-
Quantitative Imaging in Medicine and... Dec 2013To compare the findings obtained by computerised tomography (CT) enterography, which uses oral neutral contrast material and non-contrasted diffusion-weighted magnetic... (Review)
Review
AIM
To compare the findings obtained by computerised tomography (CT) enterography, which uses oral neutral contrast material and non-contrasted diffusion-weighted magnetic resonance imaging (DW-MRI) technique and reveal the diagnostic value of DW-MRI in patients with inflammatory bowel diseases.
METHODS
Patients with established or clinically suspect diagnosis of inflammatory bowel disease were included in the study. CT enterography and DW-MRI obtained from the patients were evaluated by a radiologist blinded to the endoscopic and/or histopathological results. Duodenum, jejunum, ileal loops, ascending, transverse, descending colon, sigmoid colon and rectum were evaluated in that order as for general imaging quality, luminal distension and adequate visualization of the intestinal wall. Image qualities of neutral contrast CT-enterography and DW-MRI were compared.
RESULTS
The study included 31 patients. Based on statistical analyses, the best correlation between the results of CT-enterography and diffusion-weighted imaging (DWI) were observed in the evaluation of transverse colon, ileum and duodenum in order of decreasing frequency and with an almost perfect compatibility. Radiological findings of sigmoid colon, jejunum and descending colon were completely compatible. However, a moderate degree of compatibility was estimated between radiological findings of rectum and cecum.
CONCLUSIONS
Though conventional enteroclysis is the gold standard method among radiological imaging techniques used for the evaluation of inflammatory small intestinal abnormalities, CT enterography and DW-MRI are alternative methods that can be used effectively to obtain useful information.
PubMed: 24404447
DOI: 10.3978/j.issn.2223-4292.2013.12.03 -
Journal of the Canadian Association of... Jun 2021
PubMed: 34056526
DOI: 10.1093/jcag/gwaa032 -
Evidence-based Complementary and... 2021is rich in several phytochemicals such as chromone, isoflavones, terpenes, lignans, coumarins, glycosides, and furanocoumarins and have been traditionally used for the...
is rich in several phytochemicals such as chromone, isoflavones, terpenes, lignans, coumarins, glycosides, and furanocoumarins and have been traditionally used for the management of different gastrointestinal disorders. This research reveals the effects of fruit extracts- chloroform (Fp.CHCl) and aqueous (Fp.Aq)-on gut activity through and analyses. Antidiarrheal and enteropooling assays were analyzed with castor oil-induced diarrhea and intestinal fluid accumulation. Jejunum tissues of rabbits were isolated (antispasmodic) for experiments. Antimotility was carried out by charcoal meal for determining transient time, and ethanol-induced ulcer assay was used to measure the ulceration of stomach; molecular pathways were assessed through proteomic approach. Fp.CHCl and Fp.Aq extracts attributed dose-dependently protection against diarrhea, and intestinal fluid secretions were inhibited dose dependently. Extracts of Fp.CHCl and Fp.Aq produced reduction in spontaneous and K (at 80 Mm)-induced contractions in isolated jejunum tissues, along with the decreased length covered by charcoal in charcoal meal transient time activity. The extract exhibited gastroprotective outcome in rats and reduced tumor necrotic factor (TNF-) levels and IL-18, measured by proteomic approach. Morphological studies' results showed that ethanol induced significant gastritis, apoptosis, swelling of mucosa, and hydropic degeneration leading to cellular degeneration and necrosis, observed through staining techniques. Furthermore, ethanol activated the inflammation pathway in all gastric zones by elevating the levels of cyclooxygenase-2, TNF-, and nuclear factor kappa light-chain enhancer of activated B-cells. Overall results expressed the antidiarrheal, antispasmodic, enteropooling, antimotility, and antiulcer activities of fruit extract.
PubMed: 34194521
DOI: 10.1155/2021/6613140 -
World Journal of Clinical Cases Jan 2022The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery. Of particular concern are internal hernias...
BACKGROUND
The incidence of internal hernias has recently increased in concordance with the popularization of laparoscopic surgery. Of particular concern are internal hernias occurring in Petersen's space, a space that is surgically created after treatment for gastric cancer and obesity. These hernias cause devastating sequelae, such as massive intestinal necrosis, fatal Roux limb necrosis, and superior mesenteric vein thrombus. In addition, protein-losing enteropathy (PLE) is a rare syndrome involving gastrointestinal protein loss, although its relationship with internal Petersen's hernias remains unknown.
CASE SUMMARY
A 75-year-old man with a history of laparotomy for early gastric cancer developed Petersen's hernia 1 year and 5 mo after surgery. He was successfully treated by reducing the incarcerated small intestine and closure of Petersen's defect without resection of the small intestine. Approximately 3 mo after his surgery for Petersen's hernia, he developed bilateral leg edema and hypoalbuminemia. He was diagnosed with PLE with an alpha-1 antitrypsin clearance of 733 mL/24 h. Double-balloon enteroscopy revealed extensive jejunal ulceration as the etiology, and it facilitated minimum bowel resection. Pathological analysis showed extensive jejunal ulceration and collagen hyperplasia with nonspecific inflammation of all layers without lymphangiectasia, lymphoma, or vascular abnormalities. His postoperative course was unremarkable, and his bilateral leg edema and hypoalbuminemia improved after 1 mo. There was no relapse over the 5-year follow-up period.
CONCLUSION
PLE and extensive jejunal ulceration may occur after Petersen's hernia. Double-balloon enteroscopy helps identify and resect these lesions.
PubMed: 35071535
DOI: 10.12998/wjcc.v10.i1.323 -
International Journal of Surgery Case... Aug 2021The common manifestations of gastrointestinal stromal tumors (GIST) are well established. However, jejunal diverticulosis is an uncommon phenomenon to be associated with...
INTRODUCTION
The common manifestations of gastrointestinal stromal tumors (GIST) are well established. However, jejunal diverticulosis is an uncommon phenomenon to be associated with this lesion, with its rarity compounded by the relative difficulty associated with its diagnosis. Limited literature is available on this topic. This article examines one such case of jejunal diverticulitis as a result of a GIST, and the intervention of said disease.
CASE PRESENTATION
A 69 year old lady presented with abdominal pain, vomiting, and low grade fevers, on a background of ulcerative colitis. She was peritonitic, raising concerns of an acute abdomen. Her imaging identified an intra-abdominal contained perforation, prompting a transfer to theatres overnight for a laparotomy, which identified a jejunal diverticulum, which resembled a contained perforation. This was resected, and sent for histopathological analysis, identifying the lesion as a GIST.
DISCUSSION
Unlike other forms of jejunal diverticular disease, those arising from GISTs tend to present perforated, necessitating resection. This disease displays a tendency towards formation on the anti-mesenteric border of the small bowel. Additionally, this particular form of GIST shows macroscopic and histopathological uniformity across reported cases to date despite significant geographical disparity.
CONCLUSION
A scant number of case reports worldwide have identified jejunal diverticulitis from GISTs. We suggest diverticula be excised if perforation is suspected, while incidental findings of such be left untouched. However, overall management should be undertaken at the discretion of the operating surgeon.
PubMed: 34388891
DOI: 10.1016/j.ijscr.2021.106291 -
Biological & Pharmaceutical Bulletin 2017In a study to find ways to prevent the side effects of indomethacin (IMC), we previously reported that magnesium ion (Mg) can prevent the onset of IMC-induced gastric...
In a study to find ways to prevent the side effects of indomethacin (IMC), we previously reported that magnesium ion (Mg) can prevent the onset of IMC-induced gastric mucosa in adjuvant-induced arthritis (AA) rats, a model for rheumatoid arthritis (RA). In this study we investigated whether the co-administration of IMC and Mg prevents the formation and aggravation of intestinal ulcerogenic lesions in AA rats. The single oral administration of an excessive dose of IMC (40 mg/kg) induces hemorrhagic lesions and nitric oxide (NO) production via inducible nitric oxide synthase (iNOS) in the jejunal and ileal mucosa of AA rats, and the extent of the lesions, as well as iNOS and NO levels in AA rats are higher than in normal rats. On the other hand, the co-administration of 200 mg/kg Mg attenuates intestinal ulceration and the elevation in the iNOS and NO levels in AA rats. Further, hemorrhagic lesioning and enhanced iNOS and NO levels in AA rats also result from the repetitive oral administration of 3 mg/kg IMC (therapeutic dose) for 42 d (once a day), and these changes are also prevented by the co-administration of 200 mg/kg Mg. In conclusion, the co-administration of Mg suppresses the ulcerogenic response to IMC in the jejunal and ileal mucosa of AA rats, probably by preventing the elevation of iNOS and NO levels in the region.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Experimental; Drug Therapy, Combination; Ileum; Indomethacin; Intestinal Mucosa; Jejunum; Magnesium; Male; Nitric Oxide; Nitric Oxide Synthase Type II; Peptic Ulcer; Protective Agents; Rats
PubMed: 28566633
DOI: 10.1248/bpb.b17-00151 -
Scientific Reports Oct 2019GI mucosal healing requires epithelial sheet migration. The non-receptor tyrosine kinase focal adhesion kinase (FAK) stimulates epithelial motility. A virtual screen...
GI mucosal healing requires epithelial sheet migration. The non-receptor tyrosine kinase focal adhesion kinase (FAK) stimulates epithelial motility. A virtual screen identified the small drug-like FAK mimic ZINC40099027, which activates FAK. We assessed whether ZINC40099027 promotes FAK-Tyr-397 phosphorylation and wound healing in Caco-2 monolayers and two mouse intestinal injury models. Murine small bowel ulcers were generated by topical serosal acetic acid or subcutaneous indomethacin in C57BL/6J mice. One day later, we began treatment with ZINC40099027 or DMSO, staining the mucosa for phosphorylated FAK and Ki-67 and measuring mucosal ulcer area, serum creatinine, ALT, and body weight at day 4. ZINC40099027 (10-1000 nM) dose-dependently activated FAK phosphorylation, without activating Pyk2-Tyr-402 or Src-Tyr-419. ZINC40099027 did not stimulate proliferation, and stimulated wound closure independently of proliferation. The FAK inhibitor PF-573228 prevented ZINC40099027-stimulated wound closure. In both mouse ulcer models, ZINC40099027accelerated mucosal wound healing. FAK phosphorylation was increased in jejunal epithelium at the ulcer edge, and Ki-67 staining was unchanged in jejunal mucosa. ZINC40099027 serum concentration at sacrifice resembled the effective concentration in vitro. Weight, creatinine and ALT did not differ between groups. Small molecule FAK activators can specifically promote epithelial restitution and mucosal healing and may be useful to treat gut mucosal injury.
Topics: Animals; Caco-2 Cells; Cell Movement; Epithelial Cells; Focal Adhesion Protein-Tyrosine Kinases; Humans; Intestinal Mucosa; Jejunum; Mice; Mice, Inbred C57BL; Phosphorylation; Quinolones; Small Molecule Libraries; Sulfones; Ulcer; Wound Closure Techniques; Wound Healing
PubMed: 31604999
DOI: 10.1038/s41598-019-51183-z -
Surgical Case Reports Jun 2020We encountered a case of marginal ulcer in the jejunum after distal gastrectomy with jejunal pouch interposition. However, it has not been reported and not confirmed the...
BACKGROUND
We encountered a case of marginal ulcer in the jejunum after distal gastrectomy with jejunal pouch interposition. However, it has not been reported and not confirmed the treatment. We chose truncal vagotomy, considering reduced morbidity and postoperative complications.
CASE PRESENTATION
A case was a 69-year-old woman who was admitted to our hospital with melena. She had received curative distal gastrectomy with a 15-cm jejunal pouch reconstruction for early gastric cancer. Marginal ulcer in the jejunal pouch was detected by upper gastrointestinal endoscopy. She was given medication; however, she repeated hospitalization for melena and abdominal pain. Therefore, we decided to perform surgery, and truncal vagotomy was performed. The patient's postoperative course was uneventful and was discharged on the 22nd postoperative day. Symptoms such as abdominal pain and melena were improved after truncal vagotomy.
CONCLUSION
We presented a case with a complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition, which was successfully treated by truncal vagotomy, a surgical acid-reducing procedure which does not require resection of remnant stomach.
PubMed: 32488527
DOI: 10.1186/s40792-020-00879-w -
Laboratory Investigation; a Journal of... Oct 2008Altered transforming growth factor-beta (TGFbeta) expression may contribute to inflammatory bowel disease and modulate epithelial cell restitution. Interference with...
Altered transforming growth factor-beta (TGFbeta) expression may contribute to inflammatory bowel disease and modulate epithelial cell restitution. Interference with TGFbeta-mediated signaling inhibits excisional skin wound healing, but accelerates healing of incisional cutaneous wounds and wounds in some other tissues. Therefore, we sought to clarify the potential role of Smad3-dependent TGFbeta signaling in intestinal mucosal healing in Smad3 null mice. Jejunal serosal application of filter disks saturated with 75% acetic acid yielded a circumscribed reproducible ischemic mucosal ulcer 1 day later. We compared ulcer area at 3 and 5 days to day 1 in Smad3 knockout mice and syngeneic wild-type mice, and evaluated mucosal immunoreactivity at the ulcer edge for TGFbeta, phosphorylated (activated) focal adhesion kinase (pFAK), phosphorylated extracellular signal-related kinase (pERK), proliferating cell nuclear antigen and apoptosis by TUNEL. Ulcer healing in Smad3 null mice was 17% less at day 3 (n=14, P=0.022) and 15% less at day 5 (n=14, P=0.004) than in wild-type littermates. In wild-type mice, pFAK, pERK and TGFbeta immunoreactivity were elevated in epithelium immediately adjacent to the ulcer compared with more distant mucosa. However, this pattern of immunoreactivity for pFAK, pERK and TGFbeta was not observed in Smad3 null mice. Smad3 null mice exhibited increased epithelial proliferation and no differences in apoptotic cell death compared with wild types, suggesting that ulcer healing may reflect differences in restitutive cell migration. Thus, Smad3-dependent disruption of the TGFbeta signaling pathway impairs the healing of murine intestinal mucosal ulcers and alters patterns of activated FAK and ERK immunoreactivity important for cell migration at the ulcer edge. These studies suggest a significant role for Smad3-dependent TGFbeta signaling in intestinal mucosal healing.
Topics: Animals; Disease Models, Animal; Female; Inflammatory Bowel Diseases; Intestinal Mucosa; Jejunum; Male; Mice; Mice, Knockout; Signal Transduction; Smad3 Protein; Transforming Growth Factor beta; Wound Healing
PubMed: 18711354
DOI: 10.1038/labinvest.2008.77 -
International Journal of Surgery Case... Feb 2024Small bowel bleeding can be overt or occult. Despite advances in imaging and endoscopy, the diagnosis and treatment of small bowel bleeding remain challenging due to its...
INTRODUCTION
Small bowel bleeding can be overt or occult. Despite advances in imaging and endoscopy, the diagnosis and treatment of small bowel bleeding remain challenging due to its length and location. Diagnostic procedures such as push enteroscopy, capsule endoscopy and intraoperative enteroscopy are recommended to identify the source of bleeding.
CASE PRESENTATION
A 33-year-old female with no prior history of bleeding diathesis presented with massive lower GI bleeding. Although she was in hypovolemic shock from bleeding, physical exam, splanchnic angiography and colonoscopy were unable to localize the source of bleeding. The patient continued to bleed and deteriorate despite transfusions. Exploratory laparotomy was done but localizing the source with manual palpation of small bowel was difficult. Intraoperative enteroscopy was done and showed a 2 by 1 cm ulcerative lesion at mid jejunum. Part of jejunum containing the ulcer was resected and anastomosis done. The patient did well postoperatively and on follow up.
CLINICAL DISCUSSION
A bleeding primary jejunal ulcer is rare clinical scenario difficult to diagnose. Intraoperative enteroscopy is useful in cases where initial diagnostic workups are inconclusive. It can be performed using various types of endoscopes, such as a standard or pediatric colonoscope, push enteroscope, or a sonde enteroscope, during laparotomy.
CONCLUSION
Primary jejunal ulcer is a rare cause of massive lower GI bleeding. Although minimally invasive deep endoscopic techniques to diagnose small bowel ulcers are evolving, intraoperative enteroscopy remains to be technically easy and helpful tool to make a diagnosis and guide intervention especially in a patient undergoing laparotomy for bleeding small bowel ulcer.
PubMed: 38227983
DOI: 10.1016/j.ijscr.2024.109250