed statistical significance. Only lesion diameter showed statistical significance (p < 0.05) in a multivariate model. According to the log-rank test, AVM volumes >5 cm{sup 3} and diameters >30 mm were significantly associated with the risk of radiation injury (p < 0.01). The V{sub 12} also showed strong association with the incidence of radiation injury. Actuarial incidence of radiation injury was 16.8% if V{sub 12} was <28 cm{sup 3} and 53.2% if >28 cm{sup 3} (log-rank test, p = 0.001). Conclusions: This study confirms that the risk of developing symptomatic radiation injury after radiosurgery is related to lesion diameter and volume and irradiated volume. Results suggest a higher tolerance than proposed by QUANTEC. The widely differing findings reported in the literature, however, raise considerable uncertainties.

[Bowel-associated dermatosis-arthritis syndrome during ulcerative colitis: A rare extra-intestinal sign of inflammatory bowel disease].

Science.gov (United States)

Aounallah, A; Zerriaa, S; Ksiaa, M; Jaziri, H; Boussofara, L; Ghariani, N; Mokni, S; Saidi, W; Sriha, B; Belajouza, C; Denguezli, M; Nouira, R

2016-05-01

Bowel-associated dermatosis-arthritis syndrome (BADAS) is characterized by combined pustular skin eruption and arthralgia. It may be associated with inflammatory bowel disease or bowel bypass surgery. We report a case of BADAS in a patient with ulcerative colitis. A 39-year-old woman was being treated for a severe flare-up of ulcerative colitis present over the preceding 2 months and treated with prednisone, azathioprine and cyclosporine. She was also presenting a cutaneous eruption and arthralgia that had begun three days earlier. Dermatological examination revealed profuse vesicular and pustular lesions. Biopsy specimens showed mature neutrophilic infiltrate within the dermis. A diagnosis of BADAS was made and the same treatment was maintained. Systemic symptoms were resolved but the vesicular lesions were superseded by hypertrophic scars. Bowel-associated dermatosis-arthritis syndrome consists of a vesiculopustular eruption associated with arthralgia and/or arthritis and fever, as was the case in our patient. The histological picture is characterized by abundant neutrophilic infiltrate in the superficial dermis. The clinical and histological features and the course of BADAS allow this entity to be classified within the spectrum of neutrophilic dermatoses. Treatment chiefly involves systemic corticosteroids. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Pathophysiological Responses in Rat and Mouse Models of Radiation-Induced Brain Injury.

Science.gov (United States)

Yang, Lianhong; Yang, Jianhua; Li, Guoqian; Li, Yi; Wu, Rong; Cheng, Jinping; Tang, Yamei

2017-03-01

The brain is the major dose-limiting organ in patients undergoing radiotherapy for assorted conditions. Radiation-induced brain injury is common and mainly occurs in patients receiving radiotherapy for malignant head and neck tumors, arteriovenous malformations, or lung cancer-derived brain metastases. Nevertheless, the underlying mechanisms of radiation-induced brain injury are largely unknown. Although many treatment strategies are employed for affected individuals, the effects remain suboptimal. Accordingly, animal models are extremely important for elucidating pathogenic radiation-associated mechanisms and for developing more efficacious therapies. So far, models employing various animal species with different radiation dosages and fractions have been introduced to investigate the prevention, mechanisms, early detection, and management of radiation-induced brain injury. However, these models all have limitations, and none are widely accepted. This review summarizes the animal models currently set forth for studies of radiation-induced brain injury, especially rat and mouse, as well as radiation dosages, dose fractionation, and secondary pathophysiological responses.

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

International Nuclear Information System (INIS)

Jiang Ruizhou; Chen Jincheng

2009-01-01

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)

Non-traumatic perforation of the small bowel | Eid | African Health ...

African Journals Online (AJOL)

... medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively. Results: The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients.

Software-assisted small bowel motility analysis using free-breathing MRI: feasibility study.

Science.gov (United States)

Bickelhaupt, Sebastian; Froehlich, Johannes M; Cattin, Roger; Raible, Stephan; Bouquet, Hanspeter; Bill, Urs; Patak, Michael A

2014-01-01

To validate a software prototype allowing for small bowel motility analysis in free breathing by comparing it to manual measurements. In all, 25 patients (15 male, 10 female; mean age 39 years) were included in this Institutional Review Board-approved, retrospective study. Magnetic resonance imaging (MRI) was performed on a 1.5T system after standardized preparation acquiring motility sequences in free breathing over 69-84 seconds. Small bowel motility was analyzed manually and with the software. Functional parameters, measurement time, and reproducibility were compared using the coefficient of variance and paired Student's t-test. Correlation was analyzed using Pearson's correlation coefficient and linear regression. The 25 segments were analyzed twice both by hand and using the software with automatic breathing correction. All assessed parameters significantly correlated between the methods (P software (3.90%, standard deviation [SD] ± 5.69) than manual examinations (9.77%, SD ± 11.08). The time needed was significantly less (P software (4.52 minutes, SD ± 1.58) compared to manual measurement, lasting 17.48 minutes for manual (SD ± 1.75 minutes). The use of the software proves reliable and faster small bowel motility measurements in free-breathing MRI compared to manual analyses. The new technique allows for analyses of prolonged sequences acquired in free breathing, improving the informative value of the examinations by amplifying the evaluable data. Copyright © 2013 Wiley Periodicals, Inc.

Small Bowel Adenocarcinoma Complicating Coeliac Disease: A Report of Three Cases and the Literature Review

Directory of Open Access Journals (Sweden)

Hafida Benhammane

2012-01-01

Full Text Available Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

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

Directory of Open Access Journals (Sweden)

Jagannath Mala Sherigar

2005-05-01

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.

Short bowel syndrome

International Nuclear Information System (INIS)

Engels, L.G.J.B.

1983-01-01

This thesis describes some aspects of short bowel syndrome. When approximately 1 m or less small bowel is retained after extensive resection, a condition called short bowel syndrome is present. Since the advent of parenteral nutrition, the prognosis of patients with a very short bowel has dramatically improved. Patients with 40 to 100 cm remaining jejunum and/or ileum can generally be maintained with oral nutrition due to increased absorption of the small bowel remnant as result of intestinal adaptation. This study reports clinical, biochemical and nutritional aspects of short bowel patients on oral or parenteral nutrition, emphasizing data on absorption of various nutrients and on bone metabolism. Furthermore, some technical apsects concerning long-term parenteral nutrition are discussed. (Auth.)

The history of knowledge on radiation injuries

International Nuclear Information System (INIS)

Schuettmann, W.

1988-01-01

The possible endangering with the peaceful utilization of nuclear energy and the fateful threat of mankind by nuclear weapons in a world-wide extent keep the discussion on problems of radiation injuries and the national and international activities to avoid them as well running. In view of the burning discussions, the impression may rise that radiation injuries became aware to the human-being only recently. Actually this knowledge dats back to the turn of the century. The development of the knowledge on radiation injuries originating immediately after discovery of W.C. Roentgen in 1895 is presented concisely. The application of radiotherapy is taken into consideration. A historical retrospect in various sections deals with the initial period of radiogenic skin injuries, with the recognition of radiation injuries at the internal organs, the proof of carcinogenic effects of ionizing radiations and its mutagenic influence. Finally it is presented how experience gained during decades, is used as a basis for the conception of present radiation protection. (author)

The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

International Nuclear Information System (INIS)

Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de; Villeirs, G.M.; Delrue, L.J.

2004-01-01

Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)