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Miles C, Ling N, Paul E, Armstrong D. Presentation, characteristics and management of obstructive intestinal conditions in cystic fibrosis. Frontline Gastroenterol 2024; 15:222-227. [PMID: 38665789 PMCID: PMC11042455 DOI: 10.1136/flgastro-2023-102533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/21/2023] [Indexed: 04/28/2024] Open
Abstract
Objective Constipation and distal intestinal obstruction syndrome (DIOS) are common gastrointestinal manifestations of cystic fibrosis (CF). The primary aim was to describe the characteristics of constipation and DIOS hospitalisations in a paediatric and adult CF service over a 12-year period. The secondary aims were to determine the proportion of constipation and DIOS presentations which met the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) CF Working Group definitions and to describe management strategies of both conditions. Method A retrospective study of children and adults with CF who were admitted with a primary diagnosis of constipation or DIOS between 1 January 2011 and 31 December 2022. ESPGHAN definitions for constipation and DIOS were retrospectively applied to all admissions to determine if the primary medical diagnosis met ESPGHAN criteria. Results During the 12-year study period, 42 hospitalisations for constipation were recorded in 19 patients, and 33 hospitalisations for DIOS were recorded in 23 patients. 88.10% of constipation episodes met ESPGHAN definitions, compared with 3.0% of DIOS episodes. Constipation and DIOS were primarily treated with polyethylene glycol (PEG). The use of sodium amidotrizoate meglumine enemas was significantly higher in the DIOS group (p=0.045). Those admitted with DIOS were significantly less likely to be recommended a weaning dose of PEG (p=0.018). Conclusion Children and adults with CF are more commonly admitted for the management of constipation than DIOS. There is considerable variation in diagnostic and therapeutic practice, and this study highlights the need to enhance the translation and adoption of existing best-practice guidelines.
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Affiliation(s)
- Caitlin Miles
- Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Natalie Ling
- Department of Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation (MCHRI), Monash University, Melbourne, Victoria, Australia
| | - David Armstrong
- Department of Respiratory and Sleep Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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2
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Petersbourg D. Small Bowel Diverticulitis: An Unusual Cause of Abdominal Pain. J Belg Soc Radiol 2024; 108:28. [PMID: 38523725 PMCID: PMC10959129 DOI: 10.5334/jbsr.3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Teaching point: Small bowel diverticulitis, much less common than its colonic counterpart, is a diagnosis that must be considered in the presence of abdominal pain, especially in an elderly person.
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3
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Halloran BP, Reeson M, Teshima C, Kroeker K, Huang V, Dieleman L, Holmes P, Baumgart DC, Wong K, Hoentjen F, Peerani F, Zepeda-Gomez S. Stricture dilation via balloon-assisted endoscopy in Crohn's disease: approach and intraprocedural outcomes with the single-balloon and double-balloon systems. Therap Adv Gastroenterol 2024; 17:17562848241230904. [PMID: 38425369 PMCID: PMC10903206 DOI: 10.1177/17562848241230904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Despite recent emerging literature involving the utility of endoscopic balloon dilation (EBD) of strictures via balloon-assisted endoscopy (BAE), specifically regarding the management of Crohn's disease (CD), the optimal clinical approach with balloon systems has been largely neglected in academic literature. Objectives This study assesses the intra-procedural success and safety of EBD via BAE for small bowel CD strictures while detailing our clinical approach and technique. Secondarily, we compare the single-balloon endoscope (SBE) and double-balloon endoscope (DBE) systems for EBD-related outcomes. Design Retrospective consecutive patient cohort analysis. Methods We retrospectively assessed a consecutive small bowel CD patient cohort undergoing BAE at the University of Alberta Hospital endoscopy unit from 2013 to 2020. The primary endpoint discerned the safety and immediate success rate of EBD during endoscopy, and comparisons of the dilation parameters and efficacy of SBE versus DBE were assessed as secondary outcomes. Results During the study period, 87 patients (44 male) with a mean age of 56 ± 14.7 years underwent 179 endoscopic procedures (92 DBE and 87 SBE). Of 358 strictures encountered, 320 (89.4%) were successfully dilated and traversed. The mean maximum dilation diameter was 15.76 ± 2.10 mm. There were no perforations or major adverse events. Conclusion EBD via BAE is a safe procedure in small bowel CD with a high intraprocedural success rate. Overall, SBE had a higher success rate in traversing strictures before and after dilation using our technique. This analysis is limited by the retrospective nature of our study and must be balanced against the inherent benefits of the DBE system.
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Affiliation(s)
- Brendan P. Halloran
- Director of the Small Endoscopy Bowel Program, Division of Gastroenterology, Department of Medicine, University of Alberta, 130 University Campus NW, Edmonton, AB, Canada T6G2X8
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | | | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Vivian Huang
- Division of Gastroenterology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Levinus Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Peter Holmes
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Daniel C. Baumgart
- Division of Gastroenterology
- Charité Medical Center – Virchow Hospital Berlin, Berlin, Germany
| | - Karen Wong
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Frank Hoentjen
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Farhad Peerani
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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4
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Rimondi A, Sorge A, Murino A, Nandi N, Scaramella L, Vecchi M, Tontini GE, Elli L. Treatment options for gastrointestinal bleeding blue rubber bleb nevus syndrome: Systematic review. Dig Endosc 2024; 36:162-171. [PMID: 37029779 DOI: 10.1111/den.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/05/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Blue rubber bleb nevus syndrome (BRBNS) is a rare challenging cause of gastrointestinal bleeding. We performed a systematic review of case reports and case series on BRBNS to gather information on the treatment options currently available. METHODS All studies reporting a case of BRBNS in humans were evaluated. Papers were ruled out if CARE criteria and explanations on patient's selection, ascertainment, causality, and reporting were not respected or identified. PROSPERO 2021 CRD 42021286982. RESULTS Blue rubber bleb nevus syndrome was treated in 106 cases from 76 reports. 57.5% of the population was under 18 years old, and up to 50% of the cases reported a previous treatment. Clinical success was achieved in 98 patients (92.4%). Three main types of interventions were identified: systemic drug therapy, endoscopy, and surgery. After BRBNS recurrence or previous therapy failure, systemic drug therapy emerged as a preferred second-line treatment over endoscopy (P = 0.01), but with a higher rate of reported adverse events when compared with surgery and endoscopy (P < 0.001). Endoscopic treatment was associated with a higher number of required sessions to achieve complete eradication when compared with surgery (P < 0.001). No differences between the three main areas were found in the overall follow-up time (P = 0.19) or in the recurrence rate (P = 0.45). CONCLUSION Endoscopy, surgery, and systemic drug therapy are feasible treatment options for BRBNS. Systemic drug therapy was the favorite second-line treatment after endoscopic failure or recurrence of BRBNS, but adverse events were more frequently reported.
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Affiliation(s)
- Alessandro Rimondi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Andrea Sorge
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
- Department of Gastroenterology, Cleveland Clinic London, London, UK
| | - Nicoletta Nandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Galvão D, Bettencourt R, Soares AC, Bagnari I, Bonança J. Rare Combination of Chyloperitoneum Secondary to Primary Small-Bowel Volvulus. Cureus 2024; 16:e53379. [PMID: 38435223 PMCID: PMC10907969 DOI: 10.7759/cureus.53379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Chylous ascites is the exudation from lymphatic content to the peritoneum and is a rare situation that mostly occurs following medical causes like neoplasms or cirrhosis. However, trauma to the lymphatic system due to compression by masses or altered anatomy can be a trigger too. We describe a rare combination of a primary small bowel volvulus in a young healthy adult causing chylous ascites. Obstruction caused by a primary small bowell volvulus can re-arrange the lymphatics anatomy increasing their flow pressure which can lead to rupture and leak. This is an emergent scenario that needs to be addressed quickly because of bowel ischaemia. CT scan is the gold standard to expedite diagnosis and go to surgical treatment. Although it can be an impactful finding, treatment of the cause behind chylous ascites results in complete resolution without any bowel resection.
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Affiliation(s)
- Diogo Galvão
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Rui Bettencourt
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Ana Cláudia Soares
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Inês Bagnari
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
| | - Joana Bonança
- Surgery, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, PRT
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Albandar M, Aljarayhi S. Primary Squamous Cell Carcinoma of the Cecum: A Case Report. Cureus 2024; 16:e54615. [PMID: 38524045 PMCID: PMC10959148 DOI: 10.7759/cureus.54615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Primary squamous cell carcinoma (SCC) of the colon is an exceptionally rare diagnosis. The etiology and pathogenesis of this entity remain unclear. It usually presents in patients as an emergency, typically with the tumor in the advanced stage. We report a case of SCC of the cecum presenting with perforation, initially diagnosed as SCC of unknown origin. The patient underwent a limited right hemicolectomy and end ileostomy outside our center. The patient was referred to us for further workup and possible adjuvant chemotherapy. She was assessed clinically and found to have had poor appetite and anorexia for a month, with an intermittent fever documented at 39 degrees. Thus, the patient was elected to get admitted for a septic workup and re-staging by CT scan and tumor biomarkers. CT showed a phlegmon and abscess formation at the right iliac fossa that was attached to surrounding structures, including the abdominal wall. Drain placement at the site of the phlegmon was attempted but failed due to bowel overlapping. Therefore, the patient was booked for surgical exploration and drainage, where all structures were resected en bloc. Histopathological examination revealed well-differentiated keratinized SCC with lymph node metastasis. The diagnosis of primary SCC of the cecum was confirmed after investigations to rule out primary sources were negative. Surgical resection remains the mainstay of management, with a possible role for chemotherapy and radiation therapy. The prognosis in these cases is usually poor. This warrants early diagnosis and management. Studies are needed to establish a management protocol for this entity.
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Affiliation(s)
- Mahdi Albandar
- Department of Surgery, King Saud Medical City, Riyadh, SAU
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7
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Mota J, Almeida MJ, Mendes F, Martins M, Ribeiro T, Afonso J, Cardoso P, Cardoso H, Andrade P, Ferreira J, Mascarenhas M, Macedo G. From Data to Insights: How Is AI Revolutionizing Small-Bowel Endoscopy? Diagnostics (Basel) 2024; 14:291. [PMID: 38337807 PMCID: PMC10855436 DOI: 10.3390/diagnostics14030291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The role of capsule endoscopy and enteroscopy in managing various small-bowel pathologies is well-established. However, their broader application has been hampered mainly by their lengthy reading times. As a result, there is a growing interest in employing artificial intelligence (AI) in these diagnostic and therapeutic procedures, driven by the prospect of overcoming some major limitations and enhancing healthcare efficiency, while maintaining high accuracy levels. In the past two decades, the applicability of AI to gastroenterology has been increasing, mainly because of the strong imaging component. Nowadays, there are a multitude of studies using AI, specifically using convolutional neural networks, that prove the potential applications of AI to these endoscopic techniques, achieving remarkable results. These findings suggest that there is ample opportunity for AI to expand its presence in the management of gastroenterology diseases and, in the future, catalyze a game-changing transformation in clinical activities. This review provides an overview of the current state-of-the-art of AI in the scope of small-bowel study, with a particular focus on capsule endoscopy and enteroscopy.
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Affiliation(s)
- Joana Mota
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Maria João Almeida
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Helder Cardoso
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - Patrícia Andrade
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
| | - João Ferreira
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465 Porto, Portugal;
- Digestive Artificial Intelligence Development, R. Alfredo Allen 455-461, 4200-135 Porto, Portugal
| | - Miguel Mascarenhas
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- ManopH Gastroenterology Clinic, R. de Sá da Bandeira 752, 4000-432 Porto, Portugal
| | - Guilherme Macedo
- Precision Medicine Unit, Department of Gastroenterology, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal (G.M.)
- WGO Gastroenterology and Hepatology Training Center, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-427 Porto, Portugal
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Naddouri J, Khouah R, Sekkat H, Bakali Y, EL Alaoui MM, Raiss M, Sabbah F, Hrora A. Small bowel obstruction in adults, Ladd's band is an exceptional cause: a case report. Pan Afr Med J 2024; 47:34. [PMID: 38586070 PMCID: PMC10998253 DOI: 10.11604/pamj.2024.47.34.36435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/09/2024] [Indexed: 04/09/2024] Open
Abstract
Malrotation of the gut is a congenital anomaly of foetal intestinal rotation and it's principally discovered in early childhood as acute intestinal obstruction. This condition is veritably rare and constantly silent in adults. Intestinal malrotation in adults is frequently asymptomatic and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen. Adult patients rarely present with acute midgut volvulus or internal hernias caused by Ladd's bands. We present a case of an admitted 18-year-old female with a small bowel obstruction due to an intestinal volvulus complicating intestinal malrotation in the presence of Ladd's band. Laparotomic Ladd's procedure was performed successfully with division of Ladd's band, adhesiolysis, appendicectomy, and reorientation of the small bowel on the right and the cecum and colon on the left of the abdominal cavity; the postoperative evolution was favorable. Although it is a rare pathology, it should be kept in mind in cases of patients presenting small bowel obstruction.
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Affiliation(s)
- Jaouad Naddouri
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Rachid Khouah
- Department of Digestive and General Surgery, Department of Surgery A, Lucien Hussel Hospital Center, Vienne, France
| | - Hamza Sekkat
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Younes Bakali
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Mouna M'hamdi EL Alaoui
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Mohamed Raiss
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Farid Sabbah
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
| | - Abdelmalek Hrora
- Department of Digestive and General Surgery, Department of Surgery C, University Hospital Center Ibn Sina, Rabat, Morocco
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Njima M, Lahbacha B, Ben Jabra S, Moussa A, Bellalah A, Ben Abdeljelil N, Ben Hammouda S, Njim L, Hadhri R, Zakhama A. Small Intestine Gastrointestinal Clear Cell Sarcoma: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2024; 12:23247096231225869. [PMID: 38229428 PMCID: PMC10798064 DOI: 10.1177/23247096231225869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/29/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024] Open
Abstract
Gastrointestinal clear cell sarcoma (GICCS)/malignant gastrointestinal neuroectodermal tumor (GNET) is an extremely rare form of cancer with aggressive clinical behavior. It has distinct pathological, immunohistochemical, ultrastructural, and molecular features. Herein, we present the case of a 20-year-old woman with no notable medical history who presented to the outpatient department with complaints of abdominal pain and vomiting. Symptoms had been evolving for 3 months. The physical examination revealed slight abdominal tenderness and melena. Biological investigations revealed iron-deficiency anemia. The upper and lower endoscopies showed no abnormalities. Magnetic resonance enterography revealed small bowel wall thickening of 15 mm × 2 mm. Exploratory laparotomy revealed an ileal mass with mesenteric lymphadenopathy. A wide resection of the mass was then performed. The final pathological report confirmed the diagnosis of small bowel GICCS/GNET. After 11 months of follow-up, the patient presented with mesenteric lymph node metastases.
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Affiliation(s)
- Manel Njima
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Bahaeddine Lahbacha
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Sadok Ben Jabra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Amani Moussa
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Ahlem Bellalah
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Nouha Ben Abdeljelil
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Seifeddine Ben Hammouda
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Leila Njim
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Rim Hadhri
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
| | - Abdelfattah Zakhama
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine of Monastir, Tunisia
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Bouhout T, Kharkhach A, Ramdani A, Harouachi A, Serji B. Early Small Bowel Obstruction Caused by Surgical Drain Following Rectal Cancer Surgery: A Case Report. Cureus 2024; 16:e52694. [PMID: 38384653 PMCID: PMC10879656 DOI: 10.7759/cureus.52694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
The abdominal drains are commonly used and could be a source of several complications, including infection and small bowel obstruction. We report the case of a 70-year-old male patient with intestinal obstruction related to abdominal drainage after rectal surgery. Acute bowel obstruction remains a rare complication of abdominal drains. Surgeons should be aware of this situation and use drains with caution. The treatment options include conservative treatment or surgery either a laparoscopic approach or laparotomy.
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Affiliation(s)
- Tariq Bouhout
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Ayoub Kharkhach
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Abdelbassir Ramdani
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Abdelhakim Harouachi
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
| | - Badr Serji
- Department of Surgical Oncology, Oncology Hospital of Oujda, Faculty of Medicine and Pharmacy of Oujda, Université Mohammed Premier, Oujda, MAR
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Toro Tole D, Bowden J, Kamath S, Kaur M, LaPaglia D. Renal Cell Carcinoma Metastasis to the Small Bowel: A Rare Finding 10 Years After Nephrectomy. Cureus 2024; 16:e53141. [PMID: 38420097 PMCID: PMC10901038 DOI: 10.7759/cureus.53141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Renal cell carcinoma (RCC) most commonly metastasizes to the lung, lymph nodes, bone, and liver. RCC metastasizing to the small bowel is exceedingly rare (0.7%), and the ileum is the least likely site. We discuss the case of a 63-year-old male patient who presented with melena and a 10-kg unintentional weight loss in the preceding month 10 years after undergoing curative nephrectomy for RCC; he was found to have an ileal mass on CT imaging. He subsequently underwent a diagnostic gastroscopy and laparoscopy, later converted to a laparotomy, with bowel resection and anastomosis. The immunohistochemistry was consistent with RCC. This case report highlights the need for awareness about this rare but potential site of metastasis, which may present with gastrointestinal bleeding.
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Jiang Z, Zhang G, Sun T, Zhang G, Zhang X, Kong X, Yin Y. Advantages of IMRT optimization with MCO compared to IMRT optimization without MCO in reducing small bowel high dose index for cervical cancer patients-individualized treatment options. Transl Cancer Res 2023; 12:3255-3265. [PMID: 38197072 PMCID: PMC10774067 DOI: 10.21037/tcr-22-2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/08/2023] [Indexed: 01/11/2024]
Abstract
Background Traditional intensity-modulated radiation therapy (IMRT) planning for cervical cancer is time-consuming and require iterative repeated optimization. In this study, we focused on leveraging multi-criteria optimization (MCO) to reduce the impact of small bowel high-dose indices on other optimization targets, thereby providing a rapid approach to individualized IMRT for cervical cancer patients. Methods Our research involved a cohort of 25 cervical cancer patients who underwent IMRT radiotherapy. The patient inclusion criteria were as follows: (I) histopathological confirmation of cervical cancer, (II) underwent IMRT radiation therapy, and (III) a prescribed dose of 180 cGy/28 fractions for the patient. All plans were replanned by an experienced dosimetrist without the MCO (W-IMRT). On the basis of the W-IMRT plan, the individualized IMRT (I-IMRT) plan was generated under the priority trade-off of reducing the D2cc (D2cc is the minimal dose to the 2 cm3 of the small bowel receiving the maximal dose) index of the small bowel using the MCO method, maintaining target coverage and protecting other organs at risk (OARs) as much as possible. Statistical analysis was performed using the Wilcoxon signature rank test. Results When the MCO method was applied to the IMRT plan, the high dose index decreased in the overlapping area between the small bowel and the planning treatment volume (PTV) (P<0.001, respectively). The D2cc index of the small bowel decreased to below 5,200 cGy in all I-IMRT plans. On the other hand, in PTV, the I-IMRT plan achieved a better homogeneity index (HI) compared to the W-IMRT plan. Significant dose reductions were also observed in the bladder (Dmean 144.8 cGy and V40 1.45%) (P<0.001, respectively), rectum (Dmean 43.9 cGy and V40 2.7%) (P<0.001, respectively) and bilateral femur heads (Dmean 150 cGy) (P<0.001, respectively). Conclusions Dosimetric differences suggest that the I-IMRT plan using the MCO method provides better protection of other OARs and equivalently in PTV coverage, while lowering the high-dose index in the small bowel as much as possible for patients with cervical cancer, thus providing a rapid approach to achieving individualized IMRT for cervical cancer patients.
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Affiliation(s)
- Zejun Jiang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Gongsen Zhang
- Artificial Intelligence Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guifang Zhang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xinqiang Zhang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiangyue Kong
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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DiPeri TP, Manguso N, Gong J, Atkins KM, Hendifar AE, Gangi A. Socioeconomic disparities in patients with small bowel neuroendocrine tumors. J Surg Oncol 2023; 128:1278-1284. [PMID: 37668060 DOI: 10.1002/jso.27437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/22/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Demographic and socioeconomic disparities affect cancer specific outcomes in numerous malignancies, but the impact of these for patients with small bowel neuroendocrine tumors (SBNETs) is not well understood. The primary objective was to investigate the impact of demographic and socioeconomic factors on overall survival (OS) for patients with SBNETs. METHODS We performed a retrospective cohort study utilizing the National Cancer Database to assess patients diagnosed with SBNET between 2004 and 2015. Patients were stratified by demographics, socioeconomic factors, insurance status, and place of living. RESULTS The 5-year OS for the entire cohort was 78.5%. The 5-year survival was worse in patients with lower income (p < 0.0001), lower education (p < 0.0001), not in proximity to a metro area (p = 0.0004), and treatment at a community cancer center (p < 0.0001). Adjusting for age and sex, factors associated with worse OS were lower income (<$38 000) (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.04-1.28), lower education (>20% no HSD) (HR: 1.14, 95% CI: 1.02-1.26), no insurance (HR: 1.66, 95% CI: 1.33-2.06), and not living in proximity to a metro area (HR: 1.27, 95% CI: 1.10-1.47). CONCLUSIONS Patient demographics and socioeconomic factors play an important role in survival of patients with SBNETs, specifically proximity to a metro area, median income, education level, and type of treatment center. Strategies to improve access to care must be considered in this at-risk population.
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Affiliation(s)
- Timothy P DiPeri
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nicholas Manguso
- Division of Surgical Oncology and Hepatobiliary Surgery, Pennington Cancer Institute, Renown Health, Reno, Nevada, USA
| | - Jun Gong
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Andrew E Hendifar
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Alexandra Gangi
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
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Turck D, Dratsch T, Schröder L, Lorenz F, Dinter J, Bürger M, Schiffmann L, Kasper P, Allo G, Goeser T, Chon SH, Nierhoff D. A convolutional neural network for bleeding detection in capsule endoscopy using real clinical data. MINIM INVASIV THER 2023; 32:335-340. [PMID: 37640056 DOI: 10.1080/13645706.2023.2250445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The goal of the present study was to develop a convolutional neural network for the detection of bleedings in capsule endoscopy videos using realistic clinical data from one single-centre. METHODS Capsule endoscopy videos from all 133 patients (79 male, 54 female; meanage = 53.73 years, SDage = 26.13) who underwent capsule endoscopy at our institution between January 2014 and August 2018 were screened for pathology. All videos were screened for pathology by two independent capsule experts and confirmed findings were checked again by a third capsule expert. From these videos, 125 pathological findings (individual episodes of bleeding spanning a total of 5696 images) and 103 non-pathological findings (sections of normal mucosal tissue without pathologies spanning a total of 7420 images) were used to develop and validate a neural network (Inception V3) using transfer learning. RESULTS The overall accuracy of the model for the detection of bleedings was 90.6% [95%CI: 89.4%-91.7%], with a sensitivity of 89.4% [95%CI: 87.6%-91.2%] and a specificity of 91.7% [95%CI: 90.1%-93.2%]. CONCLUSION Our results show that neural networks can detect bleedings in capsule endoscopy videos under realistic, clinical conditions with an accuracy of 90.6%, potentially reducing reading time per capsule and helping to improve diagnostic accuracy.
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Affiliation(s)
- Dorothee Turck
- Department of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Dratsch
- Institute of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Lorenz Schröder
- Department of Medicine, University of Cologne, Cologne, Germany
| | - Florian Lorenz
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Johanna Dinter
- Gastroenterologische Schwerpunktpraxis Stähler, Cologne, Germany
| | - Martin Bürger
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Lars Schiffmann
- Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Gabriel Allo
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Seung-Hun Chon
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
- Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Dirk Nierhoff
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
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15
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Bohra A, Lewis D, Segal JP, Vasudevan A, Van Langenberg DR, Niewiadomski O. Utility of panenteric capsule endoscopy for the detection of small-bowel Crohn's disease in patients with a normal magnetic resonance enterography: A prospective observational pilot study. JGH Open 2023; 7:966-973. [PMID: 38162838 PMCID: PMC10757497 DOI: 10.1002/jgh3.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Capsule endoscopy allows the direct visualization of the small bowel. We examined the diagnostic utility of a new modality, namely panenteric Crohn's capsule endoscopy (CE), in detecting active small-bowel Crohn's disease (CD) in those with normal magnetic resonance enterography (MRE). Methods We prospectively recruited patients with a diagnosis of CD or suspected small-bowel CD in whom the MRE was normal. Inclusion criteria included abdominal symptoms and abnormal serum or fecal biomarkers. The primary outcome was the detection of active small-bowel CD (measured through the Lewis score [LS]). Secondary outcomes included change in Montreal classification for those with a pre-existing CD diagnosis, change in medical therapy, clinical activity, and biomarkers at baseline and 6 months, and quality-of-life measures. Results A total of 22 patients with a diagnosis of CD or suspected new diagnosis were recruited, with CE complete to the caecum in 21 and 18/21 (86%) showing evidence of active small-bowel CD (LS > 135). Of the patients with a pre-existing diagnosis of CD, 9/11 (82%) had a change in Montreal classification. At 6 months following CE, 17/18 (94%) had clinician-directed change in therapy. This correlated with an improvement in the quality of life (P < 0.05 as per the Short Inflammatory Bowel Disease Questionnaire), a reduction in the Harvey Bradshaw index (median: 7-4, P < 0.001), and favorable CRP and albumin response. Conclusion Crohn's CE is a useful diagnostic test for assessing active small-bowel CD when imaging is normal but clinical suspicion is high. Crohn's CE should be integrated into the diagnostic algorithm for small-bowel CD.
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Affiliation(s)
- Anuj Bohra
- Department of GastroenterologyBox Hill HospitalBox HillVictoriaAustralia
- Department of GastroenterologyNorthern HospitalEppingVictoriaAustralia
- Eastern Health Clinical SchoolMonash UniversityBox HillVictoriaAustralia
| | - Diana Lewis
- Department of GastroenterologyNorthern HospitalEppingVictoriaAustralia
| | - Jonathan P Segal
- Department of GastroenterologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Abhinav Vasudevan
- Department of GastroenterologyBox Hill HospitalBox HillVictoriaAustralia
- Eastern Health Clinical SchoolMonash UniversityBox HillVictoriaAustralia
| | - Daniel R Van Langenberg
- Department of GastroenterologyBox Hill HospitalBox HillVictoriaAustralia
- Eastern Health Clinical SchoolMonash UniversityBox HillVictoriaAustralia
| | - Olga Niewiadomski
- Department of GastroenterologyBox Hill HospitalBox HillVictoriaAustralia
- Eastern Health Clinical SchoolMonash UniversityBox HillVictoriaAustralia
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16
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Popa SL, Stancu B, Ismaiel A, Turtoi DC, Brata VD, Duse TA, Bolchis R, Padureanu AM, Dita MO, Bashimov A, Incze V, Pinna E, Grad S, Pop AV, Dumitrascu DI, Munteanu MA, Surdea-Blaga T, Mihaileanu FV. Enteroscopy versus Video Capsule Endoscopy for Automatic Diagnosis of Small Bowel Disorders-A Comparative Analysis of Artificial Intelligence Applications. Biomedicines 2023; 11:2991. [PMID: 38001991 PMCID: PMC10669430 DOI: 10.3390/biomedicines11112991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Small bowel disorders present a diagnostic challenge due to the limited accessibility of the small intestine. Accurate diagnosis is made with the aid of specific procedures, like capsule endoscopy or double-ballon enteroscopy, but they are not usually solicited and not widely accessible. This study aims to assess and compare the diagnostic effectiveness of enteroscopy and video capsule endoscopy (VCE) when combined with artificial intelligence (AI) algorithms for the automatic detection of small bowel diseases. MATERIALS AND METHODS We performed an extensive literature search for relevant studies about AI applications capable of identifying small bowel disorders using enteroscopy and VCE, published between 2012 and 2023, employing PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and ClinicalTrials.gov databases. RESULTS Our investigation discovered a total of 27 publications, out of which 21 studies assessed the application of VCE, while the remaining 6 articles analyzed the enteroscopy procedure. The included studies portrayed that both investigations, enhanced by AI, exhibited a high level of diagnostic accuracy. Enteroscopy demonstrated superior diagnostic capability, providing precise identification of small bowel pathologies with the added advantage of enabling immediate therapeutic intervention. The choice between these modalities should be guided by clinical context, patient preference, and resource availability. Studies with larger sample sizes and prospective designs are warranted to validate these results and optimize the integration of AI in small bowel diagnostics. CONCLUSIONS The current analysis demonstrates that both enteroscopy and VCE with AI augmentation exhibit comparable diagnostic performance for the automatic detection of small bowel disorders.
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Affiliation(s)
- Stefan Lucian Popa
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.); (A.-V.P.); (T.S.-B.)
| | - Bogdan Stancu
- 2nd Surgical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Abdulrahman Ismaiel
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.); (A.-V.P.); (T.S.-B.)
| | - Daria Claudia Turtoi
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Vlad Dumitru Brata
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Traian Adrian Duse
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Roxana Bolchis
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Alexandru Marius Padureanu
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Miruna Oana Dita
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Atamyrat Bashimov
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Victor Incze
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Edoardo Pinna
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (D.C.T.); (V.D.B.); (T.A.D.); (R.B.); (A.M.P.); (M.O.D.); (A.B.); (V.I.); (E.P.)
| | - Simona Grad
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.); (A.-V.P.); (T.S.-B.)
| | - Andrei-Vasile Pop
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.); (A.-V.P.); (T.S.-B.)
| | - Dinu Iuliu Dumitrascu
- Department of Anatomy, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Mihai Alexandru Munteanu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania;
| | - Teodora Surdea-Blaga
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (S.L.P.); (A.I.); (S.G.); (A.-V.P.); (T.S.-B.)
| | - Florin Vasile Mihaileanu
- 2nd Surgical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
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Singh SS, Shinde RK. Minimally Invasive Gastrointestinal Surgery: A Review. Cureus 2023; 15:e48864. [PMID: 38106769 PMCID: PMC10724411 DOI: 10.7759/cureus.48864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Minimally invasive surgery uses several procedures with fewer side effects (bleeding, infections, etc.), a shorter hospital stay, and less discomfort following minimally invasive surgery. Laparoscopy was one of the first forms of minimally invasive surgery. It involves doing surgery while using tiny cameras through one or more small incisions, surgical tools along with tubes. Robotic surgery is another kind of minimally invasive procedure. Along with supporting accurate, flexible, and regulated surgical procedures, it provides the physician with a three-dimensional, enlarged view of the operative site. Minimally invasive surgery continues to advance, making it an advantage for patients with a variety of illnesses. Nowadays, many surgeons prefer it to traditional surgery, which frequently necessitates a longer hospital stay and requires larger incisions. Since then, numerous surgical specialties have greatly increased their use of minimally invasive surgery. A minimally invasive procedure is preferred for the majority of patients who require gastrointestinal surgery. Minimally invasive gastrointestinal procedures are just as successful as open procedures and, in some situations, may result in more effective outcomes. While recovery from open surgeries frequently takes five to ten days in the hospital, minimally invasive surgeries are less painful for patients and hasten recovery. It is safe from the perspective of the patient and has a lower postoperative mortality rate. This procedure involves a learning curve among surgeons.
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Affiliation(s)
- Sejal S Singh
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Stewart J, Fleishman NR, Staggs VS, Thomson M, Stoecklein N, Lawson CE, Washburn MP, Umar S, Attard TM. Small Intestinal Polyp Burden in Pediatric Peutz-Jeghers Syndrome Assessed through Capsule Endoscopy: A Longitudinal Study. Children (Basel) 2023; 10:1680. [PMID: 37892343 PMCID: PMC10605554 DOI: 10.3390/children10101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
The management of pediatric Peutz-Jeghers Syndrome (PJS) focuses on the prevention of intussusception complicating small intestinal (SI) polyposis. This hinges on the accurate appraisal of the polyp burden to tailor therapeutic interventions. Video Capsule Endoscopy (VCE) is an established tool to study SI polyps in children, but an in-depth characterization of polyp burden in this population is lacking. Methods: We performed a retrospective longitudinal cross-sectional analysis of VCE studies in pediatric PJS patients at our institution (CMKC) from 2010 to 2020. Demographic, clinical, and VCE findings reported by three reviewers in tandem were accrued. Polyp burden variables were modeled as functions of patient and study characteristics using linear mixed models adjusted for clustering. Results: The cohort included 15 patients. The total small bowel polyp count and largest polyp size clustered under 30 polyps and <20 mm in size. Luminal occlusion correlated closely with the estimated polyp size. Polyp distribution favored proximal (77%) over distal (66%) small bowel involvement. The adjusted largest polyp size was greater in males. Double Balloon Enteroscopy was associated with a decreased polyp burden. Conclusions: The polyp burden in pediatric PJS patients favors the proximal third of the small intestine, with relatively small numbers and a polyp size amenable to resection through enteroscopy. Male gender and older age were related to an increased polyp burden.
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Affiliation(s)
- Jeremy Stewart
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Children’s Medical Center, Dallas, TX 75235, USA
| | - Nathan R. Fleishman
- Division of Gastroenterology, Levine Children’s Hospital, Charlotte, NC 28203, USA
| | - Vincent S. Staggs
- Biostatistics and Epidemiology Core, Division of Health Services and Outcomes Research, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Mike Thomson
- Department of Paediatric Gastroenterology, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield University, Sheffield S10 2TH, UK
| | - Nicole Stoecklein
- Division of Gastroenterology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Caitlin E. Lawson
- Division of Genetics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Michael P. Washburn
- Department of Cancer Biology, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Shahid Umar
- Department of Surgery, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Thomas M. Attard
- Division of Gastroenterology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- University of Missouri–Kansas City School of Medicine, 2464 Charlotte St, Kansas City, MO 64108, USA
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Fallatah AA, Mashbari H, Daghestani H, Mostafa O, Alshahwan N, Alburakan A, Nouh T. Toothpick perforates small bowel-mimicking diverticulitis. J Surg Case Rep 2023; 2023:rjad511. [PMID: 37727225 PMCID: PMC10506890 DOI: 10.1093/jscr/rjad511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
Bowel perforation is an emergency condition that requires critical thinking and readily intervention; nevertheless, on occasions, its presentation can be challenging to diagnose. Several etiologies could cause bowel perforation, including obstruction, mass, inflammation, ischemia, etc. On rare occasions, a foreign body could be the cause of perforation, which mandates a detailed history and focused review of the images when the patient's condition allows. We report a case of ileal perforation caused by an ingested wooden toothpick that was suspected on the CT images, which the patient has no memory of ingesting.
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Affiliation(s)
- Ahmed A Fallatah
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
- General Surgery Section, Department of Surgery, King Abdulaziz Hospital, Ministry of Health, P.O Box 3665 Jeddah 22421, Saudi Arabia
| | - Hassan Mashbari
- Department of Surgery, Faculty of Medicine, Jazan University, P.O Box 6809 Jazan 82817-28204, Saudi Arabia
| | - Hatoon Daghestani
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
| | - Omar Mostafa
- College of Medicine, Sulaiman Al Rajhi University, P.O Box 777 Albukairiyah 51941, Saudi Arabia
| | - Nawaf Alshahwan
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
| | - Ahmed Alburakan
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
| | - Thamer Nouh
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, P.O Box 2925 Riyadh 11461, Saudi Arabia
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Navin PJ, Ehman EC, Liu JB, Halfdanarson TR, Gupta A, Laghi A, Yoo DC, Carucci LR, Schima W, Sheedy SP. Imaging of Small-Bowel Neuroendocrine Neoplasms: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:289-301. [PMID: 36752369 DOI: 10.2214/ajr.22.28877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Neuroendocrine neoplasms (NENs) of the small bowel are typically slow-growing lesions that remain asymptomatic until reaching an advanced stage. Imaging modalities for lesion detection, staging, and follow-up in patients with known or suspected NEN include CT enterography, MR enterography, and PET/CT using a somatostatin receptor analog. FDG PET/CT may have a role in the evaluation of poorly differentiated NENs. Liver MRI, ideally with a hepatocyte-specific contrast agent, should be used in the evaluation of hepatic metastases. Imaging informs decisions regarding both surgical approaches and systematic therapy (specifically, peptide receptor radionuclide therapy). This AJR Expert Panel Narrative Review describes the multimodality imaging features of small-bowel NENs; explores the optimal imaging modalities for their diagnosis, staging, and follow-up; and discusses how imaging may be used to guide therapy.
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Affiliation(s)
- Patrick J Navin
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Jason B Liu
- Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital, Boston, MA
| | | | - Akshya Gupta
- Department of Imaging Sciences, University of Rochester, Rochester, NY
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, AOU Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Don C Yoo
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Laura R Carucci
- Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus and Sankt Josef Krankenhaus, Vienna, Austria
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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21
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Clement DSVM, Brown SE, Naghibi M, Cooper SC, Tesselaar MET, van Leerdam ME, Ramage JK, Srirajaskanthan R. Feasibility of Home Parenteral Nutrition in Patients with Intestinal Failure Due to Neuroendocrine Tumours: A Systematic Review. Nutrients 2023; 15:3787. [PMID: 37686819 PMCID: PMC10490066 DOI: 10.3390/nu15173787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Maintaining adequate nutritional status can be a challenge for patients with small bowel neuroendocrine tumours (NETs). Surgical resection could result in short bowel syndrome (SBS), whilst without surgical resection there is a considerable risk of ischemia or developing an inoperable malignant bowel obstruction (IMBO). SBS or IMBO are forms of intestinal failure (IF) which might require treatment with home parenteral nutrition (HPN). Limited data exist regarding the use of HPN in patients with small bowel neuroendocrine tumours, and it is not frequently considered as a possible treatment. METHODS A systematic review was performed regarding patients with small bowel NETs and IF to report on overall survival and HPN-related complications and create awareness for this treatment. RESULTS Five articles regarding patients with small bowel NETs or a subgroup of patients with NETs could be identified, mainly case series with major concerns regarding bias. The studies included 60 patients (range 1-41). The overall survival time varied between 0.5 and 154 months on HPN. However, 58% of patients were alive 1 year after commencing HPN. The reported catheter-related bloodstream infection rate was 0.64-2 per 1000 catheter days. CONCLUSION This systematic review demonstrates the feasibility of the use of HPN in patients with NETs and IF in expert centres with a reasonable 1-year survival rate and low complication rate. Further research is necessary to compare patients with NETs and IF with and without HPN and the effect of HPN on their quality of life.
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Affiliation(s)
- Dominique S. V. M. Clement
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
| | - Sarah E. Brown
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
| | - Mani Naghibi
- Intestinal Rehabilitation Unit, St Mark’s and Northwick Park Hospitals, London HA1 3UJ, UK
| | - Sheldon C. Cooper
- Department of Gastroenterology, University Hospital Birmingham, Birmingham B75 7RR, UK
| | - Margot E. T. Tesselaar
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, ENETS Centre of Excellence, 1066 CX Amsterdam, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, ENETS Centre of Excellence, 1066 CX Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - John K. Ramage
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK
| | - Rajaventhan Srirajaskanthan
- Kings Health Partners, ENETS Centre of Excellence, Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, UK
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22
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Pierro A, Minordi LM, Larosa L, Cipri C, Guerri G, Quinto F, Rotondi F, Marcellino A, Basilico R, Iezzi R, Cilla S. Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography, Part II: The Reliable Disclosure of Crohn's Disease and Non-Inflammatory Small Bowel Disorder Plot through MRI Findings. Life (Basel) 2023; 13:1836. [PMID: 37763240 PMCID: PMC10532809 DOI: 10.3390/life13091836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
MRE has become a standard imaging test for evaluating patients with small bowel pathology, but a rigorous methodology for describing and interpreting the pathological findings is mandatory. Strictures, abscess, inflammatory activity, sinus tract, wall edema, fistula, mucosal lesions, strictures, and mesentery fat hypertrophy are all indicators of small bowel damage in inflammatory and non-inflammatory small bowel disease, and they are all commonly and accurately explained by MRE. MRE is a non-invasive modality that accurately assesses the intra-luminal, parietal, and extra-luminal small bowel. Differential MRE appearance allows us to distinguish between Crohn's disease and non-inflammatory small bowel disorder. The purpose of this paper is to present the MRE pathological findings of small bowel disorder.
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Affiliation(s)
- Antonio Pierro
- Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy;
| | - Laura Maria Minordi
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (C.C.); (G.G.); (R.I.)
| | - Luigi Larosa
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (C.C.); (G.G.); (R.I.)
| | - Carla Cipri
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (C.C.); (G.G.); (R.I.)
| | - Giulia Guerri
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (C.C.); (G.G.); (R.I.)
| | - Fabio Quinto
- Angiography Unit, “L. Bonomo” Hospital, 70031 Andria, Italy;
| | - Fabio Rotondi
- Oncological Surgery Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Annalisa Marcellino
- ASReM, Azienda Sanitaria Regionale del Molise, Via Ugo Petrella 1, 86100 Campobasso, Italy;
| | - Raffaella Basilico
- Department of Neurosciences, Imaging and Clinical Studies, “Gabriele D’Annunzio” University, 66100 Chieti, Italy;
| | - Roberto Iezzi
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (C.C.); (G.G.); (R.I.)
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy
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23
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O'Hara F, Walker C, McNamara D. Patency testing improves capsule retention rates but at what cost? A retrospective look at patency testing. Front Med (Lausanne) 2023; 10:1046155. [PMID: 37621464 PMCID: PMC10445123 DOI: 10.3389/fmed.2023.1046155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Capsule retention is one of the major complications of capsule endoscopy, which range from 2.1 to 8.2% depending on the indication. Over the last few years, reported rates of retention have fallen due to better patient selection due to the recognition of risk factors for capsule retention as well as the introduction of the patency capsule. The patency capsule is a dissolvable capsule with the same dimensions as the functional capsule. It breaks down in the GI tract after approximately 30 h, reducing the risk of symptomatic retention. Failure to pass this patency capsule out of the small bowel results in the patient being excluded from capsule endoscopy. We performed a retrospective analysis of the patency capsules performed in our unit over a 12-month period. A total of 166 (14.7%) of 1,127 patients referred for capsule endoscopy were deemed to require patency assessment (45.8% men, mean age 48 years). Of those who passed the patency assessment and underwent capsule endoscopy, no capsule retention was seen. Indication for patency assessment was found to be appropriate in 87.0% (n = 147). Overall, the failure rate at the patency assessment was 43.1%. The patency capsule remains an imperfect but useful tool in examining functional patency of the GI tract prior to capsule endoscopy.
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Affiliation(s)
- Fintan O'Hara
- Trinity Academic Gastroenterology Group (TAGG), Department of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Caroline Walker
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Trinity Academic Gastroenterology Group (TAGG), Department of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
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Pierro A, Minordi LM, Larosa L, Guerri G, Grimaldi A, Quinto F, Rotondi F, Marcellino A, Bevere T, Basilico R, Iezzi R, Cilla S. Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography: Part I: Guidance in Performing and Observing Normal and Abnormal Imaging Findings. Life (Basel) 2023; 13:1691. [PMID: 37629548 PMCID: PMC10455392 DOI: 10.3390/life13081691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
MRE has become a standard imaging test for evaluating patients with small bowel pathology, but the indications, interpretation of imaging findings, methodology, and appropriate use must be standardized and widely known. Several signs of small bowel damage in inflammatory and non-inflammatory small bowel pathology include strictures, abscess, inflammatory activity, sinus tract, wall edema, fistula, mucosal lesions, and mesentery fat hypertrophy, all of which are widely and accurately explained by MRE. MRE is a non-invasive modality that accurately assesses the intra-luminal, parietal, and extra-luminal small bowel. The differential MRE appearance allows us to distinguish between different small bowel pathologies, such as neoplastic and non-neoplastic small bowel diseases. The purpose of this paper is to present the MRE technique, as well as the interpretation of imaging findings, through the approach of a rigorous stepwise methodology.
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Affiliation(s)
- Antonio Pierro
- Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy; (A.P.); (T.B.)
| | - Laura Maria Minordi
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Luigi Larosa
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Giulia Guerri
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Alessandro Grimaldi
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Fabio Quinto
- Angiography Unit, “L. Bonomo” Hospital, 70031 Andria, Italy;
| | - Fabio Rotondi
- Oncological Surgery Unit, Gemelli Molise Hospital, 86100 Campobasso, Italy;
| | | | - Teresa Bevere
- Radiology Unit, San Timoteo Hospital, 86039 Termoli, Italy; (A.P.); (T.B.)
| | - Raffaella Basilico
- Department of Neurosciences, Imaging and Clinical Studies, “Gabriele D’Annunzio” University, 66100 Chiety, Italy;
| | - Roberto Iezzi
- Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy; (L.M.M.); (L.L.); (G.G.); (A.G.); (R.I.)
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy
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Mohanty D, Dugar D, Waliya A. A Right-Angled Thorn in the Bowel: A Curious Case of Small Bowel Perforation. Cureus 2023; 15:e44068. [PMID: 37750116 PMCID: PMC10517881 DOI: 10.7759/cureus.44068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
We present a 45-year-old man with small bowel perforation resulting from the inadvertent ingestion of a right-angled thorn of the Gum Arabic plant (Vachellia nilotica). The diagnosis was made, and an emergency laparotomy was performed for suspected enteric peritonitis. The thorn was found projecting from the terminal ileum with a minimal intra-peritoneal fluid collection. The thorn was removed, and the perforation site was repaired primarily with absorbable sutures. The lack of a reliable history of foreign body ingestion makes it impossible to arrive at an accurate preoperative diagnosis in patients presenting with perforation peritonitis. Radiological investigations have a low sensitivity for detecting radiolucent vegetative foreign bodies as the cause of bowel perforations. Primary repair should be preferred over resection procedures in the management of foreign body-induced small bowel perforations.
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Affiliation(s)
- Debajyoti Mohanty
- General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Dharmendra Dugar
- General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Asish Waliya
- General Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
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26
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Kayaalp C, Are VS, Kandaswamy R, Amateau SK. Multidisciplinary Diagnosis and Management of a Rare Dysplastic Adenoma Involving a Pancreas Transplant. ACG Case Rep J 2023; 10:e01122. [PMID: 37547479 PMCID: PMC10402948 DOI: 10.14309/crj.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
A 52-year-old man with a history of type 1 diabetes mellitus with diabetic nephropathy who underwent simultaneous pancreas-kidney transplant over a decade ago presented with small bowel obstruction and was found by enteroscopy to have a carpeted lesion encompassing the small bowel anastomosis in the region of the donor pancreas. As endoscopic mucosal resection was impracticable because of technical limitations, the patient was referred to transplant surgical team for surgical exploration and ultimately required organ resection. This represents a unique presentation of an ampullary adenoma with high-grade dysplasia requiring device-assisted enteroscopy requiring multidisciplinary management.
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Affiliation(s)
- Cemil Kayaalp
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Vijay S. Are
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Raja Kandaswamy
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN
| | - Stuart K. Amateau
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN
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27
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Tah S, Khan S, Kashyap S. Uncommon Presentation of Clostridioides difficile in the Small Bowel: A Case Report and Review of Literature. Cureus 2023; 15:e43460. [PMID: 37711949 PMCID: PMC10498804 DOI: 10.7759/cureus.43460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Clostridioides difficile infection (CDI) is a prevalent source of hospital-acquired diarrhea. The most common presentation of CDI is colitis. In cases of fulminant colitis/toxic megacolon, a colectomy and end ileostomy are part of the treatment plan. There is evidence to suggest that it may be beneficial to surgically treat severe complex CDI by constructing a loop ileostomy for fecal stream diversion followed by colonic lavage, also referred to as the Pittsburgh protocol, which has demonstrated decreased death rates in this patient population. In our case study, we present a rare case of a 60-year-old female patient diagnosed with fulminant small bowel CDI requiring resection of the necrotic small bowel. This was followed by creating an ileostomy and the Pittsburgh protocol, leading to a complete recovery. With an increasing incidence of CDI, it is important to be aware of the small bowel C. difficile infection and its treatment.
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Affiliation(s)
- Sunanda Tah
- Surgery, Saint James School of Medicine, Arnos Vale, VCT
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
| | - Saqib Khan
- Surgery, Avalon University School of Medicine, Willemstad, CUW
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
| | - Sarang Kashyap
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
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Scattolin D, Scagliori E, Scapinello A, Fantin A, Guarneri V, Pasello G. Small bowel edema and lymphocytic duodenitis as severe reversible gastrointestinal toxicity of selpercatinib in RET fusion-positive non-small cell lung cancer: a case report. Front Oncol 2023; 13:1201599. [PMID: 37492479 PMCID: PMC10363725 DOI: 10.3389/fonc.2023.1201599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Rearranged during transfection (RET) gene rearrangements occur in 1%-2% of non-small cell lung cancer (NSCLC). Because of the results of the study LIBRETTO-001, selpercatinib has been approved as the first-line treatment for patients with RET fusion-positive advanced NSCLC. Selpercatinib demonstrated to be well tolerated. Despite this, gastrointestinal adverse events (AEs) are frequently reported, and no clinical-radiological and endoscopic features and their impact in terms of treatment discontinuations, interruptions, and dose reductions have been described so far. Case report A 37-year-old never-smoker woman was treated in our institution with selpercatinib for a RET fusion-positive NSCLC. After 9 months of treatment, the patient referred abdominal pain of grade (G) 2, associated with nausea of G2, bilious vomiting of G3, and weight loss of G1. At computed tomography scan, the presence of important bowel wall thickening, free ascitic fluid, mesenteric congestion, and stranding was detected. The patient underwent an anterograde enteroscopy extended to jejunum with detection of lymphocytic duodenitis with sub-mucosal edema. Selpercatinib treatment was temporary interrupted with complete resolution of the symptoms and then re-administered with dose reduction, without relapsed of the gastrointestinal toxicity after 120 days. Conclusion To our knowledge, this is the first case report of a patient with NSCLC treated with selpercatinib outside a clinical study who developed severe gastrointestinal toxicity characterized by small bowel edema and lymphocytic duodenitis, leading to treatment interruption and dose reduction. The gastrointestinal AE has been described by a radiological, endoscopic, and histopathological point of view. Further investigations are needed to better identify pathological mechanisms of gastrointestinal toxicity for an appropriate AE management.
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Affiliation(s)
- Daniela Scattolin
- Medical Oncology 2, Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elena Scagliori
- Radiology Unit, Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | - Antonio Scapinello
- Pathology Unit, Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | - Alberto Fantin
- Gastroenterology Unit, Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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29
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Topa M, Nandi N, Scaramella L, Puricelli M, Pennazio M, Sidhu R, Sanders DS, Tontini GE, Penagini R, Vecchi M, Elli L. Clinical impact of videocapsule endoscopy and device-assisted enteroscopy in non-bleeding small bowel lesions. Therap Adv Gastroenterol 2023; 16:17562848231176424. [PMID: 37435179 PMCID: PMC10331340 DOI: 10.1177/17562848231176424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background Videocapsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are part of the diagnostic and therapeutic work-up of indications other than suspected small bowel bleeding (OSBB). The literature is currently lacking studies describing these procedures in this particular setting. Objectives We assessed the clinical impact of VCE and DBE in a large monocentric cohort of OSBB patients, as compared to a control group of suspected small bowel bleeding (SSBB) patients who underwent enteroscopy over the same period. Design Monocentric, retrospective, cohort study. Methods We collected the data of consecutive patients with OSBB undergoing VCE and/or DBE from March 2001 to July 2020. The demographic and clinical parameters of the patients, technical characteristics, and adverse events for each procedure were collected. The impact of VCE and DBE was defined in terms of diagnostic yield (DY). The patients were subdivided according to the main indication into four groups: celiac disease, Crohn's disease (CD), neoplasia, and persistent gastrointestinal symptoms. Results A total of 611 VCEs and 387 DBEs were performed for OSBB. The main indications were complicated celiac disease and CD. The DYs of VCE and DBE overall were 53 and 61.7%, respectively, with some variance among the four groups. We report no statistical differences in the DY of VCE and DBE in SSBB vs OSBB (57.7% vs 53%, p = 0.0859 and 68.8% vs 61.7%, p = 0.0582, respectively). OSBB patients were significantly younger than those with SSBB. However, similarly to SSBB (k = 0.059), poor agreement between the enteroscopic techniques was found in the OSBB population (k = 0.109). The safety of both procedures in OSBB was comparable to that in SSBB patients. Conclusion VCE and DBE are effective and safe in suspected OSBB, where their role is similar to that in SSBB, their main indication.
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Affiliation(s)
- Matilde Topa
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Nicoletta Nandi
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Lucia Scaramella
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Puricelli
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
| | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Reena Sidhu
- Academic Department of Gastroenterology and Liver Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David S. Sanders
- Gastroenterology and Liver Unit, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK
| | - Gian Eugenio Tontini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli studi di Milano, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35, Milan 20122, Italy
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Losurdo G, Di Leo M, Rizzi S, Lacavalla I, Celiberto F, Iannone A, Rendina M, Ierardi E, Iabichino G, De Luca L, Di Leo A. Familial intestinal polyposis and device assisted enteroscopy: where do we stand? Expert Rev Gastroenterol Hepatol 2023; 17:811-816. [PMID: 37515779 DOI: 10.1080/17474124.2023.2242240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Hereditary polyposis syndromes are a group of inherited disorders associated with a high risk of developing colorectal cancer. The best known ones are familial adenomatous polyposis (FAP), Peutz-Jeghers (PJS), juvenile polyposis and Cowden syndromes, as well as conditions predisposing to cancer, such as Lynch syndrome. Some of them are characterized by an increased risk of small bowel polyps occurrence. AREAS COVERED Literature search in PubMed was performed in November 2022 and a narrative review was carried out. Since performing small bowel polypectomy is important in such patients, device assisted enteroscopy (DAE) is the key for this procedure. A screening strategy for small bowel polyps is recommended only for PJS. Guidelines endorse either magnetic resonance imaging (MRI) or videocapsule endoscopy (VCE) every 1-3 years, according to the phenotype of the disease. Enteroscopy should be considered for therapeutic purpose in patients with a positive VCE or MRI. DAE has a central role in the resection of polyps larger than mm or causing symptoms of subocclusion or intussusception. Both single (SBE) and double balloon enteroscopy (DBE) are indicated and able to resect polyps up to 6-10 cm. American guidelines have restricted the indications to small bowel enteroscopy only to FAP patients with grade IV Spiegelman. EXPERT OPINION Only some groups of patients (PJS, FAP with demonstrated small bowel polyp burden) may benefit from DAE.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Ilaria Lacavalla
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Maria Rendina
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | | | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
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Hameed M, Taylor SA. Small bowel imaging in inflammatory bowel disease: updates for 2023. Expert Rev Gastroenterol Hepatol 2023; 17:1117-1134. [PMID: 37902040 DOI: 10.1080/17474124.2023.2274926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/20/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Cross-sectional imaging techniques including MR and CT enterography and ultrasound are integral to Crohn's disease management, accurate, responsive, and well tolerated. They assess the full thickness of the bowel wall, perienteric environment, and distant complications. As we strive toward tighter disease control, imaging's role will expand further with transmural healing becoming an increasingly important therapeutic target. AREAS COVERED MEDLINE and Web of Science were searched from 2012 to 2023 inclusive. We review the evidence for cross-sectional imaging in assessing disease activity, phenotyping, and therapeutic response assessment. Emerging novel imaging applications such as quantifying enteric motility and fibrosis, prognostication, and potential utility of artificial intelligence will be covered. Recent international consensus statements highlight the need for standardized imaging reporting and definitions of transmural healing and remission. We will discuss how recent advances may be best integrated into patient care and highlight key outstanding research questions. EXPERT OPINION Cross-sectional imaging is established in Crohn's disease management. Research emphasis should be placed on optimal integration of imaging modalities in clinical care pathways, workforce training, definitions, and evidence for use of imaging based therapeutic targets such as transmural healing, better phenotyping of stricturing disease, and developing novel techniques, including integration of artificial intelligence.
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Affiliation(s)
- Maira Hameed
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
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Kitazume Y, Takenaka K, Ohtsuka K, Ozawa Y, Kimura K, Watanabe R, Tsuchiya J, Fujii T, Nagahori M, Watanabe M, Tateishi U. Motility Mapping Quantification Using the Classical Optical Flow Algorithm for Small Bowel Crohn's Disease: Comparison with Balloon-assisted Enteroscopy Findings. Magn Reson Med Sci 2023; 22:325-334. [PMID: 35545505 PMCID: PMC10449560 DOI: 10.2463/mrms.mp.2021-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/05/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To quantify bowel motility shown on cine MRI using the classical optical flow algorithm and compare it with balloon-assisted enteroscopy (BAE) findings in patients with Crohn's disease (CD). METHODS This retrospective study included 29 consecutive patients with CD who had undergone MR enterocolonography (MREC) and BAE between March and May 2017. We developed computer software to present motion vector magnitudes between consecutive cine MR images as bowel motility maps via a classical optical flow algorithm using the Horn-Schunck method. Cine MR images were acquired with a balanced steady-state free precession sequence in the coronal direction to capture small bowel motility. The small bowels were divided into three segments. In total, 63 bowel segments were assessed via BAE and MREC. Motility scores on the maps, simplified MR index of activity (sMaRIA), and MREC score derived from a 5-point MR classification were assessed independently by two radiologists and compared with the CD endoscopic index of severity (CDEIS). Correlations were assessed using Spearman's rank coefficient. The areas under the receiver-operating characteristic curve (AUCs) of motility score for differentiating CDEIS was calculated; a P value < 0.05 was considered statistically significant. RESULTS Motility score was negatively correlated with CDEIS (r = -0.59 [P < 0.001] and -0.54 [P < 0.001]), and the AUCs of motility scores for detecting CDEIS ≥ 3 were 88.2% and 78.6% for observers 1 and 2, respectively. There were no significant differences in the AUC for detecting CDEIS ≥ 3 and CDEIS ≥ 12 between motility and sMaRIA or MREC score. CONCLUSION The motility map was feasible for locally quantifying the bowel motility. In addition, the motility score on the map reflected the endoscopic inflammatory activity of each small bowel segment in patients with CD; hence, it could be used as a tool in objectively interpreting cine MREC to predict inflammatory activity in CD.
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Affiliation(s)
- Yoshio Kitazume
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuo Ozawa
- Systems Laboratories Corporation, Yokohama, Kanagawa, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryosuke Watanabe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Han F, Osmani M, Jaronczyk M, Kang Y. Metastatic pulmonary pleomorphic carcinoma involving the jejunum: a case report and review of the literature. Int J Clin Exp Pathol 2023; 16:133-137. [PMID: 37425226 PMCID: PMC10326521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/17/2023] [Indexed: 07/11/2023]
Abstract
We present a case report of a pulmonary pleomorphic carcinoma that metastasized to the jejunum in an 80-year-old woman. The patient was admitted to the hospital with symptomatic anemia and melena that had been ongoing for several months. In 2021, non-small cell carcinoma was diagnosed by fine-needle aspiration. In 2022, a computed tomography (CT) scan revealed an enormous mass in the small bowel. The tumor was resected and showed pleomorphic neoplastic cells with giant and spindle cell morphology. These neoplastic cells were positive for thyroid transcription factor 1 (TTF1). Next-generation sequencing of the secondary tumor revealed 97% genomic similarities to the lung tumor and high expression of programmed cell death ligand 1 (PD-L1). The patient may benefit from immune checkpoint therapy.
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Affiliation(s)
- Fei Han
- Department of Pathology, Cooperman Barnabas Medical CenterLivingston, NJ, USA
- Department of Pathology, Monmouth Medical CenterLong Branch, NJ, USA
| | - Mohammed Osmani
- Department of Radiology, Monmouth Medical CenterLong Branch, NJ, USA
| | - Michael Jaronczyk
- Department of General Surgery, Monmouth Medical CenterLong Branch, NJ, USA
| | - Yong Kang
- Department of Pathology, Monmouth Medical CenterLong Branch, NJ, USA
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Daraghmeh L, Shbaita S, Nassef O, Melhem L, Maqboul I. Non-specific Symptoms of Small Bowel Neuroendocrine Tumor and the Diagnostic Challenges: A Case Report. Cureus 2023; 15:e41080. [PMID: 37519565 PMCID: PMC10375939 DOI: 10.7759/cureus.41080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Neuroendocrine tumors (NETs) are considered the most frequent tumors that affect the small bowels. Despite diagnostic modalities, the diagnosis of small bowel NETs is not straightforward and poses a high challenge to most physicians, due to poor accessibility to this area and the patient's non-specific presentations. We reported a case of a 60-year-old male patient, who presented with severe postprandial epigastric pain of one-month duration, loss of appetite, and weight loss. Investigations revealed no definite diagnosis. Therefore, exploratory laparoscopy was attempted along with multiple biopsies that led to the diagnosis of small bowel NET. We conclude that NETs require a high index of suspicion in patients with recurrent abdominal pain.
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Affiliation(s)
- Laith Daraghmeh
- Department of General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Sara Shbaita
- Faculty of Medicine, An-Najah National University, Nablus, PSE
| | - Omar Nassef
- Department of Radiology, An-Najah National University Hospital, Nablus, PSE
| | - Layan Melhem
- Department of Pathology, An-Najah National University Hospital, Nablus, PSE
| | - Iyad Maqboul
- Department of General Surgery, An-Najah National University Hospital, An-Najah National University, Nablus, PSE
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Chopra A, Rothstein A, Mohamed Ahmed A, Pannell S. Small Bowel Evisceration Through a Perforated Stercoral Ulcer. Am Surg 2023; 89:2885-2887. [PMID: 35128955 DOI: 10.1177/00031348221075733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Stercoral ulcers are localized areas of loss of colonic mucosal integrity. They result from pressure necrosis of the colonic mucosa, secondary to chronic constipation and fecal inspissation. These ulcers are rare and, are associated with serious complications, including bleeding and perforation. We present the case of a 50-year-old woman who presented with small bowel evisceration through the anal canal secondary to extraperitoneal perforation of the rectum. The patient underwent emergent exploratory laparotomy with reduction of the bowel, followed by second look laparotomy in 24 hours. A full thickness defect in the rectum was identified and Hartmann's procedure was performed. The patient's postoperative course was uneventful. Extraperitoneal perforation and evisceration of bowel is a rare clinical entity. These cases are diagnosed early due to the obvious clinical presentation and however may be misdiagnosed as prolapse. They necessitate urgent and careful surgical planning, to ensure preservation of bowel and complete recovery.
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Affiliation(s)
- Asmita Chopra
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Anna Rothstein
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Amin Mohamed Ahmed
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Stephanie Pannell
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
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Zhang X, Xiao X, Chen PR, Li YN, Lv XH, Yang JL. Proton Pump Inhibitors Increase the Risk of Nonsteroidal Anti-inflammatory Drug-Related Small-Bowel Injury: A Systematic Review With Meta-analysis. Clin Transl Gastroenterol 2023; 14:e00588. [PMID: 37019683 PMCID: PMC10299777 DOI: 10.14309/ctg.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION Conflicting results exist on the association between proton-pump inhibitor (PPI) and nonsteroidal anti-inflammatory drug (NSAID)-related small-bowel damage. The aim of this study was to determine whether PPIs increased the risk of NSAID-related small-bowel damage by meta-analysis. METHODS A systematic electronic search in PubMed, Embase, and Web of Science was conducted from the time the database was created until March 31, 2022, for studies reporting associations between PPI use and outcomes, including the endoscopy-verified prevalence of small-bowel injury, mean number of small-bowel injuries per patient, change in hemoglobin level, and risk of small-bowel bleeding in subjects taking NSAIDs. Meta-analytical calculations for odds ratio (OR) and mean difference (MD) were performed with the random-effects model and interpreted with 95% confidence intervals (CIs). RESULTS Fourteen studies comprising 1996 subjects were included. Pooled analysis demonstrated that concomitant use of PPIs significantly increased the prevalence and number of endoscopy-verified small-bowel injuries (prevalence: OR = 3.00; 95% CI: 1.74-5.16; number: MD = 2.30; 95% CI: 0.61-3.99) and decreased hemoglobin levels (MD = -0.50 g/dL; 95% CI: 0.88 to -0.12) in NSAID users but did not change the risk of small-bowel bleeding (OR = 1.24; 95% CI: 0.80-1.92). Subgroup analysis demonstrated that PPIs significantly increased the prevalence of small-bowel injury in subjects taking nonselective NSAIDs (OR = 7.05; 95% CI: 4.70-10.59, 4 studies, I 2 = 0) and COX-2 inhibitors (OR = 4.00; 95% CI: 1.18-13.60, 1 study, no calculated I 2 ) when compared with COX-2 inhibitors alone. DISCUSSION PPIs increased the risk of NSAID-related small-bowel damage, and the clinical significance of higher prevalence of small-bowel injuries should be studied in the future.
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Affiliation(s)
- Xian Zhang
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China;
| | - Xue Xiao
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping-Run Chen
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Na Li
- Department of Respiratory Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Xiu-He Lv
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin-Lin Yang
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, Department of Gastroenterology & Hepatology, West China Hospital, Sichuan, University, Chengdu, China
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, China
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Mahtani AU, Tahir MK, Padda I, Haider M, Ebrahimi F, Otterbeck P, Nfonoyim J. Spontaneous Cholesterol Embolism Leading to Small Bowel Obstruction and Perforation. JACC Case Rep 2023; 13:101780. [PMID: 37153475 PMCID: PMC10157106 DOI: 10.1016/j.jaccas.2023.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/04/2023] [Accepted: 01/19/2023] [Indexed: 05/09/2023]
Abstract
A spontaneous occurrence of cholesterol embolization syndrome causing small bowel obstruction and perforation is a highly scarce event. In this article, we report a case of spontaneous cholesterol embolism resulting in small bowel obstruction and perforation in a 52-year-old male with multiple cardiovascular and medical comorbidities. In our patient, the source was an eccentric left lateral atherosclerotic plaque from the abdominal aorta that was identified using computed tomography. A distal occlusion in numerous small intestinal arteries due to cholesterol embolism was confirmed on biopsy after surgical resection. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Arun Umesh Mahtani
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
- Address for correspondence: Dr Arun Umesh Mahtani, 1059, 7 Navy Pier Court, Staten Island, New York 10304, USA.
| | - Muhammad Khalid Tahir
- Department of Nephrology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Inderbir Padda
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Muhammad Haider
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Farhang Ebrahimi
- Department of Nephrology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Philip Otterbeck
- Department of Endocrinology, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Jay Nfonoyim
- Department of Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
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Dias E, Medas R, Marques M, Andrade P, Cardoso H, Macedo G. Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study. Porto Biomed J 2023; 8:e217. [PMID: 37362020 PMCID: PMC10289779 DOI: 10.1097/j.pbj.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Background There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors. Methods A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed. Results We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality. Conclusion Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.
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Affiliation(s)
- Emanuel Dias
- Corresponding author. Address: Gastrenterology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. E-mail address: (Emanuel Dias)
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Sulbaran M, Chen FK, Farraye FA, Hashash JG. A Clinical Review of Mesenteric Panniculitis. Gastroenterol Hepatol (N Y) 2023; 19:211-218. [PMID: 37705847 PMCID: PMC10496345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Mesenteric panniculitis (MP) is a benign condition characterized by chronic inflammation and fibrosis of adipose tissue mainly of the small bowel mesentery. MP is commonly detected incidentally on cross-sectional imaging of the abdomen and can be asymptomatic in up to nearly half of patients. The most frequent clinical symptom reported is abdominal pain, followed by bloating/distention, diarrhea, constipation, vomiting, anorexia, weight loss, fever, malaise, and nausea. On computed tomography, MP is seen as a mass-like area of increased fat attenuation within the small bowel mesentery, usually located in the left upper quadrant of the abdomen. This mass-like area envelops mesenteric vessels and displaces adjacent bowel segments. Lymph nodes are frequently seen within the area of mesenteric abnormality. One of the most common differential diagnoses of MP is lymphoma, and positron emission tomography/computed tomography may be performed if there is suspicion of a concurrent underlying malignancy. Because of the benign nature of MP, treatment decisions should be guided by severity of symptoms and presence of complications. First-line medical treatment is prednisone and tamoxifen. Surgery is reserved for cases of recurrent bowel obstruction. This article provides a review of MP, including its epidemiology, pathophysiology, clinical presentation, imaging findings, and treatment.
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Affiliation(s)
- Marianny Sulbaran
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Frank K. Chen
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Francis A. Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Jana G. Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Rosevics L, Madalosso I. Monomorphic epitheliotropic T-cell lymphoma of the small intestine. United European Gastroenterol J 2023; 11:307-309. [PMID: 36880478 PMCID: PMC10083456 DOI: 10.1002/ueg2.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Leticia Rosevics
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
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Ju J, Oh HS, Lee YJ, Jung H, Lee JH, Kang B, Choi S, Kim JH, Kim KO, Chung YJ. Clean mucosal area detection of gastroenterologists versus artificial intelligence in small bowel capsule endoscopy. Medicine (Baltimore) 2023; 102:e32883. [PMID: 36820545 PMCID: PMC9907992 DOI: 10.1097/md.0000000000032883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Studies comparing the detection of clean mucosal areas in capsule endoscopy (CE) using human judgment versus artificial intelligence (AI) are rare. This study statistically analyzed gastroenterologist judgments and AI results. Three hundred CE video clips (100 patients) were prepared. Five gastroenterologists classified the video clips into 3 groups (≥75% [high], 50%-75% [middle], and < 50% [low]) according to their subjective judgment of cleanliness. Visualization scores were calculated using an AI algorithm based on the predicted visible area, and the 5 gastroenterologists' judgments and AI results were compared. The 5 gastroenterologists evaluated CE clip video quality as "high" in 10.7% to 36.7% and as "low" in 28.7% to 60.3% and 29.7% of cases, respectively. The AI evaluated CE clip video quality as "high" in 27.7% and as "low" in 29.7% of cases. Repeated-measures analysis of variance (ANOVA) revealed significant differences in the 6 evaluation indicators (5 gastroenterologists and 1 AI) (P < .001). Among the 300 judgments, 90 (30%) were consistent with 5 gastroenterologists' judgments, and 82 (91.1%) agreed with the AI judgments. The "high" and "low" judgments of the gastroenterologists and AI agreed in 95.0% and 94.9% of cases, respectively. Bonferroni's multiple comparison test showed no significant difference between 3 gastroenterologists and AI (P = .0961, P = 1.0000, and P = .0676, respectively) but a significant difference between the other 2 with AI (P < .0001). When evaluating CE images for cleanliness, the judgments of 5 gastroenterologists were relatively diverse. The AI produced a relatively universal judgment that was consistent with the gastroenterologists' judgements.
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Affiliation(s)
| | - Hyun Sook Oh
- Department of Applied Statistics, School of Social Science, Gachon University, Seongnam, Korea
| | - Yeoun Joo Lee
- Captos Co., Ltd., Yangsan, Korea
- Department of Pediatrics, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- * Correspondence: Yeoun Joo Lee, Department of Pediatrics, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, Gyungnam 50612, South Korea (e-mail: )
| | - Heechul Jung
- Captos Co., Ltd., Yangsan, Korea
- Department of Artificial Intelligence, Kyungpook National University, Daegu, Korea
| | | | - Ben Kang
- Department of Pediatrics, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Sujin Choi
- Department of Pediatrics, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Yun Jin Chung
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Houdeville C, Chartier S, Delaye M, Fabiani B, Stocker N, Dray X. White small bowel in a patient with chronic diarrhoea. Gut 2023; 72:225-324. [PMID: 34911742 DOI: 10.1136/gutjnl-2021-326421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Charles Houdeville
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Suzanne Chartier
- Sorbonne Université, Département of Pathologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - Matthieu Delaye
- Sorbonne Université, Service d'Hématologie Clinique et de Thérapie cellulaire, Hôpital Saint-Antoine, APHP, Paris, France
| | - Bettina Fabiani
- Sorbonne Université, Département of Pathologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - Nicolas Stocker
- Sorbonne Université, Service d'Hématologie Clinique et de Thérapie cellulaire, Hôpital Saint-Antoine, APHP, Paris, France
| | - Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
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Love J, Raza H, Kheirkhah P, Ghoulam E, Thaker S, Carroll R. Primary Gastrointestinal T-cell Lymphoma Presenting as Spontaneous Perforation Peritonitis. Cureus 2023; 15:e35028. [PMID: 36938190 PMCID: PMC10023136 DOI: 10.7759/cureus.35028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
Primary T-cell non-Hodgkin lymphoma (NHL) of the gastrointestinal tract (GIT) is a rare, poorly-characterized clinical entity. A well-known complication of intestinal NHL is perforation due to chemotherapy, but perforation as a presenting sign of GIT lymphoma is extremely rare. Here we present a case of spontaneous intestinal perforation secondary to primary intestinal T-cell lymphoma and highlight the importance of early recognition of this uncommon cause of perforation as a crucial step to ensure expedited hematology referral and initiation of appropriate treatment.
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Affiliation(s)
- James Love
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Hasan Raza
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | | | - Elie Ghoulam
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Sarang Thaker
- Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Robert Carroll
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, USA
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Yang H, Yuan R, Alex D, Hughesman C, Liu S, Lee U, Zhou C, Wang G. Metastatic Small Bowel Adenocarcinoma Mimicking a Primary Ovarian Mucinous Tumour - Clinical, Radiologic, Pathologic and Molecular Correlation. Int J Surg Pathol 2023; 31:110-118. [PMID: 35477328 DOI: 10.1177/10668969221098083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe an interesting case of a patient who presented with a large adnexal mass, first favored to be mucinous carcinoma of the gynecologic origin. The primary tumour site was ascertained after the patient's small bowel was resected by identifying an adenomatous component evolving into an invasive adenocarcinoma identical in morphology and immunophenotype to the ovarian tumour. Notably, both tumours were found to harbor a BRAF K601E mutation, which is extremely rare for a primary of the ovary. BRAF mutations are present in a subset of large bowel and small bowel adenocarcinoma, but our case shows the first instance of a BRAF K601E mutation being present in a small bowel adenocarcinoma, to the best of our knowledge. This case serves as a great illustration of the pivotal role of molecular diagnostics in modern pathology in arriving at the correct diagnosis. Additionally, it is an excellent example of how clinical-radiologic-pathologic-molecular correlation plays into the landscape of molecular pathology to deliver optimal care for the patient.
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Affiliation(s)
- Hang Yang
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Ren Yuan
- Department of Radiology, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Deepu Alex
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Curtis Hughesman
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Shiru Liu
- Department of Oncology, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Ursula Lee
- Department of Oncology, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Chen Zhou
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Gang Wang
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
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Murate K, Nakamura M, Yamamura T, Maeda K, Sawada T, Ishikawa E, Kida Y, Esaki M, Hamazaki M, Iida T, Mizutani Y, Yamao K, Ishikawa T, Furukawa K, Ohno E, Honda T, Ishigami M, Kinoshita F, Ando M, Kawashima H. CO 2 enterography in endoscopic retrograde cholangiography using double-balloon endoscopy: A randomized clinical trial. J Gastroenterol Hepatol 2023; 38:761-767. [PMID: 36648892 DOI: 10.1111/jgh.16112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/22/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM Double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable procedure for patients with altered gastrointestinal anatomy. Nonetheless, it is time-consuming and burdensome for both patients and endoscopists, partly because route selection in the reconstructed bowel with complicating loop is challenging. Carbon dioxide insufflation enterography is reportedly useful for route selection in the blind loop. This prospective randomized clinical trial investigated the usefulness of carbon dioxide insufflation enterography for route selection by comparing it with conventional observation. METHODS Patients scheduled to undergo DBERC were consecutively registered. They were divided into carbon dioxide insufflation enterography and conventional groups via randomization according to stratification factors, type of reconstruction methods, and experience with DBERC. The primary endpoint was the correct rate of initial route selection. The secondary endpoints were the insertion time, examination time, amount of anesthesia drugs, and complications. RESULTS The correct rate of route selection was significantly higher in the carbon dioxide insufflation enterography group (23/25, 92%) than in the visual method (15/25, 60%) (P = 0.018). The insertion time was significantly shorter in the carbon dioxide insufflation enterography group than in the visual group (10.8 ± 11.1 min vs 29.8 ± 15.7 min; P < 0.001). No significant differences in complications were noted between the two groups. The amounts of sedatives and analgesics used were significantly lower in the carbon dioxide insufflation enterography group (P < 0.001 and P < 0.001, respectively). CONCLUSIONS Carbon dioxide insufflation enterography can reduce the burden of DBERC on patients and endoscopists by shortening the examination time and reducing the amount of medication.
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Affiliation(s)
- Kentaro Murate
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Kida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Esaki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Motonobu Hamazaki
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kentaro Yamao
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumie Kinoshita
- Center for Advanced Medical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medical Care, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Komorizono R, Takeuchi I, Yoshioka T, Yano T, Kumagai H, Ishiguro A, Arai K. Intestinal polypoid arteriovenous malformation in a 5-year-old boy with recurrent anemia. Pediatr Int 2023; 65:e15564. [PMID: 37368523 DOI: 10.1111/ped.15564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/22/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Rina Komorizono
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Takeuchi
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Tomonori Yano
- Division of Gastroenterology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
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Shao XD, Shao HT, Wang L, Zhang YG, Tian Y, Li CK. The Incidence of Acute Pancreatitis After Device Assisted Enteroscopy: a Systematic Review and Meta-analysis. Med Arch 2023; 77:377-383. [PMID: 38299091 PMCID: PMC10825755 DOI: 10.5455/medarh.2023.77.377-383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/15/2023] [Indexed: 02/02/2024] Open
Abstract
Background The diagnosis of small bowel diseases is challenging and device assisted enteroscopy (DAE) is a technique for visualizing the entire small bowel. DAE is considered as a safe procedure and the reported rate of adverse events associated with DAE in the literature is low. Objective The present study tried to investigate the actual incidence of AP after DAE with a systematic review and meta-analysis of available relevant studies. Methods Studies were searched through the PubMed, EMBASE, and Cochrane library databases. The following data were extracted from all eligible studies: author, country, publication year, publication type, study design, type of DAE used, route of DAE, number of patients with AP after DAE, and number of patients with hyperamylasemia after DAE.A random-effects model with RStudio version 4.2.0 was performed in all analyses. Heterogeneity was assessed using the I2 test. The risk of bias was assessed by the Newcastle-Ottawa Scale criteria and the publication bias was assessed by the Egger test. Results Twenty three studies involving a total of 11145 patients were included in the analysis. The overall, pooled AP rate after DAE was 1% (95% CI:0-1%). There was significant heterogeneity among the studies (I2 = 65%; P < 0.01).The pooled AP rate was 1% (95% CI:0-2 %)in peroral route group. The pooled proportion of patients having hyperamylasemia after DAE was 29% (95% CI: 16-46%).Among the patients who had hyperamylasemia AP were identified in 2% (95% CI: 0-6%) of patients. Conclusion The incidence of AP after DAE is about 1%. Hyperamylasemia is a common change in the patients undergoing DAE and only 2% of the patients with hyperamylasemia present with AP.
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Affiliation(s)
- Xiao-Dong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang City, Liaoning Province, China
| | - Hao-Tian Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang City, Liaoning Province, China
| | - Le Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang City, Liaoning Province, China
| | - Yong-Guo Zhang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang City, Liaoning Province, China
| | - Ye Tian
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang City, Liaoning Province, China
| | - Cheng-Kun Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang City, Liaoning Province, China
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Muacevic A, Adler JR, Farraj M, Kaliounji H, Farraj KL. A Rare Presentation of a Duodenal Neuroendocrine Tumor. Cureus 2023; 15:e33747. [PMID: 36788876 PMCID: PMC9922524 DOI: 10.7759/cureus.33747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Neuroendocrine tumors (NETs), which are a rare type of tumor, are defined as epithelial cells with predominantly neuroendocrine differentiation and consist of a spectrum of tumors emerging from stem cells throughout the body and can occur anywhere in the body. While they are rare, the incidence over the past few decades has increased. Here we present a case of a 64-year-old female who was incidentally found to have a duodenal neuroendocrine tumor. The patient initially presented to the emergency department secondary to syncope and collapse. During her trauma evaluation, an incidental lobulated soft tissue mass inferior to the distal stomach was seen on complete computed tomography (CT) scans. The surgery team was consulted for resection of the mass and an octreotide scan was performed prior to resection to further evaluate the mass and to check for any signs of metastatic disease. The octreotide scan demonstrated intense radiotracer accumulation within the duodenal mass consistent with a neuroendocrine tumor and no areas of abnormal radiotracer accumulation suspicious for metastatic disease. Pathology of the resected mass was positive for a well-differentiated neuroendocrine tumor with an organoid pattern and homogenous oval-round neoplastic cells with a salt-pepper nuclear and pseudo glandular arrangement that was well-circumscribed and partially encapsulated with negative margins. Immunohistochemistry was positive for AE ⅓, CD56, Synaptophysin, and chromogranin and negative for CD117, DOG-1, CD34, and CD45. The prevalence of NETs has increased over the years due to the improvement in diagnostic tools, such as upper gastrointestinal endoscopy. In addition to the fact that the duodenum is a rare location for such tumors, neuroendocrine tumors are also typically found in those under 50 years old. However, our patient was found to have both a duodenal mass and was over the age of 50 at the time of presentation and diagnosis. To date, a consensus on a conclusive treatment of duodenal NETs (D-NETs) has not been reached. This case brings to light the importance of further research in diagnosing and treating neuroendocrine tumors and also raises awareness for clinicians to have this in their differential.
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49
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Bamba S, Imai T, Sasaki M, Ohno M, Yoshida S, Nishida A, Takahashi K, Inatomi O, Andoh A. Altered gut microbiota in patients with small intestinal bacterial overgrowth. J Gastroenterol Hepatol 2023; 38:61-69. [PMID: 36180941 DOI: 10.1111/jgh.16013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 09/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM Small intestinal bacterial overgrowth (SIBO) is diagnosed by using quantitative culture of duodenal aspirates and/or a hydrogen breath test. However, few studies have analyzed bacterial microbiota in Japanese patients with SIBO. METHODS Twenty-four patients with any abdominal symptoms and suspected SIBO were enrolled. Quantitative culture of duodenal aspirates and a glucose hydrogen breath test were performed on the same day. SIBO was diagnosed based on a bacterial count ≥ 103 CFU/mL or a rise in the hydrogen breath level of ≥ 20 ppm. The composition of the duodenal microbiota was analyzed by 16S rRNA gene sequencing. RESULTS Small intestinal bacterial overgrowth was diagnosed in 17 of the 24 patients (71%). The positive rates for the hydrogen breath test and quantitative culture of duodenal aspirates were 50% and 62%, respectively. Patients with SIBO showed significantly reduced α-diversity compared with non-SIBO patients, and analysis of β-diversity revealed significantly different distributions between SIBO and non-SIBO patients. In addition, the intestinal microbiome in SIBO patients was characterized by increased relative abundance of Streptococcus and decreased relative abundance of Bacteroides compared with non-SIBO patients. CONCLUSIONS Duodenal dysbiosis was identified in patients with SIBO and may play a role in the pathophysiology of SIBO.
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Affiliation(s)
- Shigeki Bamba
- Division of Digestive Endoscopy, Shiga University of Medical Science, Otsu, Japan
| | - Takayuki Imai
- Division of Digestive Endoscopy, Shiga University of Medical Science, Otsu, Japan
| | - Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Japan
| | - Masashi Ohno
- Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan
| | - Shinya Yoshida
- Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan
| | - Atsushi Nishida
- Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan
| | - Kenichiro Takahashi
- Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan
| | - Osamu Inatomi
- Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan
| | - Akira Andoh
- Division of Gastroenterology, Shiga University of Medical Science, Otsu, Japan
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Tews HC, Kandulski A, Schmid S, Schlosser S, Schirner S, Putz FJ, Cosma L, Gülow K, Müller M, Jung EM. Multimodal ultrasound imaging with conventional B-mode, elastography, and parametric analysis of contrast-enhanced ultrasound (CEUS): A novel approach to assess small bowel manifestation in severe COVID-19 disease. Clin Hemorheol Microcirc 2022; 82:341-360. [PMID: 35871323 DOI: 10.3233/ch-221540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim was to describe the small bowel morphology with conventional B-mode and elastography and additionally to evaluate dynamic effects of COVID-19 associated small bowel microvascularization using CEUS with color coded perfusion parameters.Thirteen patients with severe COVID-19 acute respiratory distress syndrome (ARDS) were investigated. 13 patients required intensive care treatment with mechanical ventilation. Five patients required extracorporeal membrane oxygenation (ECMO). Contrast-enhanced ultrasound (CEUS) was performed by an experienced investigator as a bolus injection of up to 2.4 ml sulfur hexafluoride microbubbles via a central venous catheter. In the parametric analysis of CEUS, the flare of microbubbles over time is visualized with colors. This is the first work using parametric analysis of CEUS to detect perfusion differences in the small bowel.Parametric analysis of CEUS in the intestinal phase was carried out, using DICOM loops for 20 seconds. In 5 patients, parametric analysis revealed intraindividual differences in contrast agent behavior in the small bowel region. Analogous to the computed tomography (CT) images parametric analysis showed regions of simultaneous hyper- and hypoperfusion of the small intestine in a subgroup of patients. In 5 patients, the parametric image of transmural global contrast enhancement was visualized.Our results using CEUS to investigate small bowel affection in COVID-19 suggest that in severe COVID-19 ARDS systemic inflammation and concomitant micro embolisms may lead to disruption of the epithelial barrier of the small intestine.This is the first study using parametric analysis of CEUS to evaluate the extent of small bowel involvement in severe COVID-19 disease and to detect microemboli. In summary, we show that in COVID-19 the small bowel may also be an important interaction site. This is in line with the fact that enterocytes have been shown to a plenitude of angiotensin converting enzyme (ACE)-2 receptors as entry sites of the virus.
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Affiliation(s)
- H C Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - A Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schlosser
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schirner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - L Cosma
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - K Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - M Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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