A Case of Intestinal Tuberculosis with Perianal Fistula Diagnosed after 30 Years / 대한소화기학회지

Tuberculosis can occur anywhere in the gastrointestinal tract. However, anorectal tuberculosis has rarely been reported. A 46-years-old male presented with abdominal pain and perianal discharge of 30 years' duration. The patient had received operations for anal fistula and inflammation three times. Although he had been taking mesalazine for the past three years after being diagnosed with Crohn's disease, his symptoms persisted. Colonoscopy performed at our hospital revealed cicatricial change of ileocecal valve and diffuse ulcer scar with mild luminal narrowing of the ascending, transverse, and descending colon without active lesions. Multiple large irregular active ulcers were observed in the distal sigmoid and proximal rectum. An anal fistula opening with much yellowish discharge and background ulcer scar was observed in the anal canal. However, cobble-stone appearance and pseudopolyposis were not present. Therefore, we clinically diagnosed him as having intestinal tuberculosis with anal fistula and prescribed antituberculosis medications. Follow-up colonoscopy performed 3 months later showed much improved multiple large irregular ulcers in the distal sigmoid colon and proximal rectum along with completely resolved anal fistula without evidence of pus discharge.

The small bowel flora in individuals with cecoileal reflux / Estudo da flora do delgado em doentes com refluxo cecoileal

BACKGROUND: The observation of cecoileal reflux to barium enema is not rare; however, its causes and consequences have not been widely investigated. Considering that ileocecal junction exerts a function as barrier to invasion of bacteria from colon to small bowel, it seems interesting to study the intestinal microflora in subjects carrying cecoileal reflux. AIMS: This study aims at evaluating the ileal flora in individuals with cecoileal reflux. METHODS: A group of 36 subjects comprising 30 females and 6 males with a mean age of 54 years was assessed. Twenty-five individuals with cecoileal reflux and 11 without cecoileal reflux were submitted to small intestine contamination evaluation through the breath test with lactulose-H2 and measurement of the orocecal transit time by means of alternate current biosusceptometry. Small intestine bacterial overgrowth was characterized by orocecal transit time-H2 shortening. RESULTS: Comparison of basal H2, orocecal transit time-H2 and orocecal transit time-alternate current biosusceptometry measurements did not statistically differ between the groups with and without cecoileal reflux. Orocecal transit time-H2 was significantly smaller than orocecal transit time-alternate current biosusceptometry, particularly in individuals with cecoileal reflux. A significant correlation between the two methods was observed only in relation to control, not existing in relation to cecoileal reflux group. CONCLUSIONS: Smaller orocecal transit time-H2 and the loss of correlation with orocecal transit time-alternate current biosusceptometry observed in the individuals with cecoileal reflux suggest a differentiated behavior for such group relative to control, which could be associated with small intestine bacterial overgrowth.

RACIONAL: Fato de observação não rara, é o encontro de refluxo cecoileal durante realização de enema opaco. As causas e conseqüências deste achado têm sido pouco estudadas. OBJETIVOS: Sabendo que a junção ileocecal exerce função de barreira e proteção contra a invasão do delgado pela flora colônica, realizou-se o presente estudo com a finalidade de investigar se existe contaminação ileal em indivíduos com refluxo cecoileal ao enema opaco. MÉTODOS: Investigaram-se 36 indivíduos, 30 mulheres e 6 homens, idade média de 54 anos, 25 com e 11 com ausência refluxo cecoileal. Todos submetidos a pesquisa de contaminação bacteriana do delgado por intermédio de teste respiratório com lactulose-H2 e a determinação do tempo de trânsito orocecal por meio de biossusceptometria de corrente alternada. A caracterização da contaminação do delgado foi baseada no encurtamento do tempo de trânsito orocecal medido pelo teste da lactulose-H2. RESULTADOS: A comparação dos valores basais do H2, do tempo de trânsito orocecal-H2 e tempo de trânsito orocecal-biossusceptometria de corrente alternada não diferiram estatisticamente entre os grupos com e sem refluxo cecoileal. Quando comparados os tempo de trânsito orocecal-H2 e tempo de trânsito orocecal-biossusceptometria, foi observado aumento de tendência de redução do primeiro em relação ao último nos grupos com refluxo cecoileal e correlação significante entre os dois métodos apenas no grupo-controle, inexistindo nos com refluxo cecoileal. CONCLUSÃO: Encurtamento do tempo de trânsito orocecal-H2 e sua perda de correlação com o tempo de trânsito orocecal-biossusceptometria observado em indivíduos com refluxo cecoileal, sugerem comportamento diferenciado deste grupo em relação ao grupo-controle. Possível explicação para as diferenças registradas entre os grupos, seria a presença de flora anômala nos indivíduos com refluxo cecoileal.

Vólvulo ileocecal. Presentación de un caso clínico / Ileocecal volvulus. Report of a clinical case

Vólvulo de ciego término no muy correcto desde el punto de vista anatómico. Halvosen y Se (1975) en su revisión de 30 casos señalan que están involucrados el ileón terminal y cólon ascendente, entonces el término más propiado seria el vólvulo ileocecal. El vólvulo por lo común ocurre en sentido horario; el giiigante varía de 90 grados hasta 3 giros completos, el vólvulo depende de movilidad anormal del ciego y cólon ascendente. Esto pude tomar la forma de una mala rotación completa, un mecenterio ilececal común, o una fijación imperfecta

Faecal and jejunal bacterial flora in irritable bowel syndrome with incompetent ileocecal valve

The aim of this work was to study the jejunal and faecal flora in irritable bowel syndrome [IBS] patients with and without ileocecal vale incompetence to assess the qualitative and quantitative incidence of different bacterial species both aerobically and anaerobically. This study was carrid on 25 IBS patients with incompetent valve and another 25 patients with competent valve. Bacteriological examination of the jejunal aspirates and faecal samples of both groups, showed raised figures as regards all types and species of organisms studied. Irritable bowel syndrome patients with ileocecal valve incompetence showed higher significant bacteriological counts, especially in jejunal aspirates. The pattern of abnormal jejunal flora detected in patients with incompetent valve pointed to colonic origin. Therefore such IBS patients with ileocecal valve incompetence may get benefit from some bacteriostatic agents especially those affecting the anaerobes in a trial to correct the associated floral alterations and overgrowth together with motility modifying drugs as domperidone