201
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Bapaye M, Kolte S, Pai K, Godse A, Pardeshi A, Bhave A, Kumar A. Jejunogastric intussusception presenting with outlet obstruction. Indian J Gastroenterol 2003; 22:31-2. [PMID: 12617456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 77-year-old man presented with sudden-onset epigastric pain and bilious vomiting following a light breakfast. Vagotomy and gastrojejunostomy for bleeding duodenal ulcer had been done 22 years ago. Barium meal study suggested jejunogastric intussusception. At laparotomy, a retrograde type II jejunogastric intussusception was confirmed and managed by reduction of the intussusception, disconnection of gastrojejunostomy and resection of the jejunum. Postoperative recovery was uneventful.
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Affiliation(s)
- Mahadev Bapaye
- Department of General Surgery, K E M Hospital, Pune 411 011.
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202
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Norton KS, Brown WA, Johnson LW. Roux-en-Y limb intussusception: two case reports and a review of the literature. J La State Med Soc 2003; 155:57-8. [PMID: 12656278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Kathryn S Norton
- Louisiana State University Health Sciences Center, Shreveport, USA
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203
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Gomez MA, Besson M, Roger R, Watteau N, Scotto B, Alison D. [Quid? Jejunal diverticulitis with intra-abdominal abscess and reactional jejunitis]. J Radiol 2003; 84:63-5. [PMID: 12645509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- M-A Gomez
- Département de Radiologie Adults Hôpital Trousseau, CHU de Tours.
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204
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Séverin S, d'Alincourt A, Redon H, Hamy A, Mathon G, Lerat F. [Small bowel diverticulitis: the role of CT]. J Radiol 2003; 84:47-9. [PMID: 12637887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The authors report a case of small bowel diverticulitis diagnosed by computed tomography. They describe the CT findings and review its advantages for diagnosis of this uncommon entity that is rarely suspected at physical examination.
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Affiliation(s)
- S Séverin
- Service de Radiologie Générale, Hôpital G et R Laënnec, Nantes
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205
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Abstract
Jejunal diverticulitis is a very rare cause of acute abdomen. The treatment of choice in acute perforated jejunal diverticulitis is intestinal resection with primary anastomosis of the affected area. Data on long-term results, postoperative complications and the nature of this illness is limited. To our knowledge, a recurrent perforated jejunal diverticulitis has never have been reported in the literature. In this case,we present a patient who suffered from a recurrence of perforated jejunal diverticulitis 13 weeks after the initial intestinal resection. After the second intestinal resection (due to the recurrent infection), the patient suffered from a third period of jejunal diverticulitis.
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Affiliation(s)
- D Franzen
- Chirurgische Klinik,Stadtspital Triemli, Zürich, Switzerland
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206
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Wongsawasdi L, Ukarapol N, Lertprasertsuk N. The endoscopic diagnosis of intestinal capillariasis in a child: a case report. Southeast Asian J Trop Med Public Health 2002; 33:730-2. [PMID: 12757218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A 13-year-old boy was diagnosed as having intestinal capillariasis by gastroduodenoscopy. He presented with a 10-month history of chronic abdominal pain and diarrhea. The boy had stayed in central Thailand and had eaten uncooked fish and raw shellfish. Gastroduodenoscopy showed normal jejunal mucosa although histology revealed flattened villi, crypt proliferation, acute inflammation, and eosinophilic granulomata. An egg of Capillaria philippinensis was also seen. The child was treated with mebendazole for 30 days. He had gained six kilograms by the time of his last follow-up.
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Affiliation(s)
- Lumduan Wongsawasdi
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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207
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Huh SH, Kim DI, Lee BB. Superior mesenteric thrombosis associated with small bowel stricture. Case report. J Cardiovasc Surg (Torino) 2002; 43:895-7. [PMID: 12483187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Intestinal stricture from superior mesenteric vein (SMV) thrombosis is a relatively infrequent, though important cause of intestinal obstruction. The symptom of intestinal obstruction in a patient with chronic SMV thrombosis should be considered as the possibility of bowel stricture. We report 2 cases of small bowel stricture that is related to chronic SMV thrombosis which were treated with segmental resection of strictured bowel.
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Affiliation(s)
- S-H Huh
- Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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208
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Wan Muhaizan WM, Julia MJ, Al Amin D. Calibre persistent submucosal artery of the jejunum: a rare cause of massive gastrointestinal bleeding. Malays J Pathol 2002; 24:113-6. [PMID: 12887171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Historically a calibre persistent submucosal artery was most often described in the stomach. However in later years it was also discovered in the duodenum and jejunum. It is an uncommon and important cause of massive gastrointestinal bleeding in which failure of detection and early intervention would lead to death. In this paper we report a 27-year-old man with no significant medical history who presented at the emergency unit for recurrent melaena, haematochezia and hypotension. Initial investigations failed to localize the source of bleeding. Emergency exploratory laporatomy revealed a small jejunal mucosal nodule that was actively spurting blood. Histopathological evaluation identified a calibre persistent submucosal artery.
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Affiliation(s)
- W M Wan Muhaizan
- Department of Pathology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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209
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Buljevac M, Grgurević I, Lacković Z, Kujundzić M, Banić M. Duplex ultrasonography in diagnosis of spigelian hernia with incarcerated jejunal loop. Acta Med Croatica 2002; 55:225-7. [PMID: 12398029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Spigelian hernia is a very rare anterior abdominal wall hernia with uncharacteristic symptoms and challenging diagnosis. The case of a 76-year-old male patient with colicky pain and vomiting lasting for 24 hours before admission to the hospital is presented. Physical examination of the patient revealed abdominal tenderness and a round-shaped tumefaction of 3 cm in size, located in the left lower abdominal quadrant. X-ray examination of the abdomen, obtained in left lateral position of the patient, showed small bowel ileus with distended jejunal loops. The abdominal ultrasound examination, followed by duplex ultrasonography, revealed a spigelian hernia with ischemic changes of strangulated bowel segment indicating incarceration of the herniated jejunal loop. Preoperative findings were confirmed by intraoperative diagnosis of spigelian hernia and incarcerated jejunal loop with ischemic changes and deserosation, followed by resection of the bowel segment involved and plastic surgical reconstruction of anterior abdominal wall. This case report highlights the role of duplex ultrasonography in the evaluation of circulatory status of potentially incarcerated bowel segment within hernial sac.
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Affiliation(s)
- M Buljevac
- Department of Internal Medicine, Division of Gastroenterology, Dubrava University Hospital, Zagreb, Croatia
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210
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Bruni R, Chirco L, Lemeni AR, Petrocca S. Intermittent small bowel obstruction by jejunal enteroliths in a patient with a Crohn's disease stricture. Chir Ital 2002; 54:903-5. [PMID: 12613344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Small bowel obstruction is most frequently due to postoperative or inflammatory adhesions, intestinal neoplasms, hernias, or bezoars. Intermittent small bowel obstruction may be secondary to a Crohn's disease stricture or to chronic adhesive peritonitis. Enterolithiasis, usually associated with jejunal diverticulosis or with a Meckel diverticulum, should be considered in patients who have not previously undergone abdominal surgical procedures. X-ray evidence of stones in the abdominal field, outside the common sites, i.e. gallbladder, kidney, bladder, should suggest a diagnosis of enterolithiasis. The authors report a case of multiple enteroliths in a patient with a segmental ileal stricture and ulcerations (diagnosed as Crohn's disease) causing frequent, intermittent occlusive symptoms, treated by segmental ileal resection.
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Affiliation(s)
- Roberto Bruni
- U.O. di Chirurgia Generale e d'Urgenza Policlinico Casilino Azienda U.S.L. RM B, Roma
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211
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Perea García J, Turégano Fuentes F, Pérez Díaz MD, Sanz Sánchez M. [Perforated jejunal diverticulitis]. Gastroenterol Hepatol 2002; 25:526. [PMID: 12361537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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212
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Jaime-Zavala M, Martínez-Ordaz JL, Blanco-Benavides R. [Solitary jejunal diverticulum with heterotopic gastric mucosa: diagnosis and management. A case report]. Rev Gastroenterol Mex 2002; 67:264-6. [PMID: 12653073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Diverticular disease of small bowel is an uncommon entity and may be the cause of vague abdominal symptoms generally an incidental finding that occasionally require surgical therapy for resolution. METHOD We report a case of a patient with complicated solitary jejunal diverticulum with perforation and non-Meckelean heterotopic gastric tissue that required resection, and include a review of the literature of this association. CONCLUSION Surgical treatment of diverticular disease of the small bowel is limited to symptomatic patients with non-response to medical therapy or who have some acute complications of same.
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Affiliation(s)
- Martín Jaime-Zavala
- Servicio de Gastrocirugía, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F
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213
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Morán JM, Salas J, Sanjuán S, González G, Gallello A, Serrano A, Vinagre Velasco LM. [Left paramesocolic hernia with retroperitoneal incarceration of jejunum]. Cir Pediatr 2002; 15:168-71. [PMID: 12601977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We present a case left paramesocolic hernia and review the literature. The patients was a 14 years old male and had suffered periods of relapses into abdominal pain from the age of three. When for years old he was operated on using the Nisses technique. Also a laparoscopy had already been performed on this same patient when he was 13 years old, without discovering any pathological conditions. In a new upper gastrointestinal serie, realized one year later, a retroperitoneal incarceration and a paraduodenal loop of jejunum was observed, which obstructed, partially the second part of the duodenum. We have not found the anatomical characteristics of this case in any previous report. In the ample literature pressured, it was confirmed that almost all the clinical cases, previously published had suffered a relapse abdominal pain crisis, diagnosed in advanced states and in/or emergency situations. This produces a mortality rate higher than 20% and or irreparable digestive damage. In cases involving paraduodenal hernias, there exists a low rate of diagnostic suspicion. These delays and diagnostic errors cause irreparable damage. In those patients who suffer relapses into abdominal pain syndrome, one should always include the differential diagnosis of PMH, applying a complete gastrointestinal serie or a CT-Scan with contrast.
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Affiliation(s)
- J M Morán
- Cátedra de Patología Quirúrgica y de Cirugía Pediátrica, Facultad de Medicina, H.U. Infanta Cristina: Servicios de Cirugía Pediátrica y de Cirugía General, Universidad de Extremadura
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214
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Govindan VK. Acute intestinal obstruction due to solitary jejunal diverticulum. Indian J Gastroenterol 2002; 21:204. [PMID: 12416758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report a 26-year-old man who presented with acute intestinal obstruction. Laparotomy revealed a solitary jejunal diverticulum with a meso-diverticular band, through which a loop of bowel had herniated. He underwent wedge resection of the diverticulum and excision of the band.
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Affiliation(s)
- Vimal Kumar Govindan
- Department of Surgery, PSG Institute of Medical Sciences and Research, Coimbatore.
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215
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Abstract
The case of a 61-year-old woman with Whipple's disease-associated sicca complex is reported. Tropheryma whipplei infection was diagnosed by histological and ultrastructural examination of the jejunal mucosa and sequence analysis of the bacterial 16S ribosomal DNA. The role of vitamin A malabsorption in sicca complex secondary to Whipple's disease is discussed.
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Affiliation(s)
- Cesare Bosman
- Department of Experimental Medicine and Pathology, La Sapienza University, Rome, Italy
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216
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Abstract
We present two cases of fetal meconium peritonitis in a single and twin pregnancy, respectively. The first case diagnosis was made at 30 weeks and was confirmed after delivery of the twins by cesarean section at 37 weeks. The second case diagnosis was made at 31 week and was confirmed at 37 weeks. Meconium peritonitis is a rare prenatal complication that results from intrauterine perforation of small bowel with spillage of sterile meconium into peritoneal cavity. We now report two cases of meconium peritonitis diagnosed at 30 and 31 weeks gestation.
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Affiliation(s)
- H-S Pan
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih Lin District, Taipei, Taiwan
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217
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Abstract
Morgagni hernia, which is both infrequent and generally asymptomatic, is often diagnosed when complications occur. Herein we present two elderly patients with Morgagni hernia, which were complicated with bowel perforation and upper gastro-intestinal bleeding. The recognition and management of these cases are discussed.
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Affiliation(s)
- H Guven
- Department of Emergency, Ondokuz Mayis University, School of Medicine, 55139 Kurupelit-Samsun, Turkey.
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218
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Di Franco F, Adedeji OA, Varma JS. Recurrent megajejunum in an adult. J R Soc Med 2002. [PMID: 12091514 PMCID: PMC1279944 DOI: 10.1258/jrsm.95.7.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- F Di Franco
- Coloproctology Unit, Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
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219
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Mukhtar A, Sundar N, Finnie IA. Abdominal distension. Postgrad Med J 2002; 78:432, 435-6. [PMID: 12151667 PMCID: PMC1742419 DOI: 10.1136/pmj.78.921.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Mukhtar
- Department of Gastroenterology, Glan Clwyd Hospital, Bodelwyddan, Denbighshire LL18 5UJ, UK
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220
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Sevastos N, Rafailidis P, Kolokotronis K, Papadimitriou K, Papatheodoridis GV. Primary aortojejunal fistula due to foreign body: a rare cause of gastrointestinal bleeding. Eur J Gastroenterol Hepatol 2002; 14:797-800. [PMID: 12169993 DOI: 10.1097/00042737-200207000-00016] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Primary and secondary aortoenteric fistulae are infrequent causes of gastrointestinal bleeding. We report a rare case of a 49-year-old man with bleeding due to an aortojejunal fistula caused by a foreign body. This is the fifth case in the literature in which a foreign body was found to be associated with the development of an aortoenteric fistula. Our patient presented with two herald bleeds with an interval time of 1 week; in previous cases, only one herald bleed has been reported. In addition to the usual resuscitation measures, the patient was treated with primary repair of the small-intestine defect and replacement of the aneurysm with a prosthetic aortic graft. He remains in excellent health thereafter.
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Affiliation(s)
- Nikolaos Sevastos
- Academic Department of Medicine, Hippokration General Hospital, 114 Vas. Sofias ave., 11527 Athens, Greece
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221
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Di Franco F, Adedeji OA, Varma JS. Recurrent Megajejunum in an Adult. Med Chir Trans 2002; 95:361-2. [PMID: 12091514 PMCID: PMC1279944 DOI: 10.1177/014107680209500712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Di Franco
- Coloproctology Unit, Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
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222
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Vaideeswar P. Aortoenteric fistula: a rare cause of gastrointestinal hemorrhage. Indian Heart J 2002; 54:439-40. [PMID: 12462679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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223
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Abstract
Acute torsion of the small bowel mesentery is a diagnostically challenging cause of acute abdominal pain, which most commonly afflicts pediatric patients with midgut malrotation. We describe a case of mesenteric torsion in an adult patient that had manifested as acute abdominal pain. The patient had a remote history of prior abdominal surgery, presenting on multiple occasions with undiagnosed acute intermittent abdominal pain. Diagnosis of mesenteric torsion was made by contrast enhanced CT and the ailment was successfully treated with laparoscopic surgery without recurrence.
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Affiliation(s)
- T V Brennan
- Department of Surgery, San Francisco General Hospital, 1001 Potrero Avenue, Suite 3-D, San Francisco, CA 94110, USA
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224
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Ho YY. Aortojejunal fistula in non-Hodgkin's lymphoma. Clin Nucl Med 2002; 27:358-9. [PMID: 11953572 DOI: 10.1097/00003072-200205000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yvonne Y Ho
- Radclin Medical Imaging, Cabrini Hospital, Malvern, Australia.
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225
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Abstract
The differential diagnosis of subacute onset ataxia in the setting of enteropathy is wide. A 54 year old patient with a pancerebellar syndrome and known ulcerative jejunoileitis is described. Small bowel biopsy showed evidence of enteropathy associated T cell lymphoma and subsequent neuropathological analysis and immunophenotyping confirmed metastasis of this tumour to the cerebellum. The presence of anti-gliadin antibodies and MRI evidence of a more longstanding process suggested additional immunologically mediated cerebellar dysfunction. Lymphomatous involvement of the CNS is rare in patients with complicated enteropathies, and has not been previously reported to involve the cerebellar parenchyma. This diagnostic possibility should be borne in mind before attributing cerebellar dysfunction in patients with the coeliac related enteropathies to nutritional compromise or immunological dysfunction (gluten ataxia) alone.
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Affiliation(s)
- P N Shams
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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226
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Schürmann K, Bücker A, Jansen M, Tacke J, Schmitz-Rode T, Günther RW. [Selective CT mesentericography in the diagnostics of obscure overt intestinal bleeding: preliminary results]. ROFO-FORTSCHR RONTG 2002; 174:444-51. [PMID: 11960407 DOI: 10.1055/s-2002-25120] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM To evaluate intra-arterial CT mesentericography (CTM) in the diagnostics of severe obscure overt intestinal bleeding in comparison with conventional mesentericography (MG) and surgery. METHODS In 8 patients (23 - 82 years, mean 59 years), CTM was performed via the catheter left in the superior mesenteric artery after MG to detect the source of bleeding. Early and late-phase spiral CT scans were acquired after administration of contrast medium. Active bleeding was considered to be present if extravasation of contrast medium into the bowel was found. The results of MG and CTM were compared with the results of surgery. RESULTS With MG active bleeding was found in one patient, with CTM in five patients. In three patients, both MG and CTM were negative. Six patients underwent surgery. Five cases of bleeding detected with CTM were confirmed by surgery. In one case, bleeding found with CTM was not confirmed by surgery. One patient underwent surgery although all imaging procedures were negative. The source of bleeding remained unknown. Surgically, the site of bleeding was located in the jejunum in 3 patients (jejunitis, jejunal ulcers, carcinoid), one patient had a diverticulum in the ascending colon. The colonic bleeding site was correctly localized with CTM, whereas the small bowel bleeding could only roughly be assigned to the proximal or distal jejunum or jejunoileal transition area. CONCLUSION Preliminary results indicate that selective CTM is superior to MG in the evaluation of severe obscure overt intestinal bleeding.
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Affiliation(s)
- K Schürmann
- Klinik für Radiologische Diagnostik, Universitätsklinikum der RWTH Aachen, Germany.
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227
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Ermolaev VL, Dornbush AA, Iarushev AV, Titov DA, Burtsev MN. [Profuse bleeding caused by angio-digestive fistula]. Vestn Khir Im I I Grek 2002; 160:99-100. [PMID: 11517807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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228
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Săftoiu A, Ciurea T, Georgescu I, Georgescu C. Preoperative "two-way" enteroscopy, followed by intraoperative enteroscopy in a patient with obscure-overt gastrointestinal bleeding and severe iron-deficiency anemia. Rom J Gastroenterol 2002; 11:39-46. [PMID: 12096313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We present the case of a 69-year-old woman admitted to hospital because of chronic gastrointestinal bleeding of an unknown source with a consequent severe iron deficiency anemia (IDA), undiagnosed for the past 25 years. In the last three years the episodes of severe bleeding became frequent, usually followed by melena. The patient was admitted 11 times in different departments without the identification of the bleeding source. During the evolution of the disease, the biological exams showed a severe IDA with low values of hemoglobin, low serum iron, mixed deficiency depicted by bone-marrow examination, and a reticulocyte crisis after parenterally administered iron. Repeated upper (6) and lower (2) gastrointestinal endoscopies failed to find a source of bleeding. Push enteroscopy allowed the visualization of approximately 40 cm of the proximal jejunum, after the Treitz angle, and demonstrated multiple punctiform jejunal angiodysplasias, which bled excessively after bipolar coagulation. We also performed a total colonoscopy with intubation of the ileo-cecal valve and visualization of the terminal ileum on approximately 30 cm, without any pathological findings. Because endoscopic treatment was ineffective, we decided to perform a segmentary enterectomy, with the length of small bowel resection tailored by intraoperative enteroscopy. A favourable evolution after limited resection of the small bowel indicated the importance of both preoperative "two-way" enteroscopy associated with intraoperative enteroscopy for diagnosing and treating the source of obscure gastrointestinal bleeding
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Affiliation(s)
- Adrian Săftoiu
- Department of Internal Medicine, Division of Gastroenterology, University of Medicine and Pharmacy, Craiova, Romania.
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229
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Balsarkar DJ, Ranadive NU, Gore MA, Joshi MA. Recurrent inflammatory pseudotumor of small bowel mesentery presenting as perforative peritonitis. Indian J Gastroenterol 2002; 21:79-80. [PMID: 11990335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 62-year-old man with recurrent inflammatory pseudotumor of the small bowel mesentery presented with perforative peritonitis; such a presentation has not been reported. The mass was excised successfully.
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Affiliation(s)
- Dharmesh J Balsarkar
- Department of General Surgery, L T M Medical College and L T M General Hospital, Sion, Mumbai.
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230
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Sah SP, Agrawal CS, Rani S. Inflammatory fibroid polyp of the jejunum presenting as intussusception. INDIAN J PATHOL MICR 2002; 45:119-21. [PMID: 12593579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Inflammatory fibroid polyp (IFP) of jejunnum is a rare nonneoplastic lesion of gastrointestinal tract. We report a case of a 45-year-old man presenting with small bowel obstruction due to jejuno-jejunal intussusception of an inflammatory fibroid polyp. To the best of our knowledges, this is the eighth reported case with such a presentation in English medical literature. Segmental resection of the jejunum was performed and histopathology confirmed the diagnosis.
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231
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Bächle T, Rühl U, Ott G, Walker S. [Enteropathy-associated T-cell lymphoma. Manifestation as diet-refractory coeliac disease and ulcerating jejunitis]. Dtsch Med Wochenschr 2001; 126:1460-3. [PMID: 11753737 DOI: 10.1055/s-2001-19212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 61-year-old woman in poor general health was admitted to hospital because of progressive diarrheo, flatulence, fatigue and weight loss. The patient had a history of coeliac disease with poor dietary compliance over many years. Hence, the present clinical deterioration was unresponsive to a gluten-free diet. INVESTIGATIONS Laboratory results showed signs of inflammation and malabsorption. The endoscopy of the duodenum revealed a flattened mucosal architecture, as is typical for coeliac disease. Enteroscopy revealed many small jejunal lesions. Histological examination of mucosa showed typical signs of coeliac disease without definite signs of lymphoma. Immunhistochemical analysis showed atypical intraepithelial T-cells, while the molecular biological study revealed a monoclonal T-cell clone, both supporting the diagnosis of an enteropathy associated T-cell lymphoma (EATCL). DIAGNOSIS AND THERAPY The patient was enrolled in a study on intestinal non-Hodgkin lymphomas and accordingly received 6 courses of CHOP-chemotherapy. Clinical and histological improvement has lasted for over a year. CONCLUSION Patients with coeliac disease unresponsive to a gluten-free diet or with a deteriorating clinical condition may have an enteropathy-associated T-cell lymphoma. This can manifest itself in the form of an ulcerative jejunitis. In the early stages of disease, immunhistochemical and molecularbiological analyses may lead to the correct diagnosis.
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Affiliation(s)
- T Bächle
- Innere Medizin I, Schwerpunkt Gastroenterologie, Infektionskrankheiten, Onkologie, Krankenhaus Bietigheim, Kliniken Ludwigsburg-Bietigheim gGmbH, Bietigheim-Bissingen.
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232
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Abstract
This review article provides an overview of coeliac disease but also highlights its protean manifestations. These can often lead to a delay in diagnosis of this easily treatable condition.
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Affiliation(s)
- S Sen
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge CB2 2QQ
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233
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Abstract
Occult gastrointestinal bleeding frequently frustrates clinicians' attempts to locate the source. Foci of hemorrhage within the small bowel are often found only at laparotomy and can be attributed to Meckel's diverticula, carcinomas, or less frequently, pulsion-type diverticula. We report our experience with two patients whose jejunal diverticula resulted in recurrent episodes of massive gastrointestinal hemorrhage.
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Affiliation(s)
- H E Rodriguez
- Department of Surgery, Catholic Health Partners, Chicago, Illinois, USA
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234
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Kim KW, Park SY, Lee EH, Ahn CJ, Lee KS. Mucosa-associated lymphoid tissue (MALT) lymphoma combined with tuberculous enteritis at the same site in the jejunum. Leuk Lymphoma 2001; 42:1151-5. [PMID: 11697636 DOI: 10.3109/10428190109097739] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is derived from the marginal zone B-cell compartment and can be found at a wide variety of extranodal sites, most frequently at the gastrointestinal site. Recent clinicopathologic studies suggest a relationship between MALT lymphoma and chronic inflammatory disorders, such as Helicobacter pylori infection in the stomach or autoimmune disorders, such as Sjögren's syndrome in the salivary glands. Primary gastrointestinal MALT lymphomas most commonly arise in the stomach and less often in the small and large intestine. Recently we experienced a case who had MALT lymphoma combined with tuberculous enteritis at the same site (jejunum) confirmed by exploratory laparotomy. We suspect that there may be some relationship between MALT lymphoma and chronic inflammatory process of mycobacterial tuberculous enteritis.
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Affiliation(s)
- K W Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
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235
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Abstract
Two children with incidentally-diagnosed ectopic pancreatic tissue in the jejunum at surgery for extrahepatic biliary atresia (EHBA) and choledochal cyst (CC) are reported. No case has been reported in the literature describing the association of a CC with ectopic pancreas, and only one case of EHBA associated with ectopic pancreas has been reported. We believe that incidentally-detected ectopic pancreatic tissue should be excised, even though the patient is symptom-free, in order to prevent the risk of serious complications due to either the mass effect or the potential for acute pancreatitis, cystic degeneration, or malignant transformation at a later date.
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Affiliation(s)
- T R Prasad
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi
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236
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Abstract
The case of a 56-year-old patient with Henoch-Schönlein purpura (HSP) and fulminant gastrointestinal bleeding is reported. The patient was admitted to hospital because of palpable purpura on both legs, painful joints and diffuse abdominal pain. Suspected HSP was histologically proven and treated with prednisolone. Despite recovery, acute gastrointestinal bleeding, with melena and a drop in hemoglobin concentration from 11.2 to 4.2 g/dl, occurred 30 days after medication was started. Immediate endoscopic examination of the upper gastrointestinal tract showed no signs of bleeding whereas colonoscopy showed fresh blood and blood clots in the terminal ileum and the colon. Since the bleeding source could not be detected endoscopically, mesenteric angiography was performed, demonstrating active bleeding from a jejunal artery. Thereafter the bleeding source was located by intraoperative peroral enteroscopy and treated by resection of a short segment of jejunum.
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Affiliation(s)
- F Lippl
- Dept. of Internal Medicine II, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
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237
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Friebe M, Allerödder HP, Lüder J, Kindler U. [Acute gastrointestinal bleeding caused by distinct small intestinal diverticulosis]. Dtsch Med Wochenschr 2001; 126:944-6. [PMID: 11523017 DOI: 10.1055/s-2001-16580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 58-year-old man was admitted to our hospital after an acute onset of rectal bleeding. He was known to have had recurrent duodenal ulcerative disease, once with upper gastrointestinal haemorrhage. Clinical examination was remarkable only for rectal bleeding. INVESTIGATIONS After application of a nasogastric tube cherry-red blood was evacuated. Upper endoscopy showed only very small mucosal erosion in the stomach and coloscopy demonstrated several non-bleeding diverticula. Small bowel enteroclysis showed severe diverticulosis of the duodenum and jejunum. DIAGNOSIS, TREATMENT AND COURSE We assumed that the extensive duodenojejunal diverticulosis was the most probable cause of this episode of gastrointestinal bleeding because of simultaneous signs of upper and lower gastrointestinal haemorrhage. Because this was the first such episode we preferred a conservative approach. At nineteen months follow-up there was no recurrence of bleeding. CONCLUSION Gastrointestinal hemorrhage is a common cause of hospitalization. After exclusion of the more common bleeding sources small bowel diverticula should be considered as a possible rare cause. Surgical resection of the bleeding bowel part is the procedure of choice, but one of the major problems in such cases is to locate exactly the bleeding site. If the location is uncertain, a more conservative approach may be preferable, especially in haemodynamically stable patients with first-time diverticular bleeding.
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Affiliation(s)
- M Friebe
- Abteilung für Innere Medizin, Evangelisches Krankenhaus Oberhausen, Germany.
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238
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Michel JM, Dierieck V, Romagnoli R, Gutschow C, Willocx R, Collard JM. [Esophagitis secondary to jejuno-esophageal reflux after total gastrectomy and Roux-en-Y loop]. Gastroenterol Clin Biol 2001; 25:811-3. [PMID: 11598542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
We report a case of esophagitis secondary to jejuno-esophageal reflux after total gastrectomy and 60 cm Roux-en-Y jejunal loop. Both esophagitis and jejuno-esophageal reflux disappeared after lengthening of the Y-loop by 50 cm.
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Affiliation(s)
- J M Michel
- Services de Chirurgie de l'Appareil Digestif et de Gastroentérologie, Université Catholique de Louvain, Bruxelles, Belgique
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239
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240
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Estevão-Costa J, Soares-Oliveira M, Campos M, Carvalho JL. [Intestinal invagination secondary to myoepithelial hamartoma in children]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2001; 93:485-6. [PMID: 11685948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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241
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Scintu F, Capra F, Giordano M, Frau G, Mascia R, Comella D, Rais M, Casula G. [Neuromuscular and vascular hamartoma of the small intestine. Report of a clinical case and review of the literature]. Chir Ital 2001; 53:393-8. [PMID: 11452826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We present the case of a 50-year old patient, operated on for three adjoining annular strictures in the jejunum with proximal dilatation. He presented with a one-year history of recurrent cramping in the upper abdomen and vomiting, with two episodes of intestinal obstruction. Microscopic examination of the stricture revealed, in the submucosa, disorganised fascicles of smooth muscle derived from the muscularis mucosae, bundles of non-myelinated nerve fibres with scattered abnormal ganglion cells and haemangiomatous vessels. The pathological findings observed were similar to those described as neuromuscular and vascular hamartoma, a rare stricturing condition of the small intestine. Many authors have questioned the hamartomatous nature of this disorder, since identical features may be seen in Crohn's disease, in ischaemic enteritis, in radiation enteritis and in non-steroidal antiinflammatory drug-induced small intestinal strictures. On the basis of a review of the 5 previously described cases and of our own experience, we believe that neuro muscular and vascular hamartoma of the small bowel should be considered as a distinct entity if histological hallmarks of Crohn's disease are absent, in patients with no history of gastrointestinal disease, or of chronic ingestion of non-steroidal antiinflammatory drugs.
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Affiliation(s)
- F Scintu
- Chirurgia Generale II, Università di Cagliari
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242
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Schwesinger WH, Sirinek KR, Gaskill HV, Velez JP, Corea JJ, Strodel WE. Jejunoileal causes of overt gastrointestinal bleeding: diagnosis, management, and outcome. Am Surg 2001; 67:383-7. [PMID: 11308010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Major bleeding from the small intestine is uncommon and difficult to localize. We examined its etiologies and assessed available diagnostic and therapeutic approaches. The records of all adults undergoing operation for small intestinal hemorrhage over a 10-year period (1/89-12/98) were reviewed. There were eight men and four women with a mean age of 54 years. Six patients presented with arteriovenous malformations. Preoperative diagnosis was by endoscopy (three of six), scintigraphy (two of two), and/or angiography (two of six). Intraoperative panendoscopy was used for localization in 5 cases. Three other patients had tumors (leiomyoma, leiomyosarcoma, and adenocarcinoma) by CT scan (two) and/or scintigraphy (two). All were resected but one patient died of recurrence. Two patients underwent resection of a Meckel's diverticulum, one after angiographic diagnosis. Another patient with Crohn's disease had a positive angiogram and colonoscopy before resection. There were no operative deaths but major morbidity occurred in five patients (42%) and hospitalization averaged 17 days. We conclude that jejunoileal lesions are a rare cause of intestinal bleeding but can be associated with substantial morbidity. Arteriovenous malformations and tumors remain the most common causes. An accurate diagnosis and definitive management depend on selective preoperative imaging and judicious operative exploration.
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Affiliation(s)
- W H Schwesinger
- Department of Surgery, University of Texas Health Science Center at San Antonio, 78229-7842, USA
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243
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Meijer K, Peters FT, van der Meer J. Recurrent severe bleeding from gastrointestinal angiodysplasia in a patient with von Willebrand's disease, controlled with recombinant factor VIIa. Blood Coagul Fibrinolysis 2001; 12:211-3. [PMID: 11414636 DOI: 10.1097/00001721-200104000-00008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient with von Willebrand's disease had recurrent gastrointestinal bleeding from angiodysplasia, with inadequate response to von Willebrand factor substitution, medical and endoscopic treatment, and resection of affected bowel. Frequent blood transfusions were required. She started home treatment with recombinant activated factor VII (rFVIIa) at the onset of bleeding, in addition to her standard therapy. From then on, bleeds could be controlled rapidly and no more blood transfusions were needed. We conclude that rFVIIa is effective in this case of angiodysplasia and might be a therapeutic option in similar patients.
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Affiliation(s)
- K Meijer
- Division of Haemostasis, Thrombosis and Rheology, University Hospital Groningen, The Netherlands.
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244
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Gandhi D, Srivastava DN, Choudhary VP, Pande GK, Datta Gupta S. Hemangio-lymphangiomatous hamartoma of jejunum: an unusual cause of massive gastrointestinal haemorrhage. Trop Gastroenterol 2001; 22:95-7. [PMID: 11552496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- D Gandhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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245
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Oran I, Parildar M, Memis A. Mesenteric artery aneurysms in intestinal tuberculosis as a cause of lower gastrointestinal bleeding. Abdom Imaging 2001; 26:131-3. [PMID: 11178687 DOI: 10.1007/s002610000127] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 41-year-old woman with intestinal tuberculosis developed massive lower gastrointestinal hemorrhage. Angiographic examinations showed two aneurysms arising from the proximal branches of the superior mesenteric artery, one of which was resected and the other one was successfully embolized with microcoils. Understanding the angiographic features of the disease with gastrointestinal hemorrhage helps in making an appropriate clinical decision for the treatment strategy.
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Affiliation(s)
- I Oran
- Department of Radiology, Division of Angiography and Interventional Radiology, Ege University Medical School, TR-35100 Izmir, Turkey
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246
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Olejník J, Stránava I. [Diverticulosis of the small intestine and massive digestive tract hemorrhage]. Rozhl Chir 2001; 80:131-3. [PMID: 11367613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The authors present the case-record of a female patient with serious haemorrhage from the digestive tract. A surprising finding of the acute surgical diagnosis and treatment in the stage of compensated hypovolaemic shock were multiple diverticula of the small intestine aborally from the lig. Tretz on the mesenterial side of the intestine. Massive haemorrhage originated in the diverticula of the terminal ileum, haemostasis was achieved by hemicolectomy with resection of the bleeding part of the ileum. The selected surgical treatment is successful on a long-term basis.
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Affiliation(s)
- J Olejník
- Chirurgická klinika SPAM, FNsP akad. L. Dérera, Bratislava, Slovenská republika
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247
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Widgren S, Pantet B, Voirol M. [Giardia lamblia gastritis. A case report]. Rev Med Suisse Romande 2001; 121:153-6. [PMID: 11285698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A 56 year-old male patient had a gastric resection (Billroth II) at age 33. In 1993 he had vague upper digestive complaints. During investigations for a moderate anaemia biopsies performed during an oesogastroduodenoscopy revealed a jejunitis with Giardia lamblia (G.l.) trophozoites which were also found on the gastric mucosa associated with Helicobacter pylori related chronic active gastritis. The few publications dealing with the presence of Giardia lamblia in the stomach either assert or cast some doubts on the pathogenicity of this protozoa for the gastric mucosa. Gastric involvement by G.l. is usually associated with duodeno-jejunal disease responsible for diarrhoea which may occur as epidemics of varying extension. Since Giardia lamblia infection is not submitted to reporting in Switzerland, the epidemiology in our country is scarcely known and investigated. In our opinion, however, health authorities in Switzerland should consider the need of reporting this infectious disease.
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Affiliation(s)
- S Widgren
- Hôpital Cantonal Universitaire, Division de pathologie clinique, Genève
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248
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Abstract
A case of gastric heterotopia was discovered incidentally on a jejunal resection specimen in a 42-year-old patient operated for Koenig's syndrome present for 10 years. This anomaly was responsible for seven chronic ulcers with strictures at multiple levels. Gastric heterotopia, especially in the jejunum, is a rare anomaly, except in intestinal duplications and Meckel's diverticulum. The various complications are a direct result of the activity of the gastric glands: hemorrhage, Helicobacter pylori enteritis, perforation, chronic ulcer and obstructive syndrome; malignant adenocarcinomatous degeneration has also been reported.
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Affiliation(s)
- S Houissa-Vuong
- Cabinet d'anatomie et de cytologie pathologiques, 11 rue Nicolas-Fortin, 75013 Paris, France
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249
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Archimandritis AJ, Hatzopoulos N, Hatzinikolaou P, Sougioultzis S, Kourtesas D, Papastratis G, Tzivras M. Jejunogastric intussusception presented with hematemesis: a case presentation and review of the literature. BMC Gastroenterol 2001; 1:1. [PMID: 11178112 PMCID: PMC29076 DOI: 10.1186/1471-230x-1-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2000] [Accepted: 01/04/2001] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Jejunogastric intussusception (JGI) is a rare but potentially very serious complication of gastrectomy or gastrojejunostomy. To avoid mortality early diagnosis and prompt surgical intervention is mandatory. CASE PRESENTATION A young man presented with epigastric pain and bilous vomiting followed by hematemesis,10 years after vagotomy and gastrojejunostomy for a bleeding duodenal ulcer. Emergency endoscopy showed JGI and the CT scan of the abdomen was compatible with this diagnosis. At laparotomy a retrograde type II, JGI was confirmed and managed by reduction of JGI without intestinal resection. Postoperative recovery was uneventful. CONCLUSIONS JGI is a rare condition and less than 200 cases have been published since its first description in 1914. The clinical picture is almost diagnostic. Endoscopy performed by someone familiar with this rare entity is certainly diagnostic and CT-Scan of the abdomen could also help. There is no medical treatment for acute JGI and the correct treatment is surgical intervention as soon as possible.
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Affiliation(s)
- Athanasios J Archimandritis
- Department of Pathophysiology, Gastroenterology Section, and Department of Internal Medicine, University of Athens Medical School, "Liako" General Hospital, Athens, Greece
| | - Nikos Hatzopoulos
- Department of Pathophysiology, Gastroenterology Section, and Department of Internal Medicine, University of Athens Medical School, "Liako" General Hospital, Athens, Greece
| | - Petros Hatzinikolaou
- Department of Pathophysiology, Gastroenterology Section, and Department of Internal Medicine, University of Athens Medical School, "Liako" General Hospital, Athens, Greece
| | - Stavros Sougioultzis
- Department of Pathophysiology, Gastroenterology Section, and Department of Internal Medicine, University of Athens Medical School, "Liako" General Hospital, Athens, Greece
| | - Dimitris Kourtesas
- Department of Pathophysiology, Gastroenterology Section, and Department of Internal Medicine, University of Athens Medical School, "Liako" General Hospital, Athens, Greece
| | - George Papastratis
- Department of Propedeutic Surgery, University of Athens Medical School, "Laiko" General Hospital, Athens, Greece
| | - Michalis Tzivras
- Department of Pathophysiology, Gastroenterology Section, and Department of Internal Medicine, University of Athens Medical School, "Liako" General Hospital, Athens, Greece
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250
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Abstract
Cramping abdominal pain with intermittent intestinal obstruction finally prompted investigation in a 4 1/2-year-old boy with severe failure to thrive (FTT). An entero-enteric intussusception was corrected, and celiac disease was identified as the cause of his inanition. Concomitant FTT and cramping abdominal pain should prompt investigation for celiac disease and small-bowel intussusception.
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Affiliation(s)
- G Martinez
- Division of Pediatric Surgery, The Children's Hospital at the Medical Center of Central Georgia and Mercer University School of Medicine, Macon, USA
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