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BMC Surgery Jun 2019Jejunal diverticula are the rarest of all small bowel diverticula. Most patients with jejunal diverticula are asymptomatic. Major complications include diverticulitis,... (Review)
Review
BACKGROUND
Jejunal diverticula are the rarest of all small bowel diverticula. Most patients with jejunal diverticula are asymptomatic. Major complications include diverticulitis, gastrointestinal hemorrhage, intestinal obstruction and perforation. The hemorrhage has been attributed to diverticulitis with ulceration, diverticulosis associated with trauma and irritation disorder. However, only six cases reported the arteriovenous malformations within jejunal diverticulosis to be the cause of hemorrhage.
CASE PRESENTATION
We present a case of arteriovenous malformations within jejunal diverticulosis in a 68-year-old male presented with lower gastrointestinal bleeding. After admission and stabilization, upper and lower endoscopies were performed without demonstrating the bleeding site. They only revealed clotted and red blood throughout the colon. Technetium-labeled red blood cell bleeding scan, endoscopic capsule, and selective angiography were performed to localize the site of bleeding without significant findings. As the clinical status of the patient deteriorated, exploratory laparotomy was performed urgently. Extensive jejunal saccular pouches were found 10 cm distal to duodenojejunal junction extending 1.6 m distally. Segmental resection was performed with side to side primary anastomosis. Microscopic examination of the specimen revealed many diverticula. He was followed up 2 years after that without complications.
CONCLUSION
We report yet the seventh case jejunal diverticulosis with the presence of angiodysplasia, in hope of expanding the knowledge of a rare occurrence and increasing the demand for further research about the etiology, clinical impact and treatment of such anomalies coexistence. This case also highlights the importance of considering the diagnosis of AVMs within jejunal diverticulosis in the presence of uncontrollable blood loss in the pre- or intra- operatively diagnosed jejunal diverticulosis and the urgent need for surgical intervention. In addition, the diagnostic tests should be performed close to the bleeding episode.
Topics: Aged; Arteriovenous Malformations; Diverticulum; Gastrointestinal Hemorrhage; Humans; Jejunal Diseases; Laparotomy; Male
PubMed: 31248400
DOI: 10.1186/s12893-019-0538-0 -
Indian Journal of Gastroenterology :... Dec 2020Device-assisted enteroscopy including single-balloon enteroscopy (SBE) allows direct visualization of the small bowel and has good safety and efficacy in experienced...
BACKGROUND
Device-assisted enteroscopy including single-balloon enteroscopy (SBE) allows direct visualization of the small bowel and has good safety and efficacy in experienced hands. Our study is aimed to share our single-centre experience of SBE in diagnosing and treating small-bowel disorders.
METHODS
We reviewed the prospectively collected data (from December 2016 to December 2019) of 180 consecutive anterograde and/or retrograde procedures. Analysis of baseline characteristics, endoscopic findings, and diagnostic and therapeutic rates was done.
RESULTS
SBE was done in 158 patients with a median age of 55 years (range, 13-94 years) for suspected small-bowel lesions. Dual enteroscopy (anterograde plus retrograde) was done in 22 patients (13.92%). The indication for the procedure was obscure gastrointestinal bleeding in 129 (71.66%), chronic unexplained abdominal pain in 20 (11.11%), suspected small-bowel abnormality in the form of narrowing and/or mass on imaging in 10 (5.5%), chronic diarrhea in 9 (5%), unexplained iron deficiency anemia in 9 (5%), and retained capsule in 2 (1.11%). The most common finding was ulcer, which was noted in 45 (25%) patients followed by stricture in 8 (4.44%) and both ulcers and strictures in 6 (3.33%) patients. SBE was normal in 61 (33.88%) patients. SBE gave a diagnosis in 66.11% while in 28.43% cases, therapeutic intervention was done. Minor complications like bleeding were noted in 3 patients and mild acute pancreatitis in 2 patients. Jejunal perforation requiring surgical intervention was noted in 1 patient.
CONCLUSION
SBE is a safe and effective procedure in diagnosing and treating small-bowel diseases.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Safety; Single-Balloon Enteroscopy; Treatment Outcome; Young Adult
PubMed: 33191491
DOI: 10.1007/s12664-020-01088-x -
Journal of Pediatric Gastroenterology... Feb 2023Growth impairment in pediatric patients with pediatric onset inflammatory bowel disease (IBD) is multifactorial. Reports on the effect of age at menarche on adult...
OBJECTIVES
Growth impairment in pediatric patients with pediatric onset inflammatory bowel disease (IBD) is multifactorial. Reports on the effect of age at menarche on adult stature in this population are limited. This study investigated the impact of age at menarche, disease-associated factors, and mid-parental height on growth from menarche to final height (FHt) in pediatric patients with Crohn disease (CD) and ulcerative colitis (UC) and IBD unclassified (IBD-U).
METHODS
Subjects were enrolled from a prospectively maintained pediatric IBD database when IBD preceded menarche and dates of menarche and FHt measurements were recorded.
RESULTS
One hundred forty-six patients: CD 112 and UC 30/IBD-U 4. Mean age (years) at diagnosis (10.9 vs 10.1), menarche (14.4 vs 14.0), and FHt (19.6 vs 19.7). CD and UC/IBD-U patients showed significant association between Chronological age (CA) at menarche and FHt (cm, P < 0.001) but not FHt z score (FHt-Z) < -1.0 (P = 0.42). FHt-Z < -2.0 occurred in only 5 patients. Growth impairment (FHt-Z < -1.0) was associated with surgery before menarche (P = 0.03), jejunal disease (P = 0.003), low mid-parental height z score (MPH-Z) (P < 0.001), hospitalization for CD (P = 0.03) but not UC, recurrent corticosteroid, or anti-tumor necrosis factor alpha (anti-TNFα) therapy.
CONCLUSIONS
Early age of menarche was associated with greater potential for linear growth to FHt but not FHt-Z (P < 0.05). Surgery before menarche, jejunal disease, hospitalization for CD, low MPH, and weight z score were associated with FHt-Z < -1.0.
Topics: Child; Female; Humans; Colitis, Ulcerative; Crohn Disease; Inflammatory Bowel Diseases; Menarche
PubMed: 36705699
DOI: 10.1097/MPG.0000000000003667 -
World Journal of Clinical Cases Sep 2022A post-bulbar duodenal ulcer (PBDU) is an ulcer in the duodenum that is distal to the duodenal bulb. PBDU may coexist with a synchronous posterior ulcer in rare...
BACKGROUND
A post-bulbar duodenal ulcer (PBDU) is an ulcer in the duodenum that is distal to the duodenal bulb. PBDU may coexist with a synchronous posterior ulcer in rare occurrences, resulting in a kissing ulcer (KU). Duodenocaval fistula (DCF) is another uncommon but potentially fatal complication related to PBDU. There is limited knowledge of the scenarios in which PBDU is complicated by KU and DCF simultaneously.
CASE SUMMARY
A 22-year-old man was admitted to the emergency department with abdominal pain, stiffness, and vomiting. The X-ray showed pneumoperitoneum, suggesting a perforated viscus. Laparotomy revealed a KU with anterior perforation and a DCF. After Kocherization, venorrahphy was used to control caval bleeding. Due to the critical condition of the patient, only primary duodenorrahphy with gastrojejunostomy was performed as a damage control strategy. However, later, the patient developed obstructive jaundice and leakage, and two additional jejunal perforations were detected. Due to the poor condition of the duodenum and the involvement of the ampulla in the posterior ulcer, neither primary repair nor pancreatic-free duodenectomy and ampulloplasty/ampullary reimplantation were considered viable; therefore, an emergency pancreaticoduodenectomy was performed, along with resection and anastomosis of the two jejunal perforations. The patient had a smooth recovery after surgery and was discharged after 27 d.
CONCLUSION
The timely diagnosis of PBDU and radical surgery can aid in the smooth recovery of patients, even in the most complex cases.
PubMed: 36157647
DOI: 10.12998/wjcc.v10.i25.9071 -
Obesity Surgery Sep 2014As the demand for obesity surgery grows, Roux-en-Y gastric bypass remains the most commonly performed procedure associated with low complication rates and good long-term... (Review)
Review
As the demand for obesity surgery grows, Roux-en-Y gastric bypass remains the most commonly performed procedure associated with low complication rates and good long-term co-morbidity resolution and weight loss. Marginal ulcers remain a cause of significant morbidity in medium and long term and are reported in every large series of this operation. Marginal ulceration is a complex problem with unclear aetiology and lack of clear consensus on its prevention and management. A clearer understanding of the available evidence regarding the prevention and treatment of marginal ulcers is needed to improve patient care. We propose an algorithm for management of patients with marginal ulcers based on the best available evidence in the literature.
Topics: Algorithms; Anti-Bacterial Agents; Anti-Ulcer Agents; Comorbidity; Gastric Bypass; Helicobacter Infections; Humans; Jejunal Diseases; Obesity, Morbid; Peptic Ulcer; Postoperative Complications; Proton Pump Inhibitors; Smoking Cessation
PubMed: 24851857
DOI: 10.1007/s11695-014-1293-z -
Zhonghua Wei Chang Wai Ke Za Zhi =... Oct 2022At present, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have become the major bariatric and metabolic surgical procedures, but neither of them is...
At present, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have become the major bariatric and metabolic surgical procedures, but neither of them is perfect. Adding jejunojejunal bypass (JJB) to SG can enhance weight loss and hypoglycemic effect. Present clinical results show that the short-term weight loss effect of SG-JJB is better than SG, and the weight loss and hypoglycemic effect is similar to RYGB. However, SG-JJB does not have various complications like traditional jejunal ileal bypass (JIB). The existing evidence shows that SG-JJB is a safe and effective bariatric and metabolic surgery, with relatively simple technical requirement. Meanwhile, SG-JJB has almost no dumping syndrome or ulcers, and facilitates endoscopic examination of the biliary tract, and has no blind gastric pouch. Thus, SG-JJB has some clinical application prospects, but further high-quality research with long-term follow-up is needed.
Topics: Gastrectomy; Gastric Bypass; Humans; Hypoglycemic Agents; Obesity, Morbid; Retrospective Studies; Treatment Outcome; Weight Loss
PubMed: 36245113
DOI: 10.3760/cma.j.cn441530-20220712-00301 -
Cureus Apr 2023Gastrointestinal stromal tumors (GISTs) are a common type of soft tissue sarcoma that originates from the interstitial cells of Cajal in the gastrointestinal (GI) tract....
Gastrointestinal stromal tumors (GISTs) are a common type of soft tissue sarcoma that originates from the interstitial cells of Cajal in the gastrointestinal (GI) tract. These tumors usually affect people above 50 years of age and can be difficult to diagnose, as symptoms can be vague and nonspecific, with some patients remaining asymptomatic. Early diagnosis and treatment are crucial because GISTs can be aggressive and may metastasize. We present a case of a 74-year-old man who presented to our hospital with GI bleeding and anemia. Despite initial investigations, the source of bleeding was not identified until capsule endoscopy and then balloon enteroscopy revealed an ulcerated mass in the jejunum. The tumor was successfully removed using a minimally invasive laparoscopic approach, and the histopathologic report confirmed the diagnosis of GIST. The patient had an uneventful postoperative course. This case highlights the importance of considering GISTs in the differential diagnosis of obscure GI bleeding. A multidisciplinary approach is essential to ensure the best outcomes for these patients. Additionally, the use of minimally invasive surgery should be considered whenever possible to minimize postoperative complications and promote faster recovery.
PubMed: 37252549
DOI: 10.7759/cureus.38098 -
Iranian Journal of Basic Medical... Feb 2020This study was designed to investigate various gastrointestinal effects of (Sapodilla), exploring its anti-diarrheal, anti-secretary, anti-spasmodic, anti-ulcer and...
OBJECTIVES
This study was designed to investigate various gastrointestinal effects of (Sapodilla), exploring its anti-diarrheal, anti-secretary, anti-spasmodic, anti-ulcer and anti-motility potential.
MATERIALS AND METHODS
Antidiarrheal and anti-secretary activities were investigated using castor oil induced diarrhea and castor oil induced fluid accumulation. Isolated rabbit jejunum tissues (antispasmodic) were employed for experiments. Antiulcer, antimotility and molecular docking were performed using ethanol-HCl induced ulcer assay, charcoal meal transit time and Auto Doc Vina.
RESULTS
Mz.Cr exhibited protection against castor oil-induced diarrhea (0.05 vs. saline group) and dose-dependently inhibited intestinal fluid secretions (0.001 vs. castor oil group). Mz.Cr caused relaxation of spontaneous and K (80 Mm)-induced contractions with EC values of 0.11mg/ml (0.08-0.1, n=4) and 0.16 mg/ml (0.09-0.2, n=4) respectively ( 0.05 0.01 0.001). It showed protective effect against gastric ulcers induced by ethanol-HCl (0.001 vs. saline group). Mz.Cr reduced distance travelled by charcoal meal (0.001 vs. saline group). Plant constituents: caffeoylquinic acid and methyl 4-O-galloylchlorogenate showed high binding affinities (E-value≥-6.5 Kcal/mol) against histaminergic H receptors, H/K ATPase pump and voltage gated L-type calcium channels, while possesses moderate affinities (E-value≥8 Kcal/mol) against histaminergic H, muscarinic M, M and mu-opioid, whereas lower affinities (E-value≥9.5 Kcal/mol) vs. calmodulin, adrenergic α, phosphodiesterase enzyme and dopaminergic D receptors. Lupeol-3-acetate and β-amyrin-3-(3'-dimethyl) butyrate observed weak affinities.
CONCLUSION
In present study, is reported to exhibits anti-diarrheal, anti-secretory, anti-spasmodic, anti-motility, anti-ulcer effects and computational binding affinities against gastrointestinal targets.
PubMed: 32405366
DOI: 10.22038/IJBMS.2019.35595.8488 -
Eksperimental'naia I Klinicheskaia... 2015The nomenclature of digestive diseases in children was supplemented by the "new" diseases: of esophagus--gastroesophageal reflux disease (GERD), Barrett's esophagus,... (Review)
Review
The nomenclature of digestive diseases in children was supplemented by the "new" diseases: of esophagus--gastroesophageal reflux disease (GERD), Barrett's esophagus, Zenker's diverticulum; of stomach and duodenum--gastroduodenitis, peptic ulcer disease, polyps, ectopic pancreas in the stomach wall; of the intestine--jejunitis, ileocolitis, Crohn's disease, celiac disease, bacterial overgrowth syndrome in the small intestine; of biliary tract--cholelithiasis, gallbladder cholesterosis, anomalies of the biliary tract; of pancreas--acute and chronic pancreatitis, annular pancreas (2). The features of gastrointestinal diseases in children experiencing the action of factors, not always positively affecting the growing organism, were established. These features include: presence of allergic background; high level of neuro-autonomous and psycho-emotional changes in modern children, not only in schoolchildren, but even in preschoolers; polymorbidity or a combination (syntropy) of lesions of the digestive system; adverse outcomes of certain diseases as chronization, complications development, and as a consequence--a high risk of disability in children; "rejuvenation" of certain diseases of the digestive system (cholelithiasis, gallbladder cholesterosis, Crohn's disease), typical for adults. It is important to emphasize the clinical and social importance of gastroenterological diseases in childhood. Axiomatic is that the origins of many diseases of the digestive organs in adults lie in childhood. Early manifestation of certain diseases such as peptic ulcer disease, gluten enteropathy, Crohn's disease, and others, significantly impact the quality of life of sick children and their parents. It is worth to emphasize high costs of medical and prophylactic (tertiary prevention) activities using the drugs of latest generations. All this causes problems in both applied and scientific pediatric gastroenterology.
Topics: Adolescent; Adult; Biomedical Research; Child; Child, Preschool; Digestive System Diseases; Female; Gastroenterology; Humans; Infant; Infant, Newborn; Male; Pediatrics
PubMed: 26281153
DOI: No ID Found -
Current Research in Pharmacology and... 2023Non-steroidal anti-inflammatory drugs (NSAIDs) injure the proximal and distal gut by different mechanisms. While many drugs reduce gastrointestinal injury, no drug...
Non-steroidal anti-inflammatory drugs (NSAIDs) injure the proximal and distal gut by different mechanisms. While many drugs reduce gastrointestinal injury, no drug directly stimulates mucosal wound healing. Focal adhesion kinase (FAK), a non-receptor tyrosine kinase, induces epithelial sheet migration. We synthesized and evaluated a water-soluble FAK-activating small molecule, M64HCl, with drug-like properties. Monolayer wound closure and Western blots measured migration and FAK phosphorylation in Caco-2 cells, in vitro kinase assays established FAK activation, and pharmacologic tests assessed drug-like properties. 30 mg/kg/day M64HCl was administered in two murine small intestine injury models for 4 days. M64HCl (0.1-1000 nM) dose-dependently increased Caco-2 FAK-Tyr 397 phosphorylation, without activating Pyk2 and accelerated Caco-2 monolayer wound closure. M64HCl dose-responsively activates the FAK kinase domain vs. the non-salt M64, increasing the V of ATP-binding. Pharmacologic tests suggested M64HCl has drug-like properties and is enterally absorbed. M64HCl 25 mg/kg/day continuous infusion promoted healing of ischemic jejunal ulcers and indomethacin-induced small intestinal injury in C57Bl/6 mice. M64HCl-treated mice exhibited smaller ulcers 4 days after ischemic ulcer induction or indomethacin injury. Renal histology and plasma creatinine were normal. Mild hepatic inflammatory changes and ALT elevation were similar among M64HCl-treated mice and controls. M64HCl was concentrated in kidney and gastrointestinal mucosa and functional nephrectomy studies suggested predominantly urinary excretion. Little toxicity was observed in vitro or in single-dose mouse toxicity studies until >1000x higher than effective concentrations. M64HCl, a water-soluble FAK activator, promotes epithelial restitution and intestinal mucosal healing and may be useful to treat gut mucosal injury.
PubMed: 36632414
DOI: 10.1016/j.crphar.2022.100147