A Rare Complication of Gastrointestinal Bleeding: Jejunal Diverticulosis. A Case Report

Introduction: Small intestine diverticula are a rare condition with an incidence of 0.6% to 2%. Their location at the level of the jejunum is a rare alteration, and their diagnosis is often delayed due to low clinical suspicion. The clinical manifestation of this pathology is related to the development of complications -15% to 30% of patients, with approximately 10% requiring surgical intervention. Clinical case: We present a case of a middle-aged adult patient who experienced a complication due to a bleeding jejunal diverticulum. The patient underwent surgical management, which resulted in a satisfactory outcome. Objective: This article aims to describe jejunal diverticulosis, a rare condition that can have a significant impact on affected individuals. Emphasizing its clinical suspicion as a differential diagnosis for gastrointestinal bleeding is crucial. Additionally, we discuss diagnostic methods and highlight various therapeutic options, including surgical management.

Introducción: los divertículos del intestino delgado presentan una incidencia del 0,6% al 2%, su localización a nivel del yeyuno es una alteración poco frecuente y, dada su baja sospecha clínica, se retrasa el diagnóstico oportuno. La manifestación clínica de esta patología se encuentra relacionada con el desarrollo de complicaciones, las cuales ocurren entre el 15% y el 30% de los pacientes, y el 10% de estos pacientes requiere manejo quirúrgico. Caso clínico: un paciente adulto medio cursó con una complicación secundaria a la presencia de un divertículo del yeyuno sangrante, al cual se le dio un manejo quirúrgico con un resultado satisfactorio. Objetivo: este artículo tiene como objetivo describir la diverticulosis yeyunal que, aunque poco frecuente, puede generar un compromiso importante en quien la padece, lo que prioriza su sospecha clínica como diagnóstico diferencial causante de hemorragia gastrointestinal, así como dilucidar métodos diagnósticos y estar al tanto de las diferentes opciones terapéuticas que existen, incluido el manejo quirúrgico.

Massive Gastrointestinal Bleeding Caused by Multiple Small Intestinal Diverticula: A Case Study

We report the case of a 71-year-old woman with multiple comorbidities who was admitted to the hospital due to hematochezia, without hemodynamic instability. Initial investigations, including colonoscopy and upper endoscopy, did not reveal the cause of bleeding. However, the patient experienced increased bleeding, anemia, and hemodynamic instability during her hospital stay. Subsequent selective angiography did not show any signs of active bleeding. In light of the persistent shock, surgical intervention was performed, which revealed blood originating from multiple diverticula in the jejunum.

Se presenta el caso de una mujer de 71 años con múltiples comorbilidades que ingresó por hematoquecia sin inestabilidad hemodinámica. Se inició el estudio con una colonoscopia sin evidenciar la causa; durante la estancia hospitalaria presentó un aumento del sangrado, anemización e inestabilidad hemodinámica, por lo que se realizó una endoscopia digestiva alta sin hallazgos; posteriormente, se realizó una angiografía selectiva sin evidencia de sangrado activo. Ante el choque persistente se llevó a cirugía en la que se evidenció sangre proveniente del intestino delgado secundaria a la presencia de divertículos múltiples en el yeyuno.

Clinical application of water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients / 中国实用护理杂志

Objective:To evaluate the clinical application of water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients.Methods:This study was a randomized controlled trial. Eighty patients who needed indwelling nasobenteric tube were selected from June 2021 to April 2022 in the Department of Critical Care Medicine, Xiangya Hospital, Central South University. They were divided into control group ( n=40) and experimental group ( n=40) by systemic randomization. For the patients in the experimental group, the intubation was performed by water-filling with "four-eyes" sign under the guidance of ultrasound. For the control group, the traditional method was applicated under the guidance of ultrasound. Using abdominal X-ray as the gold standard of successful pylorus posterior catheterization, the result of catheterization, time of operation, efficiency of positioning in the two groups were analyzed and compared. Results:In the experimental group, 38 cases were successfully intubated, 2 were failed; in the control group, 27 cases were successfully intubated, 13 were failed, and all the failed cases in the control group were then successfully intubated again by using method of the experimental group. The success rate of tube placement in the experimental group was 95.0% (38/40), which was higher than 67.5% (27/40) in the control group ( χ2 = 9.93, P<0.05). The average time of operation in the experimental group was (45.2 ± 14.2) min, which was significantly lower than (70.2 ± 17.7) min in the control group, the difference was significantly different ( t=-5.51, P<0.05). The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic rate of nasal-jejunum intubation positioning in the experimental group were 100.0% respectively, higher than 38.4%, 77.7%, 72.4%, 45.4%, 65.0% in the control group; the false positive rate, false negative rate in the experimental group were both 0, lower than 22.2%, 61.5% in the control group, with statistically significant differences( χ2 values were 4.69- 16.97, all P<0.05). Conclusions:Water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation was a new method which can shorten the operation time and increase the success rate for intubation. It has relatively high positioning accuracy and possess valuable clinical application.

Síndrome de cascanueces acompañando un caso de síndrome de Wilkie: a propósito de un caso / Nutcracker Syndrome Combined with Wilkie Syndrome: Case Report

Resumen Objetivo: describir la presentación clínica, el diagnóstico y el tratamiento quirúrgico de un paciente con síndrome de la arteria mesentérica superior o síndrome de Wilkie combinado con síndrome de cascanueces o síndrome de compresión de la vena renal izquierda, en un centro de alta complejidad de un país latinoamericano. Descripción del caso: paciente masculino de 25 años, procedente de Estados Unidos, quien consultó por un año de pérdida de peso y episodios de obstrucción intestinal de etiología desconocida tras múltiples estudios de imagen. Se le realizaron estudios endoscópicos sin hallazgos; en la sala de recuperación desarrolló dolor abdominal que requirió ingreso al servicio de urgencias. La enterotomografía mostró dilatación de asas de colon e intestino delgado, con disminución del ángulo aortomesentérico y la serie gastrointestinal con paso filiforme del medio de contraste. Se intentó el manejo conservador como terapia inicial, con intolerancia al soporte nutricional entérico. Finalmente, se optó por el tratamiento quirúrgico, con un proceso de recuperación tórpido inicialmente, pero al final con resolución de los síntomas y aumento de peso. Conclusión: el síndrome de Wilkie es una enfermedad rara y un desafío diagnóstico en pacientes con pérdida de peso y dolor abdominal. Describimos un caso de compresión de la arteria mesentérica superior en el que se logró el diagnóstico con múltiples estrategias diagnósticas y resolución completa luego del tratamiento quirúrgico. La disminución del ángulo aortomesentérico puede comprimir la arteria mesentérica superior, así como la vena renal izquierda, que en ese caso resultó en un síndrome combinado de Wilkie y de cascanueces.

Abstract Objective: to describe the clinical presentation, diagnosis, and surgical treatment of a patient with superior mesenteric artery syndrome or Wilkie syndrome combined with the nutcracker syndrome or left renal vein compression syndrome in a tertiary referral center in a Latin American country. Case description: a 25-year-old male patient from the United States who attended for a year of weight loss and intestinal obstruction episodes of unknown etiology after multiple imaging studies. Endoscopic studies were performed without findings. While in the recovery room, he developed abdominal pain requiring admission to the emergency service. The CT enterography showed dilation of the colon loops and small intestine with a decrease of the aortomesenteric (AOM) angle and the gastrointestinal series with the filiform passage of the contrast medium. Conservative management was attempted as initial therapy with intolerance to enteric nutritional support. Finally, we initially opted for surgical treatment, with a slow recovery process, but in the end, with a resolution of symptoms and weight gain. Conclusion: Wilkie syndrome is a rare disease and a diagnostic challenge in patients with weight loss and abdominal pain. We described a superior mesenteric artery compression case in which diagnosis was achieved with multiple diagnostic strategies and complete resolution after surgical treatment. The decreased aortomesenteric angle may compress the superior mesenteric artery and the left renal vein. In this case, it resulted in a combined Wilkie and nutcracker syndrome.

Risk factors of postoperative complications after hepaticojejunostomy for benign biliary diseases / 中华普通外科杂志

Objective:To explore the postoperative biliary leakage and severe complication rate and its related risk factors of hepaticojejunostomy (HJ) for biliary disease.Methods:The clinical data of patients undergoing HJ for benign biliary diseases at the First Affiliated Hospital of Anhui Medical University from Jan 2003 to Dec 2017 were retrospectively analyzed. Multi-factor analysis was used to find a risk factor for postoperative bile leakage and severe complications.Results:Two hundred and eighty-three patients received HJ. The median age was 39 years.The short-term complication rate after surgery was 19.1% ( n=54), and the biliary leakage rate was 11.7% ( n=33), and the severe complication rate was 15.2% ( n=43). By multi-factor analysis: preoperative sepsis[ OR=3.875, 95% CI (1.583, 9.485), P=0.003], liver cirrhosis [ OR=3.212, 95% CI (1.001, 10.307), P=0.050], intraoperative blood loss≥400 ml [ OR=6.054, 95% CI (1.231, 29.781), P=0.027],postoperative hospitalization ≥9 days [ OR=6.738, 95% CI (2.287, 19.855), P=0.001] are the independent risk factors for postoperative bile leakage. Main bile duct stone[ OR=2.764, 95% CI (1.174, 6.510), P=0.020], preoperative sepsis [ OR=4.310, 95% CI (1.666, 11.149), P=0.003], intraoperative bleeding ≥400 ml [ OR=5.944, 95% CI (1.231, 29.781), P=0.022] and postoperative hospitalization ≥ 9 days [ OR=11.422, 95% CI (1.317, 49.859), P=0.001] are the independent risk factors for serious complications. Conclusions:HJ should be conducted when the sepsis was under control and sufficient bile drainage.The patients' condition should be comprehensively and accurately assessed before operation. The indications for partial hepatectomy need to be strictly defined.

Estudo da permeabilidade de fármacos por meio do modelo de saco intestinal de ratos / Study of drug permeability through the rat gut sac model

Os parâmetros de permeabilidade e solubilidade são fundamentais à absorção oral de fármacos e a partir dessas características, foi criado o Sistema de Classificação Biofarmacêutica, através do qual os fármacos são divididos em quatro classes. Atualmente, para a determinação da solubilidade de um fármaco, existem diversos métodos padronizados por agências regulatórias, no entanto, para a determinação da permeabilidade, os ensaios são passíveis de diversas variações em sua execução, diminuindo a confiabilidade dos resultados obtidos e impossibilitando a comparação dos mesmos quando realizados com técnicas diferentes umas das outras. O objetivo do presente trabalho é avaliar as variáveis experimentais do modelo do saco intestinal que podem influenciar nos resultados de permeabilidade aparente de fármacos e na viabilidade do tecido. O presente estudo foi aprovado pelo Comitê de Ética no Uso de Animais da FCF-USP (109.2018-P574). Foram utilizados 33 Rattus norvegicus da linhagem Wistar, machos, jovens adultos, com peso entre 200 g e 300 g. Para realização do procedimento, cada animal permaneceu em jejum por cerca de quatro horas e após adequada anestesia a porção do jejuno do intestino delgado foi retirada e dividida em seis segmentos de aproximadamente 8,5cm cada. Foram realizados experimentos com e sem inversão do saco intestinal, submetidos a diferentes tempos de banho de gelo após sua ressecção, na presença ou ausência de inibidor da glicoproteína-P (verapamil). Os fármacos naproxeno e famotidina foram empregados como marcadores de alta e baixa permeabilidade, respectivamente. A losartana foi utilizada como substrato da glicoproteína P. Cada um dos sacos intestinais foi colocado em um tubo de ensaio contendo tampão Krebs, a 37°C, saturado com gás carbogênio. Para avaliação da integridade e viabilidade dos segmentos intestinais, observou-se a presença de movimentos peristálticos e coletaram-se amostras do meio de incubação nos tempos 0, 30, 45, 60, 90 e 120 minutos para quantificação dos fármacos e de glicose, uma vez que esta é ativamente transportada para a serosa do intestino delgado. Determinou-se a permeabilidade aparente de cada fármaco e as concentrações de glicose nas diferentes condições experimentais, realizou-se planejamento fatorial multinível e os resultados foram analisados por análise variância (ANOVA), seguida de pós-teste de Tukey. Observou-se que as variáveis experimentais interferiram de forma significativa na viabilidade tecidual e na permeabilidade aparente dos fármacos. Não foram observadas diferenças significativas da permeabilidade de fármacos nos diferentes segmentos do jejuno. A glicose mostrou-se um bom marcador de viabilidade tecidual e foi constatado que a presença ou ausência de movimentos peristálticos não está relacionada diretamente com a viabilidade do tecido. Uma vez que foram constatadas tantas interferências nos resultados, é imprescindível que os procedimentos experimentais sejam padronizados, para que os resultados apresentem menor variabilidade e possam ser comparados entre si

The permeability and solubility parameters are fundamental to the oral absorption of drugs and from these characteristics, the Biopharmaceutical Classification System was created, through which drugs are divided into four classes. Currently, for the determination of the solubility of a drug, there are several methods standardized by regulatory agencies, however, for the determination of permeability, the tests are subject to several variations in their execution, reducing the reliability of the results obtained and making it impossible to compare the results obtained. same when performed with different techniques. The aim of this study is to evaluate if different experimental conditions can influence the results of apparent drug permeability and tissue viability on gut sac model. The present study was approved by the Ethics Committee for the Use of Animals of FCF-USP (109.2018-P574). Thirty-three male, young adult Rattus norvegicus were used, weighing between 200 g and 300 g. To perform the procedure, each animal fasted for about four hours and after adequate anesthesia, the portion of the jejunum of the small intestine was removed and divided into six segments of approximately 8.5 cm each. Experiments were performed with and without inversion of the gut sac, submitted to different times of ice bath after its resection, in the presence or absence of a P-glycoprotein inhibitor (verapamil). The drugs naproxen and famotidine were used as markers of high and low permeability, respectively. Losartan was used as a substrate for P-glycoprotein. Each of the gut sacs was placed in a test tube containing Krebs buffer, at 37°C, saturated with carbogen gas. To evaluate the integrity and viability of the intestinal segments, the presence of peristaltic movements was observed and samples of the incubation medium were collected at 0, 30, 45, 60, 90 and 120 minutes for quantification of drugs and glucose, as it is actively transported to the serosa of the small intestine. The apparent permeability of each drug and the glucose concentrations were determined under different experimental conditions, multilevel factorial design was performed and the results were analyzed by analysis of variance (ANOVA), followed by Tukey's post-test. It was observed that the experimental variables significantly interfered in the tissue viability and in the apparent permeability of the drugs. No significant differences in drug permeability were observed in the different segments of the jejunum. Glucose proved to be a good marker of tissue viability and it was found that the presence or absence of peristaltic movements is not directly related to tissue viability. Since so many interferences were found in the results, it is essential that the experimental procedures be standardized, so that the results show less variability and can be compared between different authors

Características clínico-patológicas y manejo de tumores primarios de intestino delgado de localización yeyuno-ileal / Clinical-pathological characteristics and management of primary tumors of the small intestine of jejuno-ileal location

RESUMEN Introducción : Los tumores primarios del intestino delgado (TPID) representan aproximadamente el 5% de todas las neoplasias gastrointestinales primarias; estas últimas incluyen lesiones benignas y malignas, con diferentes subtipos histológicos. Objetivo : Describir las características clínico-patológicas y el manejo de tumores de localización yeyuno-ileal. Materiales y métodos : Se realizó un estudio descriptivo, retrospectivo, en un único centro. Resultados : Se incluyó 45 pacientes, la edad promedio al diagnóstico fue de 54,2 ± 8,2 años. 27 eran de sexo masculino (60%). En el algoritmo diagnóstico se utilizó la tomografía computarizada en todos los pacientes, la enteroscopia de doble balón en 41 (91,1%) y video cápsula endoscópica en 32 (71,1%). Se realizaron procedimientos endoscópicos como: biopsias, tatuajes, resección y dilatación en 40 (88,9%), 39 (86,7%), 4 (8,9%) y 1(2,2%) paciente respectivamente. La localización más frecuente fue yeyuno en 39 (86%). Se confirmó GIST en 18 (40%), seguido de linfoma en 16 (35,6%) y adenocarcinoma en 5 (11%) casos. Todos los tumores GIST, adenocarcinoma y neuroendocrinos se sometieron a tratamiento quirúrgico y quimioterapia; el tratamiento de los linfomas consistió en tratamiento combinado principalmente; tres harmartomas y un fibroangiolipoma fueron resecados endoscópicamente. Conclusiones : Los tumores de intestino delgado yeyuno-ileal más frecuentes fueron los GIST, seguidos de linfomas y adenocarcinomas. La enteroscopia de doble balón fue la principal herramienta diagnóstica y terapéutica.

ABSTRACT Introduction : Primary tumors of the small intestine (PTID) represent approximately 5% of all primary gastrointestinal neoplasms; the latter include benign and malignant lesions, with different histological subtypes. Objective : To describe the clinical-pathological characteristics and the management of tumors located in the jejunum-ileum. Materials and methods : A descriptive, retrospective study was carried out in a single center. Results : 45 patients were included, the average age at diagnosis was 54.2 ± 8.2 years. 27 were male (60%). In the diagnostic algorithm, computed tomography was used in all patients, double-balloon enteroscopy in 41 (91.1%) and video capsule endoscopy in 32 (71.1%). Endoscopic procedures such as: biopsies, tattoos, resection and dilation were performed in 40 (88.9%), 39 (86.7%), 4 (8.9%) and 1 (2.2%) patients, respectively. The most frequent location was the jejunum in 39 (86%). GIST was confirmed in 18 (40%), followed by lymphoma in 16 (35.6%) and adenocarcinoma in 5 (11%) cases. All GIST, adenocarcinoma, and neuroendocrine tumors underwent surgical treatment and chemotherapy; treatment of lymphomas consisted mainly of combined treatment; three harmartomas and one fibroangiolipoma were resected endoscopically. Conclusions : The most frequent jejunoileal small intestine tumors were GISTs, followed by lymphomas and adenocarcinomas. Double-balloon enteroscopy was the main diagnostic and therapeutic tool.

Adenocarcinoma de yeyuno proximal: a propósito de un caso / Proximal jejunal adenocarcinoma, a case report

Resumen El adenocarcinoma de yeyuno es el tumor primario del intestino delgado más infrecuente y raro, y representa el 3 % de todos los cánceres gastrointestinales, con una incidencia anual estimada de 0,3 a 2 casos por cada 100 000 personas. En Estados Unidos y España representa el 0,4 % de los cánceres gastrointestinales y el 0,2 % de las muertes asociadas a malignidad, con síntomas inespecíficos como anemia de etiología inexplicable, dolor abdominal y pérdida de peso; la mayoría de ellos son diagnosticados en etapas avanzadas de la enfermedad. A continuación, se presenta el caso de una paciente femenina de 46 años con síntomas inespecíficos, pérdida de peso, dolor abdominal y vómito, cuya tomografía abdominal computarizada evidenció el sitio y extensión de la lesión neoplásica, mientras que la cápsula endoscopia y enteroscopia mostró una lesión neoplásica en el yeyuno proximal. La histopatología reportó un adenocarcinoma de yeyuno moderadamente diferenciado que presentó resultados favorables gracias a la resección quirúrgica curativa, lo cual mejoró el pronóstico de vida a 5 años y tuvo un seguimiento favorable hasta la actualidad.

Abstract Jejunal adenocarcinoma is the rarest primary small bowel tumor and represents 3% of all gastrointestinal cancers, with an estimated annual incidence of 0.3 to 2 cases per 100 000 people. This disease accounts for 0.4% of gastrointestinal cancers and 0.2% of deaths associated with malignancy in the United States and Spain, with nonspecific symptoms, such as anemia of unexplained etiology, abdominal pain, and weight loss; most cases are diagnosed in advanced stages of the disease. The following is the case of a 46-year-old female with non-specific symptoms, weight loss, abdominal pain and vomiting. A computerized tomography scan of the abdomen allowed determining the site and extension of the tumor, while a capsule endoscopy and an enteroscopy showed a neoplastic lesion in the proximal jejunum. A histopathology analysis reported moderately differentiated adenocarcinoma of jejunum with favorable results after a curative surgical resection that improved the prognosis of life at 5 years and with favorable follow-up until to date.

Valor de la tomografía abdominal para el diagnóstico del fibroleiosarcoma yeyunal / Abdominal tomography importance on the Leiomyosarcoma of jejunum diagnosis

RESUMEN Se presentó el caso de un paciente de 49 años de edad, que acudió a la consulta de Medicina Interna del Hospital General Docente "Dr. Agostinho Neto" por perder unas 20 libras de peso en dos meses y presentar heces fecales con aspecto aparente a "borra de café". El examen físico reveló desnutrición ligera y mucosas hipocoloreas. El ultrasonido abdominal mostró en hipocondrio y flanco izquierdo una imagen hipoecogénica heterogénea polilobulada que midió 68x61 mm con aspecto de paquete adenomegálico. En la tomografía computarizada de abdomen se identificó una imagen con densidad entre 33 y 57 UH, de 100 x 80 mm, polilobulada en topografía del yeyuno, que con el estudio contrastado realzó hasta 67 UH con aspecto tumoral. Se realizó resección quirúrgica del tumor con anastomosis termino-terminal. La biopsia informó fibroleiomiosarcoma. Se concluye que el estudio de las imágenes resulta útil para el diagnóstico de esta enfermedad.

ABSTRACT A 49-year-old patient presented to the internal medicine consultation office at the "Dr. Agostinho Neto" General teaching Hospital because of weight loss (20 pounds) and black stools in a period of 2 months before the evaluation. The physical examination revealed mild malnutrition and hypochlorous mucous membranes. The abdominal ultrasound image in the left hypochondrium showed a heterogeneous - polylobate - hypoechogenic mass measuring 68 x 61 mm with appearance of an adenomelagia. Computed tomography (CT) scan of the abdomen revealed an image with a density of 33 and 57 Hounsfield units (HU), measured 100 mm by 80 mm, polylobulated in jejunum topography, which with the contrasted study enhanced up to 67 UH with a tumor appearance. Surgical resection of the tumor with termino-terminal anastomosis was performed. Tumor biopsy diagnosed leiomyosarcoma. It was concluded that the study of the images was useful for the diagnosis of this disease.

A Retrospective Study of Intestinal Obstruction and Anastomotic Leak in Emergency and Sepsis Cases.

Intestinal obstruction is one of the most common intra-abdominal problems dealt by general surgeons. The morbidity and mortality are much higher than many diseases. If diagnosed & treated early, the recovery time, morbidity & mortality are much less. Hence the need for the study. METHODSWe have analysed 216 cases of intestinal obstruction done by a single surgeon in one hospital in the last three decades. Differences in the selection, surgical skill, capability, & post-operative care management are excluded by including a single surgeon’s (1st Author) operated cases. Only operated cases are included in the study. Conservatively managed patients are not included in this study. RESULTSFemales are more affected 56%, than 44% males. If Pelvic pathology cases are excluded – both sexes are equally affected. Small intestine was affected in 88 % of patients. Anastomotic leak occurred in 8 patients (3.7%). Burst abdomen occurred in 4 patients - 1.85%. Re-exploration was done in 13 patients (6.0%). LAMA & death together accounted for 6 cases (2.8%). Success rate of all operations was 97.2%. CONCLUSIONSFemale sex is more commonly effected. Adhesion & bands are major causes of small bowel obstruction. Anastomotic leak is common in strangulated bowels with associated with septic shock. PGA (Vicryl) & PDS are better than catgut in decreasing the leak rate. Mortality rate is more in anastomotic leak patients.

Roux-en-Y hilar-jejunum anastomosis for biliary tract reconstruction after radical resection of hilar cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the effect of Roux-en-Y hilar-jejunum anastomosis in surgical resection of hilar cholangiocarcinoma.Methods The clinical data of 31 patients with hilar cholangiocarcinoma admitted from Feb 2009 to Feb 2017 who underwent Roux-en-Y hilar-jejunum anastomosis after resection were retrospectively analyzed.Results According to Bismuth-Corlette classification there were 6 cases of Ⅲ a,6 cases of Ⅲ b and 19 cases of type Ⅳ.These patients all successfully underwent Roux-en-Y hilar-jejunum anastomosis,with intraoperative blood loss of 50-4 000 ml [on average of (1 146 ± 1 082) ml].The average operation time was (346 ± 118) min,and the average hilar-jejunum anastomosis time was (35 ± 13) min.The average postoperative hospital stay was (20 ± 11)days.There were 25 cases of R0 resection (80.6％).The postoperative complication rate was 25.8％(8/31).The overall median survival time was 21 months,and the 1-,3-,and 5-year survival rates were 68.8％,14.6％ and 3.6％,respectively.During the follow-up period,7 cases of reflux cholangitis,5 cases of biliary anastomotic stenosis,and 1 case of adhesive intestinal obstruction were found.Conclusion The hilar-jejunum anastomosis is simple,safe,widely applicable prcedure,which is easy to perform.

Mulberry extract as an ecofriendly anticoccidial agent: in vitro and in vivo application / Extrato de amoreira como agente anticoccidiano ecologicamente correto: aplicação in vitro e in vivo

Abstract Natural products are ecofriendly agents that can be used against parasitic diseases. Eimeria species cause eimeriosis in many birds and mammals and resistance to available medications used in the treatment of eimeriosis is emerging. We investigated the in vitro and in vivo activity of Morus nigra leaf extracts (MNLE) against sporulation of oocysts and infection of mice with Eimeria papillata. Phytochemical analysis of MNLE showed the presence of seven compounds and the in vitro effects of MNLE, amprolium, DettolTM, formalin, ethanol, and phenol were studied after incubation with oocysts before sporulation. Furthermore, infection of mice with E. papillata induced an oocyst output of approximately 12 × 105 oocysts/g of feces. MNLE significantly decreased oocyst output to approximately 86% and the total number of parasitic stages in the jejunum by approximately 87%. In addition, the reduction in the number of goblet cells in the jejuna of mice was increased after treatment. These findings suggest that mulberry exhibited powerful anticoccidial activity.

Resumo Os produtos naturais são agentes ecologicamente corretos que podem ser usados ​​contra doenças parasitárias. As espécies de Eimeria causam eimeriose em muitas aves e mamíferos e a resistência aos medicamentos disponíveis usados ​​no tratamento da eimeriose está emergindo. Foram investigadas as atividades in vitro e in vivo dos extratos de folhas de Morus nigra (MNLE) contra esporulação de oocistos e infecção de camundongos com Eimeria papillata. A análise fitoquímica do MNLE mostrou a presença de sete compostos e os efeitos in vitro do MNLE, amprolium, DettolTM, formalina, etanol e fenol foram estudados após incubação com oocistos antes da esporulação. Além disso, a infecção de camundongos com E. papillata induziu uma produção de oocistos de aproximadamente 12 × 105 oocistos / g de fezes. O MNLE reduziu significativamente a produção de oocistos para aproximadamente 86%, e o número total de estágios parasitários no jejuno em aproximadamente 87%. Além disso, a redução no número de células caliciformes no jejuno de camundongos aumentou após o tratamento. Esses achados sugerem que a amoreira exibia uma poderosa atividade anticoccidiana.

Sericin as treatment of obesity: morphophysiological effects in obese mice fed with high-fat diet / Sericina como tratamento da obesidade: efeitos morfofisiológicos de camundongos obesos por dieta hiperlipídica

ABSTRACT Objective To investigate the effects of sericin extracted from silkworm Bombyx mori cocoon on morphophysiological parameters in mice with obesity induced by high-fat diet. Methods Male C57Bl6 mice aged 9 weeks were allocated to one of two groups - Control and Obese, and fed a standard or high-fat diet for 10 weeks, respectively. Mice were then further subdivided into four groups with seven mice each, as follows: Control, Control-Sericin, Obese, and Obese-Sericin. The standard or high fat diet was given for 4 more weeks; sericin (1,000mg/kg body weight) was given orally to mice in the Control-Sericin and Obese-Sericin Groups during this period. Weight gain, food intake, fecal weight, fecal lipid content, gut motility and glucose tolerance were monitored. At the end of experimental period, plasma was collected for biochemical analysis. Samples of white adipose tissue, liver and jejunum were collected and processed for light microscopy analysis; liver fragments were used for lipid content determination. Results Obese mice experienced significantly greater weight gain and fat accumulation and had higher total cholesterol and glucose levels compared to controls. Retroperitoneal and periepididymal adipocyte hypertrophy, development of hepatic steatosis, increased cholesterol and triglyceride levels and morphometric changes in the jejunal wall were observed. Conclusion Physiological changes induced by obesity were not fully reverted by sericin; however, sericin treatment restored jejunal morphometry and increased lipid excretion in feces in obese mice, suggesting potential anti-obesity effects.

RESUMO Objetivo Investigar os efeitos da sericina extraída de casulos de Bombyx mori na morfofisiologia de camundongos com obesidade induzida por dieta hiperlipídica. Métodos Camundongos machos C57Bl6, com 9 semanas de idade, foram distribuídos em Grupos Controle e Obeso, que receberam ração padrão para roedores ou dieta hiperlipídica por 10 semanas, respectivamente. Posteriormente, os animais foram redistribuídos em quatro grupos, com sete animais cada: Controle, Controle-Sericina, Obeso e Obeso-Sericina. Os animais permaneceram recebendo ração padrão ou hiperlipídica por 4 semanas, período no qual a sericina foi administrada oralmente na dose de 1.000mg/kg de massa corporal aos Grupos Controle-Sericina e Obeso-Sericina. Parâmetros fisiológicos, como ganho de peso, consumo alimentar, peso das fezes em análise de lipídios fecais, motilidade intestinal e tolerância à glicose foram monitorados. Ao término do experimento, o plasma foi coletado para dosagens bioquímicas e fragmentos de tecido adiposo branco; fígado e jejuno foram processados para análises histológicas, e amostras hepáticas foram usadas para determinação lipídica. Resultados Camundongos obesos apresentaram ganho de peso e acúmulo de gordura significativamente maior que os controles, aumento do colesterol total e glicemia. Houve hipertrofia dos adipócitos retroperitoneais e periepididimais, instalação de esteatose e aumento do colesterol e triglicerídeos hepáticos, bem como alteração morfométrica da parede jejunal. Conclusão O tratamento com sericina não reverteu todas as alterações fisiológicas promovidas pela obesidade, mas restaurou a morfometria jejunal e aumentou a quantidade de lipídios eliminados nas fezes dos camundongos obesos, apresentando-se como potencial tratamento para a obesidade.

Salvadora persica protects mouse intestine from eimeriosis / Salvadora persica protege o intestino do rato da eimeriose

Abstract Eimeriosis is a global poultry health problem. In the current study, we investigated the role of Salvadora persica leaf extracts (SE) against murine eimeriosis induced by Eimeria papillata. The infection induced an oocyst output of 6242 ± 731 oocysts/g feces. After treatment with 300 mg⁄kg SE, the oocysts expelled in feces decreased by approximately 3-fold. In addition, the total number of E. papillata in the parasitic stage decreased in the jejunum of mice after treatment with SE. In addition, SE significantly reduced the number of apoptotic cells by approximately 2-fold in the infected jejunum. SE ameliorated the changes in glutathione, malondialdehyde, and catalase due to E. papillata infection. Finally, SE regulated the cytokine genes, interleukin (IL)-1β, IL-6, interferon-γ, and tumor necrosis factor-α, and the apoptotic genes, B-cell lymphoma-2, Bax, and Caspase-3. SE protects the jejunum from E. papillata induced injury and may have potential therapeutic value as a food additive during eimeriosis.

Resumo A eimeriose é um problema global de saúde avícola. No presente estudo, investigou-se o papel dos extratos de folhas de Salvadora persica (SE) contra a eimeriose murina induzida por Eimeria papillata. A infecção induziu uma produção de oocistos de 6242 ± 731 oocistos/g de fezes. Após o tratamento com 300 mg⁄kg SE, os oocistos eliminados nas fezes diminuíram em aproximadamente 3 vezes. Além disso, o número total de E. papillata no estágio parasitário diminuiu nos jejunos de camundongos após o tratamento com SE. Da mesma forma, o SE reduziu significativamente o número de células apoptóticas em aproximadamente 2 vezes no jejuno infectado. O estudo mostrou que o SE melhorou as alterações na glutationa, malonaldeído e catalase devido à infecção por E. papillata. Finalmente, o SE regulou os genes das citocinas, interleucina (IL) -1β, IL-6, interferon-γ e fator de necrose tumoral α, e os genes apoptóticos, linfoma-2, Bax e Caspase-3. Assim, o SE protegeu os jejunos das lesões induzidas por E. papillata e pode ter potencial valor terapêutico como aditivo alimentar durante a eimeriose.

Repeated mild traumatic brain injury affects microbial diversity in rat jejunum

Traumatic brain injuries (TBI) manifest into post-traumatic stress disorders such as anxiety comorbid with gut ailments. Theperturbations in gut microbial communities are often linked to intestinal and neuropsychological disorders. We havepreviously reported anxiety and abnormalities in gut function in mild TBI (MTBI)-exposed rats. The current studydemonstrates the changes in gut microbiome of MTBI-exposed animals and discusses its implications in intestinal healthand behaviours. The rats were subjected to repeated MTBI (rMTBI) and microbial composition in jejunum was examinedafter 6 h, 48 h and 30 days of rMTBI. Significant reduction in bacterial diversity was observed in the rMTBI-exposedanimals at all the time points. Principal coordinate analysis based on weighted UniFrac distances indicated substantialdifferences in gut microbial diversity and abundances in rMTBI-exposed animals as compared to that in healthy controls.The abundance of Proteobacteria increased dramatically with reciprocal decrease in Firmicutes after rMTBI. At the genuslevel, Helicobacter, Lactobacillus, Campylobacter, and Streptococcus were found to be differentially abundant in thejejunum of rMTBI-exposed rats as compared to sham controls indicating profound dysbiosis from the healthy state.Furthermore, substantial depletion in butyrate-producing bacterial communities was observed in rMTBI-exposed animals.These results suggest that the traumatic stress alters the gut microbiome with possible implications in gut health andneuropsychopathology.

Perforación del yeyuno por enfermedad diverticular: una condición a considerar en ancianos / Perforation of the jejunum due to diverticular disease: A condition to consider in the elderly

Resumen La enfermedad diverticular constituye la principal afección intestinal después de los 40 años; tiene gran relevancia por sus amplias manifestaciones, que llevan a consultas frecuentes en todos los servicios de urgencias y corresponden al hallazgo más usual en los procedimientos endoscópicos electivos. Por su parte, la diverticulosis del intestino delgado tiene una prevalencia que oscila entre 2 % y 5 %. Las presentaciones clínicas como sangrado, obstrucción, dolor abdominal, perforación, formación de abscesos y fístulas suelen ser más floridas cuando afectan el colon. Se presenta el caso de un paciente anciano quien consultó a urgencias con abdomen agudo secundario a peritonitis generalizada por perforación intestinal debida a enfermedad diverticular del yeyuno.

Abstract Diverticular disease is the most common bowel disease after the age of 40 years. It is the most common finding in elective endoscopic procedures, and it has great relevance because of its broad manifestations which lead to frequent emergency service consultations. On the other hand, the prevalence of diverticulosis of the small intestine ranges from 2% to 5%. Clinical presentations such as bleeding, obstructions, abdominal pain, perforations, formation of abscesses and fistulas are usually more florid when they affect the colon. We present the case of an elderly emergency room patient with acute abdomen secondary to generalized peritonitis due to intestinal perforation caused by diverticular disease of the jejunum.

Divertículo único de yeyuno con obstrucción intestinal y abdomen agudo / Unique diverticulum of jejunum with intestinal obstruction and acute abdomen

Introducción. El hallazgo de divertículos en el intestino delgado es poco usual, y se presentan principalmente en el yeyuno y en el íleon. Tienen una incidencia relativamente baja, aproximadamente, de 0,06 a 5 % en autopsias y de 0,5 a 2,3 % como hallazgos radiológicos. Predominan en la sexta y la séptima década de la vida y en el sexo masculino. Presentación de caso. Se trata de una paciente de sexo femenino de 90 años, que ingresó al servicio de urgencias por un cuadro clínico de un día de dolor en el hemiabdomen derecho irradiado al hipogastrio y asociado con múltiples episodios de emesis. Se hospitalizó para estudios paraclínicos y, durante la observación, presentó deterioro clínico, por lo que fue sometida a una laparotomía exploratoria, y se encontró un divertículo único de yeyuno. Discusión. Los divertículos de intestino delgado son poco frecuentes, y comprometen solo la mucosa y submucosa. Del total de casos, del 0,9 a 1 % corresponden a divertículos del yeyuno. Estos pueden asociarse con divertículos en otra parte del tubo digestivo, como esófago (2,3 %), duodeno (30 %) o colon (61 %). El manejo de esta enfermedad depende de cada paciente

Small intestine diverticulum is a rare finding; it presents more often in the jejunum and ileum. The incidence in autopsies is low (0.06-5%), and 0.5-2.3% as a radiology finding. It is most often found in the 7th decade and in men. A 90-year-old female patient presented with a clinical picture of one day consisting of acute right abdominal pain that radiates to the hypogastrium accompanied by multiple episodes of vomiting. The patient is admitted and a battery of tests are ordered; during observation the patient quickly deteriorates and is taken to an emergency laparotomy, finding a single jejunal diverticulum. Small intestine diverticuli are rare surgical findings (0.9-1%) that involve only the mucosa and submucosa. The majority of small intestinal diverticuli are found in the jejunum. These can be associated with diverticuli in other areas of the GI tract: stomach (2.3%), duodenum (30%) and colon (61%). The management approach depends on each patient's clinical presentation

Primary Adenocarcinoma of Jejunum: A Case Report

Malignancy of small intestine is a very rare entity. Duodenum is the most common site for intestinal malignancy. The lesions present with stricture mostly. Small intestinal strictures distal to the duodenum are relatively inaccessible by endoscopy. This leads to difficulty in definitive preoperative diagnosis. The symptoms in case of jejunal malignancy are very nonspecific and a high index of suspicion is required for diagnosis.

Primary Adenocarcinoma of Jejunum: A Case Report

Malignancy of small intestine is a very rare entity. Duodenum is the most common site for intestinal malignancy. The lesions present with stricture mostly. Small intestinal strictures distal to the duodenum are relatively inaccessible by endoscopy. This leads to difficulty in definitive preoperative diagnosis. The symptoms in case of jejunal malignancy are very nonspecific and a high index of suspicion is required for diagnosis.

Effects of different volume syringe on recanalization of indwelling jejunal feeding tube in pediatric patients / 中华临床营养杂志

Objective To explore the nursing intervention effects of different volume syringe on flushing the jejunum nutrient tube for enteral nutrition pipeline obstruction among pediatric patients.Methods 62 pediatric patients with pipe plugging were selected and randomly divided into observation group and control group.Different volume syringes as 5 ml and 10 ml were used as punching tools respectively.The cases of recanalization,the rate of one time recanalization,the rate of unplanned extubation and the total time for nurse treatment of pipe plugging were compared between the two groups.Results There were no significant difference in the cases of recanalization,the rate of one time recanalization and unplanned extubation between the two groups (P＞0.05).The total time for nurse treatment of pipe plugging in the control group was higher than that in the observation group [(8.2±1.2) h vs.(7.2±0.9) h,P＜0.05].Conclusion 5 ml volume syringe as a tube washing tool after pipeline obstruction,can not only save labors but also save time,which can improve the work efficiency of nurses.