A rare case of neonatal intestinal obstruction

Omphalocele minor is often associated with the presence of other anomalies compared to that of omphalocele major. The occurrence of intestinal atresia is seldom associated with omphalocele minor. Prompt diagnosis and intervention can prevent morbidity and mortality. Following is a rare case report of combination of omphalocele minor and intestinal atresia with strangulation of the proximal bowel.

A rare anatomical variation of ileocolic veins involving in gastrocolic vein trunk: case report and literature review / 中华胃肠外科杂志

Objective: Due to its various anatomical variations and numerous branches, the gastrocolic vein trunk (Henle trunk) is the most common site to develop bleeding and other complications in laparoscopic right hemicolectomy for colon cancer. This study aims to investigate the role of ileocolic vein (ICV) joining with Henle trunk, a rare anatomical variation. Methods: A rare case whose ICV was newly found to involve in the formation of Henle trunk during laparoscopic resection of right hemicolon cancer was reported as right gastroepiploic vein+ right colic vein+superior right colic vein+ICV. This anatomical variation was confirmed by multi-slice spiral CT coronal two-dimensional reconstruction of right hemicolon angiography. The literatures about ICV participating in formation of Henle trunk were systematically searched from PubMed, The Cochran Library, CNKI net and Wanfang database, and the occurrence probability and composition of its anatomical variation were analyzed. Results: This was a 47-year-old female patient who underwent laparoscopic right hemicolectomy. When the vessels were dissected during operation, it was found that ICV did not accompany the ileocolic artery, but directly flowed into Henle trunk. Two-dimensional reconstructed CT images of right hemicolon vessels showed that the composition of Henle trunk was rarely varied, which was composed of right gastroepiploic vein, right colonic vein, superior right colonic vein and ICV. Five literatures were enrolled from literature retrieval. A total of 12 cases with ICV participating in the construction of Henle trunk were reported, with a probability of 0.27%-6.31% and 6 forms of the formation of Henle trunk. In this case, Henle trunk was made up of right gastroepiploic vein, right colonic vein, upper right colonic vein and ICV, which was reported for the first time. Conclusions: ICV involving in Henle trunk is a rare vascular variation, and this type of variation should be fully recognized. Careful dissection during operation is necessary to prevent intraoperative bleeding caused by improper operation.

Multidisciplinary treatment discussion of a personalized approach of laparoscopic right hemicolectomy for variant middle colic artery and ileocolic vein / 中国肿瘤临床

Objective: To investigate the variants of middle colic artery (MCA) and ileocolic vein (ICV) and their influence on the deci-sion regarding approach of laparoscopic right hemicolectomy. Methods: We analyzed the diagnosis and treatment of one right colon cancer patient with variant MCA and ICV who was admitted to the Tianjin Medical University Cancer Hospital in March 2018. The pa-tient underwent laparoscopic right hemicolectomy via a limited medial approach after a multidisciplinary treatment (MDT) discussion. Following were the observation indicators: 1) surgical and postoperative recovery situations; 2) postoperative pathological examina-tion; and 3) follow-up situation. Results: 1) Surgical and postoperative recovery situations: the patient successfully underwent laparo-scopic right hemicolectomy via a limited medial approach. No intraoperative or postoperative complications occurred. Duration of postoperative hospital stay was 11 days. 2) Postoperative pathological examination: the number of dissected lymph nodes was 39. Postoperative pathological tumor stage was pT3N0. Postoperative pathological tumor type was moderately differentiated adenocarci-noma. 3) Follow-up situation: the patient was followed-up for 10 months with disease-free survival. Conclusions: Individual and stan-dard surgery will be the best choice for treating colon cancer patients. MDT can facilitate clinical decision-making and benefit patients.

Detecting the Non-physiological, Surgically Tailored Ileocolic Anastomosis Using the Wireless Motility Capsule. A Pre- and Post-operative, Prospective, Within Subject Trial

BACKGROUND/AIMS: Wireless motility capsule (WMC) detects the ileocolic junction (ICJ) in most non-operated patients. We find no data concerning this examination in patients where the ileocolic valve is replaced by a per definition incompetent, surgically created ICJ. We wanted to see if WMC could detect the ICJ after a right colectomy and assess the competency. METHODS: Prospective cohort study using a within-subject design to eliminate subject-subject variability. Selected patients operated with right colectomy underwent 3 WMC examinations (pre-operatively, 3 weeks, and 6 months after surgery). RESULTS: Twenty patients (8 men) included, 7 (4 men) excluded due to poor recordings (4) and unforeseen events (3). Thirteen patients (4 men), median age 63 years completed 3 tests. Median bowel lengths removed were 11 cm for ileum and 21 cm for colon. Thirty-nine examinations analyzed by 2 physicians who found all 13 ICJs at 3 examinations with high inter-rater reliability (intra-class correlation coefficient: 0.99, 0.91, and 0.99 respectively), whereas the computer found 9, 8, and 10 out of the 13 ICJs, respectively. Computed values significantly more often deviated from the 2 raters. Mean magnitude and duration of pH-drop at the ICJ (3 examinations) was 1.16–1.02–1.13 pH units and 3.15–4.78–3.75 minutes, respectively. pH-drop was smaller and duration longer at 3 weeks. We found no differences between the pre-operative (competent ICJ) and post-operative 6-month examinations (incompetent ICJ). Highest pressure immediately prior to ICJ was equal before and after surgery. CONCLUSION: WMC can identify the non-physiological ICJ after right colectomy. Ileocolic competence cannot be assessed.

Analysis of surgery-related complications and risk factors of ileocolic Crohn's disease / 中华消化外科杂志

Objective To investigate the surgery-related complications and risk factors of ileocolic Crohn's disease (CD).Methods The retrospective case-control study was conducted.The clinicopathological data of 52 patients with ileocolic CD who underwent surgery at the Peking Union Medical College Hospital from January 2010 to April 2016 were collected.Observation indicators:(1) surgery-related complications,(2) risk factors analysis of surgery-related complications:gender,age of onset,preoperative body mass index (BMI),course of disease,smoking history,history of appendectomy,perianal lesions,oral ulcer,C-reactive protein (CRP),erythrocyte sedimentation rate,disease behavior,short crohn's disease activity index (sCDAI),preoperative amino salicylic acid therapy,preoperative hormone therapy,preoperative antituberculosis therapy,preoperative immunosuppressive agents therapy,preoperative biologic agents therapy,emergency operation,surgical method and ileocolic anastomosis method,(3) follow-up.The follow-up using outpatient examination and telephone interview was performed to detect recurrence of disease up to August 2016.Measurement data with normal distribution were represented as-x ± s.The univariate analysis was done using the chi-square test,and multivariate analysis was done using the Logistic regression model.Results (1) Surgery-related complications:of 52 patients,12 had postoperative complications.Four patients complicated with wound infection had good healing of the wound after debridement and dressing change.Of 4 patients with abdominal infection,3 were improved by anti-infection symptomatic treatment and 1 die of septic shock at postoperative day 1.One patient with intestinal obstruction had a smooth recovery after open adhesiolysis.One patient with intestinal fistula discharged from hospital due to a critical condition under families' requestion.One patient with acute cholecystitis and 1 with acute pancreatitis were respectively improved by conservative treatment.(2) Risk factors analysis of surgery-related complications:theresult of univariate analysis showed that sCDAI and emergency operation were the factors infecting surgery-relatedcomplications of ileocolic CD (x2 =6.299,8.494,P ＜ 0.05).The result of multivariate analysis showed that sCDAI was an independent factor infecting surgery-related complications of ileocolic CD [OR =2.716,95％ confidence interval (CI):1.216-6.066,P ＜ 0.05].(3) Follow-up:all the 52 patients were followed up for 5-76 months with a median time of 39 months.During the follow-up,15 had recurrence of diseases and then underwent medical treatment.Conclusions Patients with ileocolic CD are easily complicated with wound infection and abdominal infection in the active period,and sCDAI is an independent factor infecting surgery-related complications of ileocolic CD.

Risk Factors for Surgical Procedure on Ileo-Colic Intussusception in Children / 소아외과

PURPOSE: The aim of this study was to analyze of the risk factors for surgical procedure on ileo-colic intussusception without leading point in children. METHODS: We retrospectively reviewed medical records of patient treated for ileo-colic intussusception between January 2003 and December 2014. We exclude the patients who had leading point. Because of the large difference on patient's numbers between non-operative group (cases of ileo-colic intussusceptions successfully reduced by air reduction) and operative group (cases underwent operation due to failed air reduction), we compared the data of operative group of patients without leading point between 2003 and 2014 with the data of non-operative group as control group from 2013 to 2014. Clinical features such as gender, age, body temperature, body weight in diagnosis, growth curves for age-gender-body weight, and laboratory data of blood test were compared. RESULTS: In non-operative group, total 94 patients who were treated successfully by the non-operative air reduction. In operative group, total 21 patients treated by surgical procedure. The age under 12 months, weight over upper 75 percentile group, increased segment neutrophil count, decreased hemoglobin level and lymphocyte count were significantly associated with a requirement for surgical procedure. CONCLUSION: We conclude that younger age, higher weight percentile group, increased segment neutrophil, decreased hemoglobin and lymphocyte are the independent risk factors related to operative treatment for ileo-colic intussusception in children. If primary air reduction is failed in patients with such risk factors, operative treatment over ultrasonography or secondary reduction can prevent unnecessary effort and complications, thus emphasizing the consideration of operative treatment when selecting treatment methods.

Morphological variations of Superior Mesenteric Artery: A cadaveric study.

Background: Anatomical knowledge of the variations of Superior mesenteric artery (SMA) and its branches is important to minimize the complications and hence this article will be helpful for the clinicians planning surgery and intervention around the aforementioned vessels. Materials and Methods: In the present study, we studied the pattern of arrangement and distribution of the SMA in twenty cadavers in the gross anatomy dissection room in the department of anatomy, AIIMS, New Delhi. Results and Discussion: On the basis of branching pattern of SMA, the cadavers were divided into three groups I, II, III. Group I consisted of the most usual pattern of arrangement of SMA, in 70% of cases (14 cadavers). In Group II i.e. in 25 % cases (5 cadavers) we observed a common trunk of ileocolic and right colic arteries. Group III consisted of the rarest variation in the branching pattern of SMA, where we got a common trunk of left colic artery with an accessory splenic artery arising from anterior aspect of SMA, instead of Inferior mesenteric artery (IMA) which was seen in 5% cases (1 cadaver).Main splenic artery took origin from coeliac trunk as usual. Conclusions: These uncommon and rare variations in the branching pattern of arteries of the gut are clinically very important for surgeons and radiologists to prevent damage to these vessels which otherwise may lead to severe haemorrhage and other complications. In the present article we discuss about the morphology and development of the SMA along with its variations.

Intususcepción ileocólica en adulto secundaria a enterocilitis por Salmonella enteriditis / Ileocolic intussusception in an adult secondary to Salmonella enteriditis

Introduction: Intussusception is defined as the invagination of a segment of the gastrointestinal tract into an adjacent portion. Adult intussusception is rare accounting for only 5 percent or less of all causes of intestinal obstruction; in 90 percent of these cases a leading point will be demostrable. Case report: A female patient, 35 years-old, was admitted into our institution complaining of 5 days of colicky abdominal pain associated to diarrhea without peritoneal sing. Abdominal ultrasonography showed the classic features of intussusceotion; target or doughnut sing and the pseudokidney sing. The study was completed with a computed abdominal tomography scan, confirming the sonographic findings. The surgical exploration revealed that the terminal ileum, cecum, appendix, and 10 cm of ascending colon were intussuscepted into the remaining colon. Abdominal inflammatory free-fluid was aspirated for culture. A right hemicolectomy with primary anastomosis was performed. The culture report finding of the abdominal liquid was Salmonella enteritidis. The histology reported an edematous thickened terminal ileum wall with Peyer´s patches infiltrated by polymorphonuclear cells. Discussion: The cause of intussusception in patients with infectious enterocolitis caused by Salmonella enteritidis could be related to stimulation of the intestinal mucosa causing inflamatory changes of the Peyer´s patches resulting in an edematous mass in the terminal ileum acting as a leading point for intussusception. Although rare, Salmonella infections should be considered among the precipiting causes of adult ileocolic intussusception.

Introducción: La intususcepción se define como la invaginación de un segmento intestinal dentro otro segmento adyacente. En adultos, la intususcepción es infrecuente dando cuenta del 5 por ciento o menos de todas las causas de obstrucción intestinal; en estos casos se podrá demostrar una causa en 90 por ciento de los pacientes. Reporte de caso: Paciente femenino de 35 años de edad, hospitalizada por un cuadro clínico de 5 días de evolución con dolor abdominal cólico, diarrea y ausencia de signos de irritación peritoneal. La ecografía abdominal mostró los signos clásicos de intususcepción; el "signo del blanco o del donut" y el "signo del pseudo-riñon". El estudio se completó con una tomografía abdominal, la cual confirmó los hallazgos de la ecografía. La exploración quirúrgica demostró que el íleon terminal, ciego, apéndice y 10 cm de colon ascendente. Se encontró líquido inflamatorio que se aspiró para cultivo. La cirugía consistió en una hemicolectomía derecha con anastomosis primaria. El resultado del cultivo fue positivo para Salmonella enteritidis. La histología demostró edema y engrosamiento de la pared del íleon terminal con infiltración polimorfonuclear de las placas de Peyer. Discusión: La causa de intususcepción en pacientes con enterocolitis infecciosa por Salmonella enteritidis está relacionada con la inflamación de la mucosa intestinal y de las placas de Peyer, lo que resulta en una masa edematosa en el íleon terminal que actúa como "punto tractor" para la intususcepción. Las infecciones por Salmonella deben considerarse entre las causas precipitantes de intususcepción en adultos.

CT findings of suspected anastomotic recurrence of Crohn's disease after ileocolic resection / 中华临床营养杂志

@#Objective To determine the utility of computed tomographic (CT) enteroclysis for characterization of the status of the anastomotic site in patients with Crohn's disease (CD) who have previously undergone ileocolic resection. Methods Totally 31 CD patients who had previously undergone ileocolic resection were enrolled in the study. After having been orally administered with isosmotic mannitol, the patients received CT scanning including plain scan, arterial phase scan, and portal venous phase scan. The abnormal CT findings were analyzed based on portal venous phase images. CT enteroclysis findings in 31 patients were evaluated by two radiologists in consensus. Endoscopic findings, histopathologic findings, and/or the Crohn's disease activity index (CDAI) were used as the reference criteria. Associations between CT enteroclysis findings and anastomotic site status were assessed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT enteroclysis for the diagnosis of normal anastomosis versus anastomotic recurrence were estimated. Results Twenty-six cases and 5 cases were diagnosed as disease recurrence and normal anastomosis, respectively. In the disease recurrence group, 11 patients (42%) had lymphadenopathy (diameter＞ 1 cm) and 8 patients (31%) had peri-anastomotic fistulas, which were absent in normal anastomosis group, but the difference was not significant Anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding were found in 16 (62%), 19 (73%), 14 (54%), and 20 (77%) cases, respectively, in disease recurrence group, which were absent in normal anastomosis group ( all P ＜ 0.05 ). When the diagnosis of anastomotic recurrence was based on more than two of the following six variables, including lymphadenopathy, peri-anastomotic fistulas, anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding, its sensitivity, specificity, postive predictive value, negative predictive value, and accuracy yielded 88%, 100%, 100%, 63%, and 90%, respectively. The diagnostic accuracy of anostomotic stenosis with CT was only 53%. Conclusion CT enteroclysis yields objective and relatively specific morphologic criteria that help differentiate between recurrent disease and normal at the anastomotic site after ileocolic resection for CD.

Invaginación ileocecal como forma de presentación de linfoma no Hodgkin en un paciente con SIDA / Ileocolic intussusception due to a large B cell lymphoma in a patient with AIDS

La invaginación intestinal es poco frecuente en el adulto. Aquí se describe el caso de un paciente adulto con SIDA que desarrolló una invaginación ileocólica secundaria a un linfoma de células B localizado en el ciego. Los hallazgos quirúrgicos fueron: íleon libre de tumor, invaginado en el ciego infiltrado por la neoplasia. Se realizó la resección del hemicolon derecho debido a la tumoración localizada en el ciego, causante de la invaginación. Se revisó la literatura inglesa y española sobre este tema.

Adult intussusception is rare. Here, we describe a case of an AIDS adult patient who developed an ileocolic intussusception secondary to a large B cell lymphoma of the cecum. Surgical findings included the ileon free of the tumor and invaginated within the cecum with infiltrating neoplasm. Surgical treatment included the resection of the right hemicolon because of the tumor, located in the cecum, causing intussusception. The english and spanish literature is reviewed.

Two Cases of Benign and Malignant Lesion Caused Ileocolic Intussusception: Preoperative Colonoscopic Reduction was Attempted for These Patients / 대한소화기내시경학회지

In contrast to the idiopathic cause of intussusception in children, adult intussusception in most patients is associated with organic causes. The majority of these patients are brought to the operating room with the preoperative diagnosis of bowel obstruction, and the surgeon discovers an intussusception intraoperatively. But the increasing use of abdominal CT may improve the ability to diagnose intussusception. There is no universal agreement upon the correct treatment of adult intussusception, although most authors agree that surgical intervention is necessary. In the more recent reports, colonoscopic reduction of intussusception has been reported for selected patients. For patients in whom the involved ileum is extremely long, it is advisable to attempt an operative reduction or colonoscopic reduction selectively. Thus, we report here on two patients with benign and malignant lesion, respectively, that caused ileocolic intussusception; preoperative colonoscopic diagnosis and reduction were attempted for these patients, although the patients were not reduced by colonoscopic procedure.

A Case of Crohn's Disease with Giant Pseudopolyposis and Ileocolic Fistula / 대한소화기내시경학회지

Pseudopolyp is a common association of ulcerative colitis but may also occur in Crohn's disease, ischemic colitis and infective colitis. Pseudopolyps are results of the repair process, representing islands of granulation tissue surrounded by mucosa with ulceation. When a pseudopolyp is larger than 1.5 cm, it is often called a "giant pseudopolyp". Such lesions of inflammatory origin are often confused with polypoid carcinoma or infiltrating submucosal malignancy. We report a case of asymptomatic Crohn's disease as giant pseudopolyposis mimicking malignancy on sigmoid colon, with a review of relevant literatures.

The Ileocolic Neobladder: 5-Year Experience in 49 Male Bladder Cancer Patients / 대한비뇨기과학회지

Since 1991 the orthotopic ileocolic neobladder after radical cystoprostatectomy for bladder cancer has been performed at our hospital. We report our 5 year experience of ileocolic neobladder with focus on complications, urodynamic data and continence status. Between May 1991 and April 1996, a total of 49 men underwent bladder replacement with an orthotopic ileocolic neobladder following radical cystectomy for management of invasive bladder cancer. Mean age of the patient .was 53.2 years (range 34-68) Mean follow up was 42 months (range 4-63). There was one perioperative death due to sepsis who had been suffered from diabetes mellitus. Early complications were developed in 8 patients (16.7%); neobladder leak in 1 (2.1%), wound infection in 2 (4.2%), wound dehiscence in 2 (4.2%), prolonged ileus in 1 (2.1%), and pneumonia in 1 (2.1%). Neobladder-related late complications requiring rehospitalization were noted in 7 patients (14.6%); cecourethral anastomosis site stricture in 1 (2.1%) which was treated endoscopically, ureteral strictures at the reimplantation site in 5 (7 renal unites, 10.4%) which were successfully treated with balloon dilation in 4 patients and with open revision in 1 patient, and neobladder perforation in 1 (2.1%) which was managed conservatively without sequelae. Urethral recurrence was noted in 1 patient and has been managed with M-VAC chemotherapy. There was no. vesicoureteral reflux in any patient. Urodynamic study of the neobladder at 6 months showed a low pressure (mean 24.2 cm H2O), large capacity (mean 553 ml) and an adequate maximal urethral closure pressure (mean 51.3 cmH2O). The peak flow rate in all patients was good (mean 11.3m/sec). All patients were dry during daytime but mild stress urinary incontinence was noted in 5 patients (10.4%) and nighttime continence was good in 91.7% at 6 months. Our results indicate that orthotopic ileocolic neobladder provides good functional results and would be one of the ideal urinary diversion for bladder substitution after radical cystoprostatectomy and will continue to be our procedure of choice in selected male bladder cancer patients.

Antirefluxing Augmentation Cystoplasty with Ileocolic Pouch in Single Kidney with Refluxing Contracted Bladder / 대한비뇨기과학회지

The contracted bladder has a high intravesical pressure, noncompliant, small-capacity bladder. The goal of augmentation cystoplasty is the preserving of renal function at low pressure during storage, and effective voiding without residual urine. Even though, there is some controversy, the vesicoureteral reflux with contracted bladder influence on renal function. Herein, we report a case of contracted bladder with unilateral functioning kidney and vesicoureteral reflux, which was treated with augmentation cystoplasty with ileocolic pouch (Le bag).

Urodynamic Analysis of the Ileocolic Neobladder / 대한비뇨기과학회지

From May 1991 to December 1993, 30 male bladder cancer patients with 34 to 68 years old age (mean age 52.4 years) underwent bladder replacement with the ileocolic neobladder. A divided segment of ileum and colon was used to create a neobladder after radical cystectomy with a cecourethral anastomosis to provide volitional voiding with continence. Urodynamic studies were followed up 3, 6, l2 and 18 months postoperatively. The mean maximal reservoir capacity was 420+/-87.7, 553+/-65.3, 565+/-60.3, 563+/-53.5ml, mean maximal reservoir pressure was 33.2+/-7.5, 24.2+/-6.1, 24.0+/-5.9, 23.1+/-6.3cmH2O, mean maximal urethral closure pressure was 57.9+/-9.5, 61.3+/-7.6, 61.0+/-7.3, 61.5+/-6.9cmH2O, maximal flow rate was 23.2+/-7.2, 24.3+/-5.8, 24.0+/-6.1, 24.1+/-5.4ml/s and residual urine was 40.0+/-10.3, 35.0+/-7.8, 24.0+/-6.1, 24.1+/-5.4ml/s. The daytime continence rate was 100% and the nighttime continence rate was 93% at 6 months postoperatively. With its very good functional results and its ease of performance, ileocolic neobladder may be one of the ideal urinary diversion for bladder substitution after radical cystectomy.

Urinary diversion in conjunction with radical cystectomy in bladder cancer patient / 대한비뇨기과학회지

Several different methods of urinary diversion currently are available in conjunction with radical cystectomy. We reviewed our last 30 months of experience with diversion in 56 patients with bladder cancer undergoing surgery from May, 1990 through October. 1992 and focused on the decision- making process used to select the type of diversion. The results obtained were as follows. 1. Of the 56 patients. 27 patients had a diversion with an external appliance (26 via an ileal conduit and 1 via a cutaneous ureterostomy), 15 patients had a diversion with a continent urinary reservoir(Indiana pouch) and 14 patients had a diversion with an internal reservoir anastomosed to the urethra( 13 via an ileocolic neobladder and 1 via a Camey procedure). 2. The ileal conduit was evenly performed during the period. But the Indiana pouch was more performed between May 1990 and April 1991 and the ileocolic neobladder was mainly per formed since May 1991. 3. There were 50 men and 6 women. The majority of female patients (83%) underwent the Indiana pouch. The ileocolic neobladder was performed in patients who were relatively young and in good medical condition. 4. Urodynamic studies of the Indiana pouch and ileocolic neobladder performed at 6 months postoperatively showed low pressure, large capacity reservoir and high outlet (plicated ileum or urethra) resistance. All patients achieved satisfactory continence during the day. However.1 or 13 patients who underwent the ileocolic neobladder was incontinent at night. In conclusion. there are inherent advantages and disadvantages to each form of urinary diversion. Our general policy is the ileal conduit remains the most wise diversion in most patients but the alternative methods may be reasonable in certain circumstances and patients selection will be important to identify the most appropriate method of diversion for individual. Though the follow-up period is not long enough. Indiana pouch and ileocolic neobladder met the demands for ideal form of urinary diversion. With improvement in the technical aspects or the continent and internal functional reservoir, the number of patients having these reservoirs will increase.