Late mesenteric ischemia after Sars-Cov-2 infection: case report / Isquemia mesentérica tardia após infecção por Sars-Cov-2: relato de caso

Abstract The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of COVID-19, complaining of an initially insidious epigastric pain that had progressed to severe pain radiating to the interscapular vertebral region, with hyporexia and episodes of projectile vomiting, with no nausea or fever. Laboratory tests revealed no signs of acute infection or pancreatic injury. Abdominal computed tomography showed dilated, fluid-filled small bowel loops with thickened walls. After clinical treatment, the patient developed persistent abdominal pain. An exploratory laparotomy was performed, finding two sites of small bowel stenosis, with no extrinsic cause, and signs of local ischemia and considerable distension of jejunal and ileal loops. After enterectomy and side-to-side enteroanastomosis, the patient recovered satisfactorily and was discharged with a prescription for oral anticoagulants for outpatient use.

Resumo O objetivo deste artigo é relatar o caso de um homem de 53 anos de idade, negro, sem comorbidades prévias, com diagnóstico confirmado de COVID-19 há 48 dias anteriores ao início do quadro de dor epigástrica insidiosa, que evoluiu para dor de forte intensidade que irradiava para região interescapulovertebral, associada a hiporexia e episódios de vômitos em jato, sem náuseas ou febre. Os exames laboratoriais não apresentavam sinais de infecção aguda ou lesão pancreática. A tomografia computadorizada do abdome mostrou alças do intestino delgado dilatadas, cheias de líquido e com paredes espessas. Após terapia de suporte, o paciente evoluiu com dor abdominal persistente. Foi realizada laparotomia exploratória, na qual foram encontrados dois sítios de estenose no intestino delgado sem causa extrínseca, ao lado de sinais de isquemia local e distensão importante das alças jejunais e ileais. Após enterectomia e enteroanastomose primária látero-lateral, o paciente evoluiu de forma satisfatória e recebeu alta hospitalar com prescrição de anticoagulantes orais para uso ambulatorial.

Linfangiectasia intestinal em adulto: relato de caso / Intestinal lymphangiectasia in an adult: case report

Resumo A linfangiectasia intestinal consiste em um grupo de doenças raras caracterizadas pela dilatação dos canais linfáticos. A fisiopatologia compreende a obstrução da drenagem linfática do intestino delgado com dilatação secundária dos vasos linfáticos mucosos, submucosos ou subserosos, que distorcem a arquitetura das vilosidades e conduzem à perda de linfa para a luz intestinal, levando à má absorção. Os vasos linfáticos afetados localizam-se primariamente no intestino delgado, que é atingido em extensão variável. A sua etiologia é ainda desconhecida. O relato a seguir apresenta um raro caso de linfangiectasia intestinal em paciente adulto.

Abstract Intestinal lymphangiectasia is a group of rare diseases characterized by dilation of lymphatic channels. Its pathophysiology comprises obstruction of small bowel lymphatic drainage with secondary dilation of mucosal, submucosal, or subserous lymphatic vessels, distorting villous architecture and causing loss of lymph into the intestinal lumen, leading to malabsorption. The affected lymphatic vessels are primarily located in the small intestine, which is affected to a varying extent. Its etiology is still unknown. The following report presents a rare case of intestinal lymphangiectasia in an adult patient.

Effect of postconditioning and atorvastatin in preventing remote intestinal reperfusion injury / Efeito do pós-condicionamento e da atorvastatina na prevenção de lesão de reperfusão intestinal remota

ABSTRACT Objective: To evaluate the capacity of ischemic postconditioning and atorvastatin in prevent or minimize reperfusion injury in small bowel of rats subjected to ischemia and reperfusion by abdominal aorta clamping. Methods: 41 Wistar norvegic rats were distributed into 5 groups: ischemia and reperfusion, ischemic postconditioning, postconditioning + statin, statin and Sham. After anesthesia, laparotomy and dissection of the infra-renal abdominal aorta were performed; except the Sham group, all others were subjected to aorta clamping for 70 min (ischemia) and withdrawal of clamp for 70 min (reperfusion). In the IPC and IPC + S groups, four cycles of postconditioning were performed between the phases of ischemia and reperfusion lasting 30 s each. In IPC + S and S groups, 3.4 mg/day of atorvastatin was given for seven days per gavage; 1 cm of the ileum were removed for histological study and the results were subjected to statistical treatment considering significant p < 0.05. Results: The average of intestinal lesion was 2 in the I/R group, 0.66 in the IPC group, 0 in the IPC + S group, 0 in the S group, and 0 in the SHAM group. Conclusion: The ischemic postconditioning and atorvastatin were capable of minimizing intestinal reperfusion injury, either alone or in combination.

RESUMO Objetivo: Avaliar a capacidade do pós-condicionamento isquêmico e da atorvastatina para prevenir ou minimizar a lesão de reperfusão no intestino Delgado de ratos submetidos à isquemia e reperfusão por pinçamento de aorta abdominal. Métodos: 41 ratos noruegueses Wistar foram distribuídos em 5 grupos: isquemia e reperfusão, pós-condicionamento isquêmico, pós-condicionamento + estatina, estatina e simulacro. Depois da anestesia, procedeu-se à laparotomia e dissecação da aorta abdominal infrarrenal; exceto no grupo de simulacro, todos os demais grupos foram submetidos ao pinçamento da aorta durante 70 minutos (isquemia) e à retirada do pinçamento também durante 70 minutos (reperfusão). Nos grupos PCI e PCI + E, foram efetuados quatro ciclos de pós-condicionamento entre as fases de isquemia e de reperfusão, com duração de 30 segundos cada. Nos grupos PCI + E e E, foram administrados 3,4 mg/dia de atorvastatina durante 7 dias por gavagem; procedemos à remoção de 1 cm do íleo para o estudo histológico, e os resultados foram estatisticamente tratados. Consideramos p < 0,05 como estatisticamente significativo. Resultados: As médias para as lesões intestinais foram 2 no grupo I/R, 0,66 no grupo PCI, 0 no grupo PCI + E, 0 no grupo E, e 0 no grupo S. Conclusão: O procedimento de pós-condicionamento e atorvastatina demonstraram capacidade de minimizar a lesão de reperfusão intestinal, tanto isoladamente como em conjunto.

Expression of oxidative stress and antioxidant defense genes in the kidney of inbred mice after intestinal ischemia and reperfusion

PURPOSE: To determine the gene expressions profile related to the oxidative stress and the antioxidant response in the kidneys of mice subjected to intestinal ischemia and reperfusion. METHODS: Twelve inbred mice (C57BL/6) were randomly assigned to one of two groups: the control group (CG) underwent anesthesia and was observed for 120 min and the ischemia/reperfusion group (IRG), animals were anesthetized and subjected to laparotomy and ischemia for 60 minutes followed by 60 minutes of reperfusion. The expressions of 84 genes from the kidney were determined by the Reverse Transcription qualitative Polymerase Chain Reaction (RT-qPCR). All genes that were up regulated by more than threefold using the algorithm [2(ΔΔCt)] were considered statically significant (p<0.05). RESULTS: In the IRG group 29 (34.52%) of 84 genes, were up regulated by more than threefold. The genes that were differentially up regulated in the glutathione peroxidase cluster (10 genes): were Gpx2 and Gpx7. The genes that were up regulated in the peroxidase cluster (16 genes) were following: Duox1, Epx, Lpo, Mpo, Ptgs2, Rag2, Serpinb1b, Tmod1 and Tpo. The genes that up regulated in the reactive oxygen species cluster (16 genes): Il19, Il22, Nos2, Nox1, Noxa1, Noxo1, Recql4 and Sod2. The genes that were up regulated in the oxidative stress cluster (22 genes) were: Mpp4, Nudt15, Upc3 and Xpa. The genes that were up regulated in the oxygen carriers cluster (12 genes) were: Hbq1, Mb, Ngb, Slc38a1 and Xirp1. The peroxiredoxins genes (10) showed no consistent differential regulation. CONCLUSION: The genes related to oxidative stress and antioxidant defense showed increased expression in renal tissue trigged intestinal ischemia and reperfusion.

Sindrome de intestino irritable: ¿Un trastorno funcional? / [Irritable bowel syndrome: a functional disorder?].

Irritable bowel syndrome is a highly prevalent condition responsible for almost one third of visits to the gastroenterologist and huge expenses for diagnosis, treatment and loss of working days. A unique pathophysiologic mechanism has not been elucidated yet and several possibilities have been proposed such as senso-perception and motor disturbances, the effect of stress and anxiety, serotonin receptor failures, activation of abnormal brain areas and pain modulation differences, among others. The absence of a biological marker has led the investigators to consider this syndrome as an exclusion diagnostic condition, once the organic diseases have been discarded The changes in gut microbiota have recently raised great interest among gastroenterologists. The study of the small intestinal bowel overgrowth syndrome, the effect of antibiotics upon the flora, the recognition of post-infectious irritable bowel syndrome and the action of probiotics, together with the effect of malabsortion of diet carbohydrates have brought some new light in our knowledge. The present update will focus on the published evidence about the subject, bearing in mind that the mechanisms elicited here are only suitable for a subgroup of patients.

Enteroscopia doble balón y videocápsula endoscópica en el diagnóstico de patologías del intestino delgado: hospital universitario de maracaibo. 2007-2010 / Double-balloon enteroscopy and endoscopic video capsule in the diagnosis of diseases of the small intestine: maracaibo university hospital. 2007-2010

Introducción: La Enteroscopia Doble Balón (EDB) y la Videocápsula Endoscópica (VCE) se introdujeron en el Hospital Universitario de Maracaibo desde 2007 y 2008, respectivamente. Se analizó y comparó el desempeño de estas pruebas para diagnosticar enfermedades del intestino delgado. Pacientes y Métodos: Se revisaron retrospectivamente los casos sometidos a EDB superior (EDBS), EDB inferior (EDBI) y/o VCE, desde su implementación hasta enero de 2010. Resultados: En 94 casos (55 ♂ y 39 ♀; 10-89 años) se realizaron 155 procedimientos: 52 EDBS, 8 EDBI, 16 VCE y 79 procedimientos combinados. Indicaciones predominantes: Hemorragia de origen oscuro, hemorragia digestiva superior o inferior, anemia, diarrea crónica y sospecha de tumoración intestinal. Visualización completa del tracto entérico: 86,7% (EDBS), 57,7% (EDBI) y 100% (VCE). Biopsias, terapias y/o cromomarcaje: 58,2% (EDBS) y 23,1% (EDBI). Diagnósticos endoscópicos predominantes: Malformaciones vasculares, enteropatías de aspecto parasitario, neoplasias malignas, enteropatías ulcerosas y erosivas. Concordancia indicación/diagnóstico: 74,3% (EDBS), 57,7% (EDBI) y 70% (VCE). Conclusiones: La EDB y la VCE constituyen herramientas eficientes con ventajas particulares para diagnosticar patologías del intestino delgado: La EDB permite realizar procedimientos adicionales; la VCE ofrece mayor probabilidad de visualizar todo el tracto entérico. En casos concretos, combinar estar pruebas podría aumentar su eficiencia diagnóstica y terapéutica.

Introduction: Double Balloon Enteroscopy (DBE) and Endoscopic Viocapsule (EVC) were introduced in the University Hospital of Maracaibo since 2007 and 2008, respectively. Their performance in diagnosing small bowel diseases were analyzed and compared. Patients and Methods: Cases undergoing upper DBE (UDBE), lower DBE (LDBE) and/or CE, were retrospectively reviewed since the introduction of these techniques, until January 2010. Results: In 94 cases (♂: 55; ♀:39; Ages: 10 to 89), 155 diagnostic procedures were performed: 52 UDBE, 8 LDBE, 16 EVC and 79 combined procedures. Predominating indications: obscure gastrointestinal bleeding, upper and/or lower gastrointestinal bleeding, anemia, chronic diarrhea, and suspicion of an intestinal tumor. Full visualization of small bowel: 86.7% (UDBE), 57.7% (DBUE) and 100% (EVC). Biopsies, therapies and/or India ink tattooing: 58.2% (UDBE) and 23.1% (DBLE). Predominant endoscopic diagnoses: vascular malformations, parasitic enteropathies, malign tumor, ulcerative enteropathies and erosive enteropathies. Agreement indication/diagnosis: 74.3% (UDBE), 57.7% (LDBE) and 70% (EVC). Conclusions: DBE and EVC constitute efficient methods with particular advantages for diagnosing small bowel pathologies: DBE allows additional procedures; EVC provides a greater chance of full visualization of small intestine. In specific cases, combination of these tests could improve their diagnostic and therapeutic efficiency.

Curso de Reumatologia: aula 5: anti-inflamatórios não hormonais e alterações intestinais / Course of Rheumatology: class 5: nonsteroidal anti-inflammatory drugs and intestinal alterations

A enteropatia relacionada aos anti-inflamatórios não hormonais (ou não esteroides) é um processo gradual que envolve efeito tóxico direto à mucosa, lesão mitocondrial, quebra da integridade intercelular, recirculação êntero-hepática do anti-inflamatório e ativação neutrofílica pelo conteúdo intraluminal, inclusive por bactérias. A mediação pela cicloxigenase provavelmente é menos importante do que no trato gastrointestinal superior. Estudos com a nova modalidade endoscópica, como a que se utiliza de cápsula endoscópica, demonstram anormalidades relacionadas aos anti-inflamatórios não esteroides (AINEs), que incluem inflamação, erosões, fibrose, estenoses, lesões enantemáticas, erosões patequiais, perfurações e formação de membranas diafragmáticas no jejuno, íleo e colon.

Nonsteroidal anti-inflammatory drug enteropathy is a stepwise process involving direct mucosal toxity, mitochondrial damage, breakdown of intercellular integrity enterohepatic recirculation and neutrophil activation by liminal contents including bacteria. Unlike upper gastrointestinal toxity, cyclooxygenase-mediated mechanisms are probably less important. Newer imaging modalities such as capsule endoscopy studies demonstrate nonsteroidal anti-inflammatory drug-induced abonormalities that include inflammation, erosion, fibrosis, stricture, red spots, petechiae erosions, perforation, and formation of mucosal diaphragms in the jejunum, ileum and colon.

Mesenteric microcirculatory dysfunctions and translocation of indigenous bacteria in a rat model of strangulated small bowel obstruction

PRUPOSE: Bacterial translocation has been shown to occur in critically ill patients after extensive trauma, shock, sepsis, or thermal injury. The present study investigates mesenteric microcirculatory dysfunctions, the bacterial translocation phenomenon, and hemodynamic/metabolic disturbances in a rat model of intestinal obstruction and ischemia. METHODS: Anesthetized (pentobarbital 50 mg/kg, i.p.) male Wistar rats (250-350 g) were submitted to intestinal obstruction or laparotomy without intestinal obstruction (Sham) and were evaluated 24 hours later. Bacterial translocation was assessed by bacterial culture of the mesenteric lymph nodes (MLN), liver, spleen, and blood. Leukocyte-endothelial interactions in the mesenteric microcirculation were assessed by intravital microscopy, and P-selectin and intercellular adhesion molecule (ICAM)-1 expressions were quantified by immunohistochemistry. Hematocrit, blood gases, lactate, glucose, white blood cells, serum urea, creatinine, bilirubin, and hepatic enzymes were measured. RESULTS: About 86 percent of intestinal obstruction rats presented positive cultures for E. coli in samples of the mesenteric lymph nodes, liver, and spleen, and 57 percent had positive hemocultures. In comparison to the Sham rats, intestinal obstruction induced neutrophilia and increased the number of rolling (~2-fold), adherent (~5-fold), and migrated leukocytes (~11-fold); this increase was accompanied by an increased expression of P-selectin (~2-fold) and intercellular adhesion molecule-1 (~2-fold) in the mesenteric microcirculation. Intestinal obstruction rats exhibited decreased PaCO2, alkalosis, hyperlactatemia, and hyperglycemia, and increased blood potassium, hepatic enzyme activity, serum urea, creatinine, and bilirubin. A high mortality rate was observed after intestinal obstruction (83 percent at 72 h vs. 0 percent in Sham rats). CONCLUSION: Intestinal obstruction and ischemia in rats is a relevant model for ...

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.

Corrección quirúrgica de infartode intestino delgado en un equinomediante yeyunocecostomíacon grapadora quirúrgica mecánica / Surgical management of small intestine infarction by stapled jejunocecostomy in a horse

Un equino macho, entero, criollo colombiano de siete años de edad, fue remitido a la clínica de grandes animales del centro de veterinaria y zootecnia CES debido a síndrome abdominal agudo. Al ser evaluado clínicamente presentó depresión, ruidos abdominales disminuidos, deshidratación (6%), frecuencia cardiaca y respiratoria en 40 lpm y 28 rpm, respectivamente, temperatura en 37.1 °C y distensión marcada de intestino delgado evidente mediante palpación rectal y ultrasonografía transabdominal. No hubo respuesta a los analgésicos por parte del equino; los parámetros en líquido peritoneal estuvieron alterados. Se sospechó lesión estrangulante en intestino delgado. La laparotomía exploratoria reveló infarto idiopático de siete metros de yeyuno y la porción proximal del íleon. Fue practicada una yeyunocecostomía latero lateral con grapadora quirúrgica mecánica (GIA 80). El animal permaneció hospitalizado 10 días y la recuperación postquirúrgica fue exitosa. Este caso es el primer reporte en el país de esta cirugía.

A 7- years-old criollo colombiano stallion was referred to the Large Animal Hospital Centro de Veterinaria y Zootecnia CES (Envigado, Colombia) because of an acute abdominal syndrome that had persisted for seven hours despite medical treatment. On physical examination the stallion was depressed, dehydrated (6%), borborygmi were diminished, rectal temperature was � 37.1 °C,hearth and respiration rates were 40 beats/min and 28 breaths/min, respectively. On rectal examination and abdominal ultrasonography small intestine was distended. Peritoneal fluid analysis was altered. Signs of pain were nonresponsive to analgesics. The diagnosis by exploratory � laparotomywas infarctionof small intestine (seven meters of the jejunum and proximal portion of the ileum) of unknown etiology. A jejunocecostomy was done using a GIA 80 surgical stapler (United Surgical). Postsurgical recuperation was successful. This case becomes the first report of a jejunocecostomy in a horse in Colombia.

Enteroscopia de duplo-balão para diagnóstico de linfomas do intestino delgado: relatos de caso / double-balloon enteroscopy to diagnose small bwel lymphomas: case reports

Os linfomas do intestino delgado são entidades raras e seu diagnóstico é muitas vezes difícil. Recentemente, a enteroscopia de duplo-balão foi idealizada com o objetivo de aprimorar o diagnóstico de doenças que afetam o intestino delgado, permitindo também a realização de biópsias em todo o trajeto desse órgão. Neste artigo, apresentam-se 3 casos diagnosticados como linfomas de intestino delgado através da técnica de enteroscopia de duplo-balão

¿Existe en la constipación idiopática severa un trastorno difuso de la motilidad intestinal? / Disturbances of small intestinal motility in patients with chronic constipation

Background: Studies in patients with chronic severe constipation, suggest the presence of a diffuse motor disorder of the gastrointestinal tract. Aim: To investigate small bowel motor activity in a group of patients with severe constipation. Material and Methods: Forty three patients (age range 13 to 70 years, 40 women) with severe constipation referred to our motility laboratory, where studied. Ten had a previous colectomy. Radiological examinations showed a megacolon in 30 and dilatation of small intestinal loops in nine; the remaining X rays studies were normal. Small intestinal motility was studied using perfused catheters and external transducers. Results: Ten patients had normal motor recordings. Eight patients showed a neuropathic disorder characterized by a continuous irregular pattern of contractions of normal amplitude, with absence of phase III of the migrating motor complex (MMC). Sixteen presented a normal MMC associated to a decreased amplitude of contractions (Miopatic disorder). Nine showed both types of motor disorders (Mixed pattern). Normal radiological findings were more commonly associated to normal manometric recordings. By contrast, an altered motor activity, mainly of myopathic and mixed type motor disorder, was observed in all patients with dilated small intestinal and colonic loops. Conclusions: The presence of small intestinal motor disorders was a frequent finding in this selected group of patients with chronic constipation.

Liver disease associated with intestinal failure in the small bowel syndrome / Doença hepática associada à falência intestinal na síndrome do intestino curto

The introduction of the Total Parenteral Nutrition (TPN) has given rise to a new hope in the treatment of intestinal failure (LF) associated with the Short Bowel Syndrome (SBS). However, together with the TPN and the increase of survival of these patients, new problems and questions have emerged, as well as new therapeutical procedures. Taking into consideration this emerging reality, this paper has the purpose to undertake a review of current concepts and available treatments for patients with IF associated-liver disease. Although TPN provides an increase of survival of patients with intestinal failure, it is a potential source of complication such as: septicemia, hyperglycemia, venous thrombosis and liver disease. There are several hypothesis conceived to explain the liver disease associated to intestinal failure, however the only definite treatment as a potential to reverse the non-cirrhotic liver disease is the small intestine transplantation. Despite indications for intestine transplantation are not entirely defined in literature, the trend is its early indication in high-risk patients, preserving the liver integrity and preventing the eventual need of both liver and intestine transplantations altogether.

A introdução da Nutrição Parenteral Total (NPT) despertou uma nova esperança para o tratamento da falência intestina (FI) associada a Síndrome do Intestino Curto (SIC). No entanto, junto com a NPT e o aumento da sobrevida destes pacientes, novos problemas e perguntas emergiram, assim como novas terapêuticas. Tendo em vista esta realidade emergente, o intuito deste artigo é realizar uma revisão dos conceitos atuais e dos tratamentos disponíveis para pacientes com doença hepática associada a FI. A NPT apesar de proporcionar aumento da sobrevida nos pacientes com falência intestinal é fonte potencial de complicações, como: septicemia, hiperglicemia, trombose venosa e doença hepática. Diversas são as hipóteses aventadas para explicar a doença hepática associada a falência intestinal, no entanto, o único tratamento definitivo, com potencial para reverter à doença hepática não cirrótica, é o transplante de intestino delgado. Apesar das indicações do transplante de intestino não estarem totalmente definidas na literatura, a tendência é indicá-lo precocemente em pacientes de alto risco, preservando a integridade hepática e prevenindo a eventual necessidade de transplante de fígado e intestino combinados.

Obesity and Gastrointestinal Motility / 대한소화기학회지

Gastrointestinal (GI) motility has a crucial role in the food consumption, digestion and absorption, and also controls the appetite and satiety. In obese patients, various alterations of GI motility have been investigated. The prevalence of GERD and esophageal motor disorders in obese patients are higher than those of general population. Gastric emptying of solid food is generally accelerated and fasting gastric volume especially in distal stomach is larger in obese patients without change in accommodation. Contractile activity of small intestine in fasting period is more prominent, but orocecal transit is delayed. Autonomic dysfunction is frequently demonstrated in obese patients. These findings correspond with increased appetite and delayed satiety in obese patients, but causes or results have not been confirmed. Therapeutic interventions of these altered GI motility have been developed using botulinum toxin, gastric electrical stimulation in obese patients. Novel agents targeted for GI hormone modulation (such as ghrelin and leptin) need to be developed in the near future.

Reducing radiation dose to pelvic small bowel in cervical cancer patients treated with Ir-192 intracavitary brachytherapy by using urinary bladder distension.

OBJECTIVES: Several techniques and devices have been used in an attempt to minimize radiation dose to gastrointestinal tract while giving pelvic radiation. We evaluated the effect of urinary bladder distension to displace pelvic small bowel out of intracavitary brachytherapy field to minimize radiation dose to small bowel in cervical cancer patients. MATERIAL AND METHOD: Eleven cervical cancer patients who received Ir-192 intracavitary brachytherapy with tandem and transverse ovoids were included in this study. Oral contrast material was used to visualize pelvic small bowel. Urinary bladder was distended by injection 125-200 ml. normal saline solution. Pelvic radiograph, anteroposterior and lateral view, was performed before and after bladder distention for brachytherapy treatment planning and comparing radiation dose at small bowel. RESULTS: The average maximum radiation dose at small bowel before and after bladder distension were 3123 cGy and 1998 cGy respectively. The summation of small bowel dose was reduced 54.17% (p = 0.002). CONCLUSION: Urinary bladder distension could effectively displace pelvic small bowel and reduce the radiation dose to small bowel from Ir-192 intracavitary brachytherapy in cervical cancer patients.

Divertículo de Meckel invertido como causa de intususcepción intestinal en el adulto: reporte de un caso / Inverted Meckel´s diverticulum as a cause of intestinal intussusceptions in the adult: a case report

Se reporta el caso de un paciente con divertículo de Meckel invaginado asociado a intususcepción con clínica de obstrucción intestinal intermitente y simulando un posible tumor de intestino delgado. Se discute su fisiopatología, clínica, estudio imagenológico y tratamiento.

Pattern of small intestinal mucosal changes in patients with type 1 diabetes mellitus

The coexistence of type 1 diabetes mellitus [DM] and Celiac disease [CD] is well recognized with a prevalence of CD in type 1 DM reported to be between 0% and 10.4%. The aim of this study was to find the pattern of small intestinal mucosal changes in patients with type 1 DM. A cross sectional study done in Al-Faiha hospital in Basrah,Iraq,on patients with type 1 DM. Duodenoscopy was done and at least four biopsies were taken from the second part of the duodenum. Four patients had normal biopsy, 16 patients had duodenitis, and 10 patients had Marsh type I. Marsh type IILA were seen in 4 patients. Marsh IIIB were seen in two patients, and Marsh IIIC in 4 patients. Marsh IIIB and C histology were regarded compatible with CD, so the incidence of CD was 15%. All patients with type 1 DM should be screened for CD-Duodenal biopsy is a relevant tool for screening CD in patients with type I DM

Intussuscepção do intestino delgado / Intussusception in the small intestine

Doença freqüente na faixa etária entre três e trinta e seis meses, apresenta maior incidência aos dez meses. Apenas 5% dos casos são encontraddos no adulto e a proporção entre sexo masculino e feminino é de 2:1. Existem várias teorias para explicar a sua causa, mas a mais aceita é a da hipertrofia focal linfóide secundária à infecção viral que ocorre na massa do tecido linfóide localizada no íleo terminal. Nos pacientes acima de 60 anos de idade, a presença de tumor maligno é verificada entre 50 a 70% dos casos, sendo metástases em sua maioria. A sintomatologia mais freqüentemente encontrada é a tríade clássica formada por: dor abdominal tipo cólica intermitente, vômitos e fezes com sangue e muco. O diagnóstico de intussuscepção intestinal pode ser feito apenas com dados clínicos na criança enquanto no adulto o diagnóstico pode ocorrer apenas durante a laparotomia. O estudo radiológico simples, enema de bário, ultrassonografia, colonoscopia e a tomografia computadorizada fazem parte dos métodos de diagnóstico, sendo que o padrão ouro em alguns serviços é enema baritado. O tratamento pode ser conservador através da redução hidrostática utilizando enema da bário, que apresenta resolução em 93% dos casos em algumas séries e a redução pneumática em que o ar substitui o bário com resolução igual a técnica anterior mas com menores complicações quando da presença de perfuração intestinal. Alguns serviços passaram a utilizar enema com contraste hidrossolúvel para facilitar a retirada da cavidade abdominal nos casos de perfuração. O tratamento cirúrgico está reservado para os casos de complicações como peritonite e para os casos de insucesso do tratamento conservador.

Producción endógena de alcohol en pacientes con cirrosis hepática, alteración motora y sobrecrecimiento bacteriano / Endogenous ethanol production in patients with liver cirrhosis, motor alteration and bacterial overgrowth

BACKGROUND: Small intestinal bacterial overgrowth generates endogenous ethanol production both in experimental animals and humans. Patients with cirrhosis have small intestinal bacterial overgrowth, but endogenous ethanol production has not been studied in them. AIM: To investigate endogenous ethanol production in patients with cirrhosis, altered intestinal motility and small intestinal bacterial overgrowth. PATIENTS AND METHODS: Eight patients with cirrhosis of different etiologies and altered gastrointestinal motility, consisting in changes in the migrating motor complex, were studied. All had also small intestinal bacterial overgrowth, measured by means of the H2 breath test with lactulose. Plasma ethanol levels were measured by gas liquid chromatography in fasting conditions and 120 min after a carbohydrate rich meal. RESULTS: In fasting conditions, no patient had endogenous ethanol production. Alter the meal, ethanol in concentrations of 11.3 and 8.2 mg/del were detected in two patients. Negligible amounts of ethanol were detected in 4 patients and two patients had undetectable alcohol levels. CONCLUSIONS: A low endogenous production of ethanol was demonstrated in six of eight patients with cirrhosis.