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South African Journal of Surgery.... Oct 2013A young woman with persistent postprandial vomiting was found to have a high-grade proximal jejunal stricture. The stricture was surgically excised, and...
A young woman with persistent postprandial vomiting was found to have a high-grade proximal jejunal stricture. The stricture was surgically excised, and histopathological examination showed gastric heterotopia with localised ulceration and fibrosis. Symptomatic gastric heterotopia in the small bowel is rare, and to our knowledge this is the first report of jejunal gastric heterotopia resulting in ulceration with subsequent stricturing and obstruction.
Topics: Adolescent; Choristoma; Female; Humans; Intestinal Obstruction; Jejunal Diseases; Stomach; Ulcer
PubMed: 24209701
DOI: 10.7196/sajs.1735 -
Journal of Paediatrics and Child Health Nov 2004Alimentary tract duplications are rare congenital anomalies that occasionally contain ectopic gastric mucosa that secretes acid peptic juice and can cause pain,...
Alimentary tract duplications are rare congenital anomalies that occasionally contain ectopic gastric mucosa that secretes acid peptic juice and can cause pain, ulceration, bleeding and rarely perforation. We report a case of a 2-year-old girl who developed perforation of a jejunal duplication lined with ectopic gastric mucosa who was managed surgically.
Topics: Abdominal Pain; Child, Preschool; Choristoma; Digestive System Abnormalities; Female; Gastric Mucosa; Humans; Intestinal Mucosa; Intestinal Perforation; Jejunal Diseases; Jejunum; Laparotomy; Time Factors; Treatment Outcome
PubMed: 15469539
DOI: 10.1111/j.1440-1754.2004.00497.x -
Surgery, Gynecology & Obstetrics Dec 1989RYA was designed to avoid biliary reflux, which complicated earlier forms of gastrojejunostomy. The emerging popularity of the procedure was squelched by the frequent...
RYA was designed to avoid biliary reflux, which complicated earlier forms of gastrojejunostomy. The emerging popularity of the procedure was squelched by the frequent complication of gastrojejunal stomal ulceration. RYA returned from surgical oblivion after World War II in its use in replacing the esophagus and stomach. It is now commonly used to drain other organs, mainly the biliary system, and in various remedial operations for complications from gastrectomy. Conversion to RYA is efficacious for the treatment of inflammation of the stomach and esophagus caused by alkaline reflux. The main complication of RYA is Roux Y syndrome, secondary to gastric or efferent jejunal stasis, or both. Peptic ulceration is much less a problem since the advent of vagotomy. Better understanding of the physiologic characteristics of various forms of RYA should soon better define the limits of its clinical application.
Topics: Anastomosis, Roux-en-Y; Esophagus; Evaluation Studies as Topic; Gastrectomy; History, 19th Century; History, 20th Century; Jejunum; Peptic Ulcer; Postoperative Complications; Switzerland
PubMed: 2683158
DOI: No ID Found -
Journal of Pediatric Surgery Jul 2011Systemic polyarteritis nodosa (PAN) is a rare disease in childhood affecting small and midsized arteries. The typical presentation in children is of isolated 1- or...
Systemic polyarteritis nodosa (PAN) is a rare disease in childhood affecting small and midsized arteries. The typical presentation in children is of isolated 1- or 2-organ involvement, and the diagnosis is often based on the histopathology. We report a case of pediatric PAN whose presenting symptom was jejunal obstruction owing to ischemic necrosis of the small bowel. The postoperative recovery was uneventful, and the patient responded well to steroid therapy. There are only a few cases of PAN with intestinal involvement described in the literature, some of them fatal. The diagnosis of PAN should be considered in children with acute intestinal obstruction with no obvious etiology, as early recognition and treatment may reduce its high mortality.
Topics: Abdominal Pain; Anastomosis, Surgical; Antirheumatic Agents; Combined Modality Therapy; Fever; Humans; Infant; Intestinal Obstruction; Ischemia; Jejunal Diseases; Jejunum; Male; Methylprednisolone; Necrosis; Polyarteritis Nodosa; Ulcer; Vomiting
PubMed: 21763822
DOI: 10.1016/j.jpedsurg.2011.03.084 -
Journal of the Royal College of... Jul 1964
Topics: Black People; Diagnosis, Differential; Duodenal Ulcer; Gastrectomy; Gastroenterostomy; Humans; Jejunum; Nigeria; Peptic Ulcer; Postgastrectomy Syndromes; Ulcer; Vagotomy
PubMed: 14199390
DOI: No ID Found -
Abdominal Imaging 2008We describe the clinical and radiographic findings in two patients who developed giant, intractable ulcers in the jejunal Roux limb after gastric bypass surgery, most...
We describe the clinical and radiographic findings in two patients who developed giant, intractable ulcers in the jejunal Roux limb after gastric bypass surgery, most likely secondary to chronic jejunal ischemia. The diagnosis of such ulcers is important because of the need for aggressive medical or surgical treatment of these patients.
Topics: Adult; Aged; Female; Gastric Bypass; Humans; Jejunal Diseases; Male; Obesity, Morbid; Postoperative Complications; Ulcer
PubMed: 18175166
DOI: 10.1007/s00261-007-9344-8 -
Chirality 1993The most common, and sometimes life-threatening, side-effects associated with the human use of the analgesic, nonsteroidal antiinflammatory drugs (NSAIDs) are... (Comparative Study)
Comparative Study
The most common, and sometimes life-threatening, side-effects associated with the human use of the analgesic, nonsteroidal antiinflammatory drugs (NSAIDs) are gastrointestinal. These include gastritis, ulceration, and severe bleeding. The aryl propionic acid class of NSAIDs are among the most widely used of these drugs in the world, including rac-ibuprofen, rac-flurbiprofen, and rac-ketoprofen. Marketed as racemates, it was assumed that the "inactive" (R)-enantiomers, having no cyclooxygenase inhibiting effect, also had no toxic effect. In a 30-day dose response study of (S)-, (R)-, and rac-flurbiprofen given daily over a range of doses the (R)-isomer alone proved to be without apparent gastrointestinal (GI) toxicity. On the other hand the racemate proved to be 2 to 4 times as ulcerogenic in enantiomerically equivalent doses as the (S)-enantiomer. These results have significant clinical implications.
Topics: Animals; Digestive System; Female; Flurbiprofen; Gastrointestinal Diseases; Jejunum; Necrosis; Rats; Rats, Sprague-Dawley; Stereoisomerism; Ulcer; Weight Gain
PubMed: 8240924
DOI: 10.1002/chir.530050703 -
Clinical Journal of Gastroenterology Feb 2023Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation as the result of immunosuppressant medications. Epstein-Barr...
Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation as the result of immunosuppressant medications. Epstein-Barr virus (EBV) has been implicated in most of these cases, specifically with B-cell predominant lymphoma. This case report describes a 24-year-old female who presented with recurrent GI bleed within 6 months post-orthostatic heart transplant. Endoscopic evaluations including video capsule study, push enteroscopy, and colonoscopy revealed multiple ulcerated lesions in duodenum, jejunum, and colon secondary to Epstein-Barr Virus-associated monomorphic PTLD. Despite continuation of rituximab after discharge, she returned to the hospital for recurrent GI bleed requiring additional endoscopic intervention. PTLD is a devastating disease of the post-transplant population. Due to a high risk of recurrent GI bleeding, patients with PTLD may benefit from careful monitoring by gastroenterology as an outpatient with a low threshold for repeat endoscopic evaluation despite being on immunotherapy or chemotherapy.
Topics: Female; Humans; Young Adult; Adult; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Ulcer; Duodenum; Lymphoproliferative Disorders
PubMed: 36251246
DOI: 10.1007/s12328-022-01718-1 -
The Turkish Journal of Gastroenterology... Apr 2021Double-balloon enteroscopy (DBE) enables the detection of ulcerations in the small bowel. However, determining an etiological diagnosis remains challenging. This study...
BACKGROUND
Double-balloon enteroscopy (DBE) enables the detection of ulcerations in the small bowel. However, determining an etiological diagnosis remains challenging. This study was conducted to investigate the clinical and endoscopic features of ulcerations with isolated involvement of the small bowel (UIISB) to improve diagnostic ability.
METHODS
Patients (n = 565) who underwent DBE and presented with ulcerations in the small bowel at Nanfang Hospital from January 2005 to January 2018 were eligible. Medical records were retrospectively examined. Predictors to determine ulceration etiology were identified by logistic regression analysis.
RESULTS
After excluding patients with extra-ulcerations in other sites (n = 306) and those without follow-up records (n = 50), 209 patients with UIISB were enrolled. Among them, 59.3% of the ulcers were in the ileum, 26.8% in the jejunum, and 13.4% in the jejunoileum. Initial symptoms included abdominal pain (54.1%) and obscure gastrointestinal bleeding (30.0%). The multiplicity of ulceration was categorized as a single (22.0%) or multiple (78.0%). Cases were diagnosed with Crohn's disease (50.7%), chronic nonspecific inflammation (21.5%), diverticulum (9.1%), lymphoma (6.2%), gastrointestinal stromal tumor (4.3%), intestinal tuberculosis (1.9%), adenocarcinoma (1.4%), infective enteritis (1.4%), hemangioma (1.0%), cryptogenic multifocal ulcerous stenosing enteritis (1.0%), anastomotic ulcer (0.5%), intestinal duplication (0.5%), or neuroendocrine tumor (0.5%). Etiology identification indicated the if patients were aged 40 years or more, or had overt bleeding, single ulceration, and ulcer at jejunum, it as more prone to be neoplastic (P < .05).
CONCLUSION
When we manage patients with UIISB, Crohn's disease should be first under consideration. Age≥40, overt bleeding, single ulceration, and ulcer at jejunum were reasonable indications for etiology of neoplasm or non-neoplasm.
Topics: Abdominal Pain; Adult; Crohn Disease; Double-Balloon Enteroscopy; Female; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Male; Middle Aged; Retrospective Studies; Ulcer
PubMed: 34231487
DOI: 10.5152/tjg.2021.20646 -
Plastic and Reconstructive Surgery Feb 2002Reconstruction of the pharyngoesophagus with free jejunal transfer is a major challenge when recipient neck vessels are absent because of previous surgery or...
Reconstruction of the pharyngoesophagus with free jejunal transfer is a major challenge when recipient neck vessels are absent because of previous surgery or irradiation. In such instances, jejunal transfer using a muscle flap as a "vascular carrier" may be a problem-solving alternative. Pretransfer vascularization of the jejunum is achieved by wrapping the muscle flap around the small bowel segment. After a short staging period, the mesenteric pedicle is divided and the bowel segment is transferred up to the neck based on its new blood supply. The objectives of this study were to develop an animal model for prefabricating independently revascularized jejunal segments using the rectus abdominis muscle flap and to determine the minimal time required for independent bowel survival. Twenty-four mature (500-g to 700-g) rats were divided into six experimental groups of four animals each. In each animal, a 1.5-cm segment of proximal jejunum was isolated on two jejunal arteries and wrapped with a superior pedicled rectus abdominis muscle flap. To determine the time of neovascular takeover, the mesenteric pedicles were ligated on postoperative day 2 (group I), day 3 (group II), day 4 (group III), day 5 (group IV), day 6 (group V), and day 7 (group VI). At the time of pedicle ligation, the composite flap was transposed to a new subcutaneous position. Viability of bowel was assessed according to gross appearance and histologic examination 48 hours after transfer. Complete survival of revascularized jejunum in 11 of 12 animals was obtained after pedicle ligation on postoperative day 5 and beyond (p < 0.0001, Fisher's exact test). These bowel segments demonstrated luminal patency, intact pink mucosa, mucus production, and visible peristalsis. Histologic examination showed healthy intestinal epithelium and tissue integration along the serosa-muscle interphase. In contrast, pedicle ligation on day 4 and earlier resulted in varying degrees of bowel necrosis characterized by flattening or ulceration of mucosa (day 4), mucosal sloughing and necrosis of mural musculature (day 3), and complete loss of bowel architecture with lumen obliteration (day 2). These findings suggest that jejunal segments may be independently revascularized with the rectus abdominis muscle flap in the rat model. Complete survival and gross normal bowel function may be obtained without mesenteric perfusion after a minimal time of 5 days.
Topics: Abdominal Muscles; Angiography; Animals; Graft Survival; Jejunum; Male; Neovascularization, Physiologic; Rats; Rats, Sprague-Dawley; Surgical Flaps
PubMed: 11818849
DOI: 10.1097/00006534-200202000-00036