Evisceración intestinal transvaginal incarcerada con perforación intestinal después de una colporrafia con malla. Reporte de un caso / Incarcerated transvaginal bowel evisceration with intestinal perforation after a mesh colporraphy. A case report

Introducción. La evisceración intestinal transvaginal es consecuencia, en la gran mayoría de casos, de dehiscencia del muñón vaginal posterior a histerectomía en pacientes postmenopáusicas. A través de la dehiscencia vaginal se produce la salida del contenido abdominopélvico, que puede presentarse como una evisceración simple, incarceración, obstrucción, estrangulamiento y perforación de un asa intestinal. Caso clínico. Mujer de 78 años, con antecedente inmediato de colpocleisis y colporrafia con malla de polipropileno por prolapso vaginal, que presentó dehiscencia del muñón vaginal debido a rechazo de la malla, que condicionó la solución de continuidad de la pared vaginal, con prolapso, incarceración, obstrucción y perforación de íleon. Con el diagnóstico de evisceración intestinal transvaginal incarcerada con perforación intestinal se llevó a tratamiento quirúrgico, con abordaje inicial por vía vaginal para liberar el asa intestinal, luego por laparotomía se realizó resección y anastomosis de íleon, sacrocolpopexia con malla y plastia de Douglas. Presentó buena evolución postoperatoria.Conclusión. La evisceración intestinal transvaginal con perforación intestinal es una entidad de muy rara presentación. El órgano más frecuentemente comprometido es el intestino delgado, especialmente el íleon. Puede complicarse con incarceración, obstrucción intestinal, isquemia y perforación. El manejo quirúrgico involucra resección intestinal, cuando hay signos de necrosis, con reparación y fijación del muñón vaginal.

Introduction. Transvaginal intestinal evisceration is a consequence, in the vast majority of cases, of dehiscence of the vaginal stump after hysterectomy in postmenopausal patients. Through vaginal dehiscence, the exit of the abdominopelvic content occurs, which can present as a simple evisceration, incarceration, obstruction, strangulation and perforation of an intestinal loop. Clinical case. A 78-year-old woman with an immediate history of colpocleisis and polypropylene mesh colporrhaphy due to vaginal prolapse, presents dehiscence of the vaginal stump caused by rejection of the mesh that conditioned the solution of continuity of the vaginal wall, prolapse, incarceration, obstruction and perforation of the ileum. Surgical treatment was performed with the diagnosis of incarcerated transvaginal intestinal evisceration with intestinal perforation. The initial approach was to free the intestinal loop vaginally, followed by laparotomy, ileal resection and anastomosis, mesh sacrocolpopexy, and Douglas plasty were performed. He presented good postoperative evolution.Conclussion. Transvaginal intestinal evisceration with intestinal perforation is a very rare entity. The most common organ involved is the small intestine, especially the ileum. It can be complicated by incarceration, intestinal obstruction, ischemia, and perforation. Surgical management involves intestinal resection, when there are signs of necrosis, with repair and fixation of the vaginal stump.

Íleo biliar: reporte de casos / GALLSTONE ILEUS: CASES REPORT

El íleo biliar se define como una obstrucción intestinal mecánica secundaria a la presencia de un cálculo biliar. Menos del 1% de los casos de obstrucción intestinal se derivan de esta etiología. La causa más frecuente es la impactación del cálculo en el íleon, tras su paso por una fístula bilioentérica. Es una complicación rara y potencialmente grave de la colelitiasis. Esta patología se presenta más en adultos mayores, la edad promedio en la que se presenta es entre los 60 y 84 años, afectando principalmente al sexo femenino, atribuido a la mayor frecuencia de patología biliar en dicho sexo. Presenta una alta morbimortalidad, principalmente por la dificultad y la demora diagnóstica.

Gallstone ileus is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone. Less than 1% of cases of intestinal obstruction are derived from this etiology. Te most frequent cause is the impaction of the stone in the ileum, after passing through a bilioenteric fistula. It is a rare and potentially serious complication of cholelithiasis. Tis pathology occurs more in the elderly, the average age at which it occurs is between 60 and 84 years, mainly affecting the female sex, attributed to the higher frequency of biliary pathology in said sex. It presents a high morbidity and mortality, mainly due to the difficulty and the diagnostic delay

Risk factors for anastomotic leakage following total or subtotal colectomy

Introduction: A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. Themain aimof the present studywas to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods: We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results: Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of ALwas 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p=0.038), in the electivelaparoscopic approach subgroup (p=0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p=0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion: A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgerymay improve short-term outcomes. (AU)

The value of terminal lleum intubation during colonoscopy

Abstract It is uncertain whether terminal ileum intubation should be performed routinely during colonoscopy, as there is uncertainty regarding its diagnostic value. The aim of the present study is to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy. This is a cross-sectional study in which the results of 294 total colonoscopy procedures were reviewed; ileal intubation was performed in 269 (91.49%) patients. The indications for colonoscopy, the results of ileoscopy, and the histopathological results of ileal biopsies were evaluated. A total of 54 (20%) out of 269 patients who had successful intubation into the terminal ileumshowed macroscopic abnormalities on the terminal ileum. Biopsies were positive in 4 out of 54 (7.4%); all were of Crohn disease. Two were erosions (9.5%.) and 2 were ulcers (18.8%). The two erosions were presented as abdominal pain, abdominal pain and alternating bowel motion. Those with ulcers were presented with diarrhea and perianal disease. Conclusions Considering the low diagnostic yield of ileal intubation during colonoscopy, the decision to performileoscopy or not during colonoscopy needs to bemade on a case-by-case basis. However, routine ileal intubation, brief attempts should be considered despite low diagnostic yield. (AU)

Effect of Suanzaoren Decoction on molecular levels of bile acids in serum, liver, and ileum of insomnia mice / 中国中药杂志

To explore the mechanism of Suanzaoren Decoction in the treatment of insomnia from endogenous bile acid regulation, the present study investigated the hepatoprotective effect of Suanzaoren Decoction and the molecular changes of bile acids in the serum, liver, and ileum of insomnia model mice and Suanzaoren Decoction treated mice. The insomnia model in mice was established by the sleep deprivation method. After Suanzaoren Decoction(48.96 mg·kg~(-1)·d~(-1)) intervention by gavage for 7 days, the related indicators, such as water consumption, food intake, body weight, aspartate aminotransferase(AST), alanine transaminase(ALT), and total bile acid(TBA) were detected, and the pathological changes of the liver and ileum were observed. The molecular levels and distribution of 23 bile acids in the serum, liver, and ileum were analyzed by UPLC-MS/MS combined with principal component analysis(PCA) and partial least squares discriminant analysis(PLS-DA). The results showed that Suanzaoren Decoction could improve the decreased water consumption and food intake, weight loss, and increased AST and ALT in the model group, and effectively reverse the injury and inflammation in the liver and ileum. The bile acids in the liver of the insomnia model mice were in the stage of decompensation, and the bile acids in the serum, liver, and ileum of the mice decreased or increased. Suanzaoren Decoction could regulate the anomaly of some bile acids back to normal. Seven bile acids including glycoursodeoxycholic acid(GUDCA), glycodesoxycholic acid(GDCA), tauro-α-MCA(T-α-MCA), α-MCA, taurodeoxycholate(TDCA), T-β-MCA, and LCA were screened out as the main discriminant components by PLS-DA. It is concluded that Suanzaoren Decoction possesses the hepatoprotective effect and bile acids could serve as the biochemical indicators to evaluate the drug efficacy in the treatment of abnormal liver functions caused by insomnia. The mechanism of Suanzao-ren Decoction in soothing the liver, resolving depression, tranquilizing the mind, and improving sleep may be related to the molecular regulation of bile acid signals.

Ileoscopia: quando a avaliação ileal não é mandatória durante a colonoscopia / Ileoscopy: when ileal evaluation is not mandatory during colonoscopy

ABSTRACT BACKGROUND: Ileitis is defined as ileal inflammation, with several etiologies, including inflammatory bowel disease (IBD), and can be evaluated during the colonoscopy exam, but its mandatory evaluation is discussed, because of few diagnosis and procedure time. OBJECTIVE: This study aims to evaluate the correlation of colonoscopic ileitis with the clinical presentation, in order to identify the cases where ileal examination is mandatory. METHODS: A retrospective, cross-sectional study was conducted between 2013 and 2017. The examination report, indications for colonoscopy, and medical records were evaluated in order to identify whether the colonoscopic findings were clinically significant. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age, those with previous intestinal resections, and repeated examinations of the same patient in the study period were excluded. The estimated association measure was the odds ratio with 95% confidence intervals. P-values <0.05 indicated statistical significance. RESULTS: A total of 3382 cases were included. Among these participants, 64.5% were females and the average age was 56.9±13.1 years (18-89 years). Ileal alterations were observed in 5.3% of the patients, with 2.69% being clinically significant between all patients, and 0.96% excluding those with IBD. There was a positive correlation between the ileitis findings and IBD control examinations and a negative correlation in screening and change in bowel habit indications. Among the indications with ileitis clinically significant, IBD control still had a positive correlation, 'diarrhea' and 'others' did not show a statistical significance, and all other indications presented a negative correlation for ileal assessment. CONCLUSION: Ileal evaluation in only mandatory in IBD control. When the main colonoscopy objective is detecting colonic neoplasms, ileoscopy is unnecessary.

RESUMO CONTEXTO: Ileíte é definida como inflamação ileal, com diversas etiologias, incluindo doença inflamatória intestinal (DII), e pode ser avaliada durante o exame de colonoscopia, mas sua avaliação obrigatória é discutida, devido aos poucos diagnósticos e tempo de procedimento. OBJETIVO: O objetivo deste estudo é avaliar a correlação da ileíte colonoscópica com a apresentação clínica, a fim de identificar os casos em que o exame ileal é obrigatório. MÉTODOS: Foi realizado um estudo transversal retrospectivo entre 2013 e 2017. O laudo do exame, as indicações para colonoscopia e os prontuários médicos foram avaliados para identificar se os achados colonoscópicos eram clinicamente significativos. Pacientes maiores de 18 anos submetidos à ileoscopia foram incluídos, enquanto pacientes menores de 18 anos, aqueles com ressecções intestinais prévias e exames repetidos do mesmo paciente no período de estudo foram excluídos. A medida de associação estimada foi o odds ratio com intervalos de confiança de 95%. Valores de P <0,05 indicaram significância estatística. RESULTADOS: Foram incluídos 3382 casos. Desses, 64,5% eram mulheres e a média de idade foi de 56,9±13,1 anos (18-89 anos). Alterações ileais foram observadas em 5,3% dos pacientes, sendo 2,69% clinicamente significativos entre todos os pacientes e 0,96% excluindo aqueles com DII. Houve uma correlação positiva entre os achados de ileíte e exames de controle de DII e uma correlação negativa no rastreamento e alteração de hábito intestinal. Entre as indicações com ileíte clinicamente significativa, o controle de DII ainda teve uma correlação positiva, 'diarreia' e 'outros' não apresentaram significância estatística, e todas as outras indicações apresentaram correlação negativa para avaliação ileal. CONCLUSÃO: A avaliação ileal é obrigatória apenas no controle de DII. Quando o objetivo principal da colonoscopia é detectar neoplasias colônicas, a ileoscopia é desnecessária.

Morbidity and mortality associated with loop ileostomy closure procedures in a reference service in coloproctology in Recife, Pernambuco / Morbimortalidade associada aos procedimentos de fechamento de ileostomia em alça em um serviço de referência em coloproctologia em Recife, Pernambuco (PE)

Objective: To evaluate the morbidity and mortality related to the surgical procedure of loop ileostomy closure, in a reference service in coloproctology, as well as possible variables that may be related to a higher frequency of complications. Methods: A retrospective study evaluated 66 procedures of loop ileostomy closure, performed between December 2005 and December 2017, at the coloproctology service of Barão de Lucena Hospital, in Recife, Brazil. Results: There were complications in 20 (30.3%) patients, 11 of whom were classified as grade I (Clavien-Dindo), and 9 of whom were classified as grade II to V. In 7.6% of the cases, one or more surgical reassessments were required. Mortality was 1.5%. There was no statistical relevance in the correlation of the studied variables with the occurrence of complications. Conclusion: Loop ileostomy closure presents an important morbidity, reaching more than 30%, although mortality is low. The analyzed variables did not show significant statistics for a higher occurrence of complications. (AU)

Objetivo: Avaliar a morbimortalidade relacionada ao procedimento cirúrgico de fechamento ileostomia em alça, em um serviço de referência em coloproctologia, bem como possíveis variáveis que possam se relacionar com uma maior frequência de complicações. Métodos: Estudo retrospectivo, com análise de prontuários de 66 procedimentos de fechamento de ileostomia em alça, realizados entre dezembro de 2005 e dezembro de 2017, no serviço de coloproctologia do Hospital Barão de Lucena, em Recife, PE. Resultados: Houve complicações em 20 (30,3%) pacientes, sendo 11 delas classificadas como grau I (Clavien-Dindo) e 9 classificadas de grau II a V. Em 7,6% dos casos, houve necessidade de uma oumais reabordagens cirúrgicas. Amortalidade foi de 1,5%. Não houve relevância estatística na correlação das variáveis estudadas com a ocorrência de complicações. Conclusão: O procedimento cirúrgico de fechamento de ileostomia apresenta morbidade importante, podendo chegar a mais de 30%, embora a mortalidade seja baixa. As variáveis analisadas não demonstraram significância estatística para maior ocorrência de complicações. (AU)

Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients

ABSTRACT Objective: To assess the functional outcomes and complications of modified Hautmann neobladder with Wallace ureteroileal anastomosis on a 6-8 cm long isoperistaltic chimney, following radical cystectomy. Materials and Methods: Between January 2015 and October 2019, 22 patients (18 men and 4 women) underwent radical cystectomy and Hautmann neobladder reconstruction with chimney modification and Wallace I ureteroileal anastomosis. The mean age of patients was 61 years (45-74 years). All procedures were performed by the same surgeon and the mean follow-up was 29.4 months. Complications were registered as early (occurring within 3 months) or late (occurring after 3 months), with particular attention addressed to the ureteroileal anastomotic stricture and anastomotic leakage rate. Patient evaluation also included symptom analysis for daytime continence and voiding frequency. Results: Ureteroileal anastomotic stricture was not detected as a cause of hydronephrosis. Hovewer, the anastomotic leakage occurred in one patient during the early postoperative period. Early complications occurred in 9 patients and the most common was bilateral hydronephrosis, detected in 5 examinees. Late complications occurred in 4 patients. Complete daytime and nighttime continence achieved in 18 and 16 patients respectively, with two patients (9%) still required intermittent catheterization three months after surgery. Conclusions: The functional results with modified Hautmann neobladder, incorporating short afferent limb in Wallace I uretero-enteric anastomosis, were efficient. This technique is an effective way to minimize potential uretero-enteric stricture, anastomotic leakage and incidence of vesicoureteral reflux.

Nutritive evaluation, metabolisable energy and digestible amino acid contents of different indigenous feedstuff for Nile tilapia (Oreochromis niloticus) / Avaliação nutricional, energia metabolizável e conteúdo de aminoácidos digestíveis de diferentes alimentos indígenas para tilápia do Nilo (Oreochromis niloticus)

Abstract Three trials were executed to examine the nutritive profile, metabolisable energy and digestible amino acid (AA) contents of four indigenous feed ingredients including wheat (W), wheat middling (WM), canola meal (CM) and rapeseed meal (RSM) in Nile tilapia. Three samples of each test ingredient were collected from three different locations of Multan (MUL) and Sukkar (SKR), of Pakistan. The collected three samples were pooled thereafter to make a homogenous/ representative sample of each test ingredient from a particular study site. Nutrients composition, AA and energy digestibility of these indigenous ingredients were evaluated by using laboratory analyses and fish studies. Proximate analysis indicated variations in some of the nutrients due to location (p < 0.05). Differences were also observed in some AA including arginine, lysine, serine, cysteine, glutamic and aspartic acids, histidine, valine and glycine contents of these ingredients (p < 0.05). Digestibility of leucine, glycine and glutamic acid was higher (p < 0.05) in RSM from MUL. Among W samples from MUL, AA digestibility for lysine, threonine, and aspartic acid was higher (p < 0.05). Crude protein, arginine, alanine, serine, and aspartic acid had higher digestibility (p < 0.05), whereas digestibility was lower (p < 0.05) for threonine, valine and tyrosine in RSM from MUL. Metaboliseable energy contents did not differ among W, WM, CM and RSM regarding their origin (p > 0.05). The results indicated that nutritional profiles and their digestibility indices vary with the location for Nile tilapia.

Resumo Três experimentos foram executados para examinar o perfil nutritivo, a energia metabolizável e o conteúdo de aminoácidos digestíveis (AA) de quatro ingredientes alimentícios, incluindo trigo (W), farelo de trigo (WM), farelo de canola (CM) e farelo de colza (RSM) em tilápia do Nilo. Três amostras de cada ingrediente do teste foram coletadas de dois locais diferentes (Multan (MUL) e Sukkar (SKR), do Paquistão) e assim agrupadas. A composição nutricional, AA e digestibilidade energética desses ingredientes indígenas foram avaliadas por meio de análises laboratoriais e estudos de peixes. A análise imediata indicou variações (p <0,05) em alguns dos nutrientes devido à localização. Variações (p <0,05) também foram observadas em alguns teores de AA desses ingredientes. A digestibilidade da leucina, glicina e ácido glutâmico foi maior (p <0,05) em RSM de MUL. Entre as amostras de W da MUL, a digestibilidade de AA para Lys, Thr e Asp foi maior (p <0,05). Proteína Crud, arginina, alanina, serina e ácido aspártico apresentaram maior digestibilidade (p <0,05), e menor (p <0,05) para treonina, valina e tirosina em MRS. Nenhuma diferença (p> 0,05) relacionada a energia metabolizável foi observada entre esses ingredientes em relação à sua origem. Os resultados indicaram que os perfis nutricionais e sua digestibilidade variam com a localização.

Clinical features of 44 patients with small bowel Crohn / 中南大学学报(医学版)

OBJECTIVES@#At present, there are many studies on Crohn's disease of terminal ileum and colon, but few studies on Crohn's disease of small intestine alone. This study aims to analyze the clinical features and therapeutic effect of small bowel in adult patients with Crohn's disease so as to strengthen the diagnosis and treatment for this disease.@*METHODS@#From July 1, 2015 to October 31, 2018, patients with small bowel Crohn's disease at Department of Gastroenterology, Third Xiangya Hospital of Central South University, were enrolled. At the same time, patients' demographics and clinical data were collected.@*RESULTS@#A total of 44 patients were small bowel Crohn's disease. Among them, 40 patients were male. The age at diagnosis was (35.8±10.3) years old and disease duration was (35.2±59.5) months. The subtypes included 29(65.9%) of ileum, 7(15.9%) of jejunum, 8(18.2%) of ileum with jejunum. There were 27(61.4%) of stricture behavior, 4(9.1%) of penetrating behavior, and 13(29.5%) of non-stricture and non-penetrating behavior. Endoscopic visible stricture (29/85, 34.1%) was common, followed by longitudinal ulcers (27/85, 31.8%). Non-caseate granulomatous were found in 2 cases (4.5%). The score of Crohn's disease activity index was correlated to hemoglobin, hematocrit, and erythrocyte sedimentation rate (all @*CONCLUSIONS@#Patients with ileum account for a large proportion in patients with small bowel Crohn's disease. Stricture is more common in small bowel Crohn's disease. Stricture and longitudinal ulcer are more common under enteroscopy. Crohn's disease activity index is correlated to hemoglobin, red blood cell specific volume, and erythrocyte sedimentation rate. The most common complication is intestinal obstruction. Mesalazine is less effective on small bowel Crohn's disease.

Tratamento colonoscópico de íleo biliar: relato de um caso / Colonoscopic treatment of gallstone ileus: a case report

O íleo biliar representa de 1 a 4% das causas de obstrução mecânica do trato gastrointestinal, causado por um cálculo de origem biliar quando atinge a luz intestinal através de uma fístula bilioentérica. O seu tratamento normalmente é cirúrgico através da enterolitotomia, com ou sem realização de colecistectomia e correção da fístula bilioentérica no mesmo tempo cirúrgico. Relata-se o caso de um paciente de 78 anos com obstrução intestinal ao nível do íleo terminal. Devido ao risco cirúrgico elevado optou-se pela realização de colonoscopia de urgência, que extraiu um cálculo de 2,1cm, impactado na válvula ileocecal. O paciente evoluiu bem após o procedimento, sendo optado pelo tratamento conservador da vesícula biliar e fístula durante o internamento. Conclui-se que pacientes de alto risco se beneficiam com procedimentos menos invasivos, como os endoscópicos, que além de diagnósticos podem ser terapêuticos

The gallstone ileus represents 1 to 4% of the causes of mechanical obstruction from gastrointestinal tract, caused by a gallstone when it reaches the intestinal lumen through a bilioenteric fistula. The treatment is usually the enterolithotomy, with or without cholecystectomy and correction of the bilioenteric fistula at the same surgical time. We report a case of a patient, 78 years old, with intestinal obstruction at the level of the ileocecal valve. The examination showed abdominal distension and pain, with no signs of peritonitis. Due to the surgical risk, a emergency colonoscopy was performed, which removed a 2.1 cm gallstone impacted into the ileocecal valve. The patient evolved well after the procedure and it was chosen the conservative approach to the gallbladder and fistula during the same hospital stay. We conclude that the high-risk patients could benefit from less invasive treatments, such as endoscopy, which can be diagnoses and therapeutic

Diagnóstico diferencial de obstrucción del íleon distal en mujeres jóvenes. ¿Cuál es el rol de la enterorresonancia? / Differential diagnosis of distal ileal obstruction in young women What is the role of magnetic resonance enterography?

Resumen La obstrucción intestinal en pacientes jóvenes es poco frecuente. La mayor parte de los casos se presentan en mujeres jóvenes (premenopáusicas) y suelen estar relacionados a enfermedad inflamatoria intestinal tipo enfermedad de Crohn, o endometriosis con compromiso intestinal. En esta serie de casos presentamos tres pacientes mujeres en etapa reproductiva, con síntomas de obstrucción intestinal, quienes tienen patologías y desenlaces diferenciales. En el abordaje inicial de la obstrucción, se realizó enterorresonancia. Hacemos la presentación de casos, discusión y revisión de la literatura del diagnóstico diferencial de la estenosis en íleon distal y del uso de la enterorresonancia en ese escenario.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1327).

Abstract Intestinal obstruction is uncommon in young patients. Most cases present in young (premenopausal) women and tend to be related to inflammatory intestinal disease such as Crohn's disease or endometriosis with intestinal involvement. In this case series we present three female patients of reproductive age with intestinal obstruction symptoms who have differential diseases and outcomes. The initial approach to the obstruction included magnetic resonance enterography. We present the cases, discussion and review of the literature on the differential diagnosis of distal ileal stenosis and the use of magnetic resonance enterography in this scenario.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1327).

Ileal impaction resolution in a horse with colic via a standing right flank laparotomy ˗ case report / [Laparotomia de equino em estação para resolução de compactação de íleo ˗ relato de caso]

This report describes a horse presenting ileal impaction that went through a right flank laparotomy procedure while standing. The decision to use this technique was made under the influence of several factors: the patient exhibited a calm temperament and demonstrated responsiveness to the analgesic treatment for pain control; the abdominal lesion was amenable to correction by a standing right flank approach. Also, the owner reported financial problems. Ileal obstruction was relieved successfully, and the horse recovery was satisfactory. This case highlights that, in specific cases of colic syndrome, the use of surgical procedures in the standing position might be a viable option and promote fast recovery.(AU)

Este relato de caso descreve um equino com compactação de íleo corrigida por laparotomia em estação pelo flanco direito. A decisão dessa abordagem foi influenciada por vários fatores: o paciente exibiu um temperamento calmo e demonstrou responsividade ao tratamento analgésico para controle da dor; a afecção intestinal em questão foi passível de correção pela abordagem pelo flanco direito em estação; e o proprietário relatou limitações financeiras. A desobstrução ileal foi realizada com sucesso e o cavalo apresentou recuperação satisfatória. Este caso destaca que, em casos específicos da síndrome de cólica, o uso de um procedimento em estação pode ser uma abordagem viável e promover uma rápida recuperação.(AU)

Obstrucción mecánica secundaria a íleo biliar / MECHANICAL OBSTRUCTION SECONDARY TO GALLSTONE ILEUS

Gallstone ileus is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone. Less than 1% of cases of intestinal obstruction are derived from this etiology. The most frequent cause is the impaction of the stone in the ileum, after passing through a bilioenteric fistula. It is a rare and potentially serious complication of cholelithiasis. This pathology occurs more in the elderly, the average age at which it occurs is between 60 and 84 years, mainly affecting the female sex, attributed to the higher frequency of biliary pathology in said sex. It presents a high morbidity and mortality, mainly due to the difficulty and the diagnostic delay.

Invaginación íleo-colónica en un paciente adolescente con fibrosis quística / Ileocolonic intussusception in an adolescent patient with cystic fibrosis

La invaginación intestinal ocurre cuando un segmento proximal de intestino se repliega dentro de la luz de un segmento distal adyacente y provoca obstrucción intestinal. Es una causa común de abdomen agudo en los dos primeros años de la vida, pero raro en niños mayores. Un varón de 16 años, con diagnóstico de fibrosis quística, se presentó con un cuadro compatible con síndrome de oclusión intestinal distal. Consultó a la clínica con dolor abdominal y una masa palpable en el hipocondrio derecho. Se realizó ecografía abdominal y tomografía de abdomen contrastada, que demostraron invaginación íleo-colónica con signos de isquemia intestinal, necrosis y neumatosis de la pared intestinal. Fue intervenido: se realizó resección del íleon terminal y hemicolon derecho, y se detectó una tumoración en ciego. La invaginación íleo-colónica es una causa rara de abdomen agudo en pacientes adolescentes con fibrosis quística y puede estar asociada a una causa orgánica subyacente.

Intestinal intussusception occurs when a proximal segment of the intestine telescopes into the lumen of an adjacent distal segment, causing intestinal obstruction. It is a common cause of acute abdomen in the first two years of life, but rare in older children. A 16-year-old male with a diagnosis of cystic fibrosis presented with symptoms compatible with distal intestinal occlusion syndrome. He came at the cystic fibrosis clinic with a 5-day evolution of abdominal pain and a palpable mass in the right hypochondrium. Abdominal ultrasound and abdominal contrasted tomography were performed demonstrating ileo-colonic invagination with signs of intestinal ischemia, necrosis and pneumatosis of the intestinal wall. He underwent surgery with resection of the terminal ileum and right hemicolon, ana tumor in the caecum was found. This is a rare cause of acute abdomen in young patients with cystic fibrosis and may be associated with an underlying organic cause.

Fístula aorto-ileal primaria / Primary Aortoenteric Fistulas

RESUMEN Introducción: Las fístulas aorto-entéricas son una causa infrecuente de hemorragia digestiva. El pronóstico, generalmente ominoso, depende de una alta sospecha clínica y diagnóstico oportuno. Objetivo: Presentar el caso de una hemorragia digestiva por una fístula Aortoentérica diagnosticada y tratada. Presentación del caso: Se reporta el caso de un hombre de 72 años intervenido con el diagnóstico hemorragia digestiva masiva en el preoperatorio; sin embargo, el diagnóstico de la fístula se hizo en el intraoperatorio, sin observar dilatación aneurismática, pero si una aorta ateromatosa y un proceso inflamatorio hacia la fístula. Se realizó reparación quirúrgica urgente con reparación cara anterior aorta infrarrenal cercana a la bifurcación y resección del íleo terminal con ileoascendentostomía termino-lateral. Discusión: Las fístulas aorto-entéricas es una causa potencialmente fatal de hemorragia digestiva. El diagnóstico continúa siendo un desafío debido a su presentación inespecífica y siempre debiese ser considerado frente a una hemorragia digestiva sin causa aparente. Existen varias opciones para el enfrentamiento quirúrgico que deben ser analizadas caso a caso, sin retrasar la reparación. Conclusiones: La fístula aorto-entérica primaria es una causa poco frecuente de hemorragia digestiva, que todo médico y cirujano debe tener en cuenta frente a un paciente con sangrado digestivo de causa no precisada(AU)

ABSTRACT Introduction: Aortoenteric fistulas are a rare cause of gastrointestinal bleeding. The generally ominous prognosis depends on high clinical suspicion and timely diagnosis. Objective: To present a case of gastrointestinal hemorrhage for aortoenteric fistula diagnosed and treated. Case presentation: The case is reported of a 72-year-old man who received surgery after the diagnosis of massive gastrointestinal bleeding during the preoperative period. However, the diagnosis of the fistula was made intraoperatively, without observing aneurysmal dilation, but an atheromatous aorta and an inflammatory process leading to the fistula instead. Urgent surgical repair was performed with repair of anterior infrarenal aorta near the bifurcation and resection of the terminal ileum with end-to-side ascending ileostomy. Discussion: Aortoenteric fistulas are a potentially fatal cause for gastrointestinal bleeding. Diagnosis continues to be a challenge due to its nonspecific presentation and should always be considered for any case of unexplained gastrointestinal bleeding. There are several options for surgical management that must be analyzed case by case, without delaying repair. Conclusions: Primary aortoenteric fistula is a rare cause for gastrointestinal bleeding, which every doctor and surgeon must take into account when dealing with a patient with digestive bleeding of an unspecified cause(AU)

Glabridin alleviates ischemia/reperfusion-induced functional failure of smooth muscle of rat ileum by upregulating the cAMP / Glabridin alivia la falla funcional inducida por isquemia/reperfusión del músculo liso de ileum murino regulando el incremento de cAMP

Despite the development of modern medicine, alternative medicine, which has not lost its timeliness, remains attractive for the treatment of various diseases. Glabridin, a major flavonoid of Glycyrrhiza glabra, is known for its antioxidant and anti-inflammatory activity. The aim of this study was: 1) to determine the possible protective role of glabridin against ischemia/reperfusion (I/R) injury of the intestine; 2) to evaluate the in vitrocontractile responses of ileum smooth muscles to acetylcholine after an intestinal I/R; and 3) to explain the underlying molecular mechanism of its effect. Rats were assigned to groups of six rats each; 1) I/R, 2) gla10, 3) gla20, 4) gla40, 5) N5-[imino(nitroamino)methyl]-L-ornithine, methyl ester monohydrochloride (L-NAME)+gla40, and 6) Sham group. The healing effect of glabridin was abolished by L-NAME. Glabridin did not cause contractility of the smooth muscles to acetylcholine-induced contractile responses in intestinal I/R. Yet, it increased to spontaneous basal activity.

A pesar del desarrollo de la medicina moderna, la medicina alternativa, sin perder su vigencia, sigue siendo atractiva para el tratamiento de varias enfermedades. Glabradina, el flavonoide mayoritario de Glycyrrhiza glabra, es conocido por su actividad antioxidante y antiinflamatoria. Los propósitos de este estudio fueron: 1) Determinar el posible rol protector de glabradina ante daños intestinales por isquemia/reperfusion (I/R) 2) Evaluar in vitrolas respuestas de contracción de los músculos lisos del ileum ante acetilcolina después de I/R intestinal; y 3) Explicar el mecanismo molecular subyacente de este efecto. Se asignaron grupos de seis ratas: 1) I/R, 2) gla10, 3) gla20, 4) gla40, 5) N5-[imino(nitroamino)metil]-L-ornithina, metil ester monohidrochloruro (L-NAME)+gla40, y 6) Grupo testigo. El efecto curativo de glabridina fue abolido por L-NAME. Glabridina no causó contracción en el músculo liso como respuesta acetilcolina-inducida I/R. Además, incrementa la actividad basal expontánea.

Histological analysis of the intestinal wall of newborn rats submitted to hypoxia and reoxygenation to evaluate the protective effect of N-Acetylcysteine

Abstract Purpose To evaluate the effect of N-Acetylcysteine (NAC) in newborn rats submitted to hypoxia and reoxygenation (H/R) conditions in an experimental model of necrotizing enterocolitis. Methods Eight pregnant rats and their 70 cubs were used (5 groups) and exposed to H/R conditions and received NAC at different times. The animals in the H/R groups were placed in a gas chamber (100% CO2) for 10 minutes and then reoxygenated for 10 minutes (100% O2), twice a day for the first three days of life, with a six-hour span between events. On the third day of life, the animals were anesthetized, laparotomized and the intestines were resected. Results The H/R and NAC groups showed changes in the intestinal wall in relation to the number, height and width of the villi when compared to the control group (p<0.0001), but with better preservation of structures in the NAC group. There were no differences between groups regarding the number (%) of mitoses. Conclusion The administration of NAC decreased the lesions in the intestinal wall of rats submitted to H/R, therefore suggesting that this drug can be used to prevent the development of necrotizing enterocolitis in newborns.

Transplantation of Autologous Peritoneum Using Ileal Seromuscular Flaps for Orthotopic Neobladder Reconstruction / 中国医学科学院学报

To develop an ideal surgical procedure for neobladder reconstruction in experimental porcine models. Six experimental female pigs weighting 28-33 kg underwent transplantation of autologous peritoneum for bladder reconstruction under general anesthesia.The flaps were used to reconstruct the orthotopic neobladder by suturing with the edges of the triangle and neck of the remnant bladder.The ureteral catheters were removed on the 5 postoperative day and the balloon catheter was removed on the 7 postoperative day.Voiding behaviour was monitored.The animals were euthanized at week 12 for routine pathology,immunohistochemistry,and electron microscopy. All the pigs survived after the surgery,and no postoperative complication such as peritonitis,intestinal obstruction,or urinary fistula was observed.All the peritoneum-ileum composite free valves survived after transplantation.Voiding behaviour was normal after catheter removal,and the urine was clear.At autopsy,reconstructed bladders were healthy.Pathological examination showed the neobladder had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual.Scanning electron microscope showed the transitional cells of neobladder were complete and orderly,and the urothelium around suture border was continuous and showed no malposition. Reconstruction of bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach in the experimental pigs as it can prevent regrowth of ileal epithelial cells and avoid the complications of conventional enterocystoplasty.Its clinical application deserves further investigations.

Could the intestinal epithelial alterations promoted by roux-en-y gastric bypass explain higher tendency for colonic diseases in bariatric patients? / As alterações epiteliais intestinais promovidas pelo bypass em y-de-roux podem explicar maior tendência a doenças colônicas em pacientes bariátricos?

ABSTRACT Background: Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. Aim: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. Method: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. Results: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p<0.001) and in the colon (p=0.027). There was also a significant difference in relation to the height of the villus in the ileum (p<0.001) and the depth of the crypts in the jejunum (p0.001). The results indicated that there is a significant difference between the groups regarding the expression of Ki-67 in the colon (p<0.001). No significant differences were found between the groups regarding the expression of Ki-67 in the jejunum and ileum. In the P53 evaluation, negative nuclear staining was found in all cases. Conclusion: The jejunojejunal deviation performed in the Roux-in-Y gastrojejunal bypass, predispose epithelial proliferative effects, causing an increase in the thickness of the mucosa, height of the villi and depth of the crypts of the jejunum, ileum and ascending colon.

RESUMO Racional: As derivações intestinais revolucionaram o tratamento da obesidade mórbida pela sua viabilidade e resposta sustentada. Porém, estudos experimentais sugerem, após estas derivações, risco maior de câncer de cólon. Objetivo: Analisar as alterações histológicas e imunoistológicas que a derivação jejunojejunal possa produzir no jejuno, íleo e cólon ascendente. Método: Foram utilizados 24 ratos Wistar machos randomicamente divididos em dois grupos, controle (n=12) e experimento (n=12) e subdivididos em grupos de quatro. Nove semanas após a derivação jejunojejunal procedeu-se a ressecção segmentar do jejuno excluso, íleo terminal e cólon ascendente. Análise histológica focou na espessura da mucosa, altura dos vilos, profundidade das criptas e a imunoistoquímica na expressão do Ki-67 e p53. Resultados: Foram encontradas diferenças significativas entre os grupos experimento e controle em relação à espessura da mucosa no jejuno (p=0,011), no íleo (p<0,001) e no cólon (p=0,027). Também houve diferença significativa em relação à altura dos vilos no íleo (p<0,001) e profundidade das criptas no jejuno (p<0,001). Os resultados indicaram que existe diferença significativa entre os grupos em relação à expressão do Ki-67 no cólon (p<0,001). Não foram encontradas diferenças significativas entre os grupos em relação à expressão do Ki-67 no jejuno e no íleo. Na avaliação do P53, foi encontrada coloração nuclear negativa em todos os casos. Conclusão: O desvio realizado na derivação gastrojejunal em Y-de-Roux, predispõem efeitos proliferativos epiteliais, causando aumento da espessura da mucosa, altura dos vilos e profundidade das criptas do jejuno, íleo e cólon ascendente.