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J. coloproctol. (Rio J., Impr.) ; 41(2): 168-175, June 2021. tab, graf
Article in English | LILACS | ID: biblio-1286984


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)

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Ileostomy/adverse effects , Ileum/surgery , Postoperative Complications/epidemiology , Treatment Outcome
Arq. gastroenterol ; 58(2): 175-179, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285324


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.

Humans , Female , Adolescent , Adult , Aged , Colonoscopy , Ileum , Cross-Sectional Studies , Retrospective Studies , Endoscopy, Gastrointestinal , Middle Aged
Int. braz. j. urol ; 47(2): 426-435, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154471


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.

Humans , Male , Female , Urinary Diversion/adverse effects , Urinary Bladder Neoplasms/surgery , Postoperative Complications , Anastomosis, Surgical/adverse effects , Cystectomy/adverse effects , Follow-Up Studies , Ileum/surgery , Middle Aged
Braz. j. biol ; 81(1): 44-52, Feb. 2021. tab
Article in English | LILACS | ID: biblio-1153322


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.

Animals , Cichlids , Amino Acids , Pakistan , Diet , Digestion , Ileum , Animal Feed/analysis , Animal Nutritional Physiological Phenomena
Rev. Méd. Paraná ; 79(1): 82-84, 2021.
Article in Portuguese | LILACS | ID: biblio-1282483


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

Humans , Digestive System Fistula , Biliary Fistula , Intestinal Fistula , Gallbladder , Intestinal Obstruction , Ileum
Article in English | WPRIM | ID: wpr-922591


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.

Adult , Crohn Disease/drug therapy , Endoscopy, Gastrointestinal , Humans , Ileum , Intestinal Obstruction/etiology , Intestine, Small , Male , Middle Aged
Acta méd. colomb ; 45(3): 70-74, jul.-set. 2020. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1130702


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:

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:

Humans , Female , Adult , Crohn Disease , Intestinal Obstruction , Women , Magnetic Resonance Spectroscopy , Ileum , Intestinal Diseases
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1369-1374, July-Aug. 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131499


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)

Animals , Horses/surgery , Ileal Diseases/veterinary , Ileum/surgery , Intestinal Obstruction/urine , Laparotomy/veterinary
Prensa méd. argent ; 106(5): 313-315, 20200000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1367299


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.

Humans , Female , Aged , Gallstones , Tomography, X-Ray Computed , Diagnosis, Differential , Abdomen/surgery , Ileum/pathology , Intestinal Obstruction/surgery
Arch. argent. pediatr ; 118(3): e338-e341, jun. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1117378


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.

Humans , Male , Adolescent , Cystic Fibrosis , Intussusception/diagnostic imaging , Abdominal Pain , Ileum/surgery , Intestinal Obstruction , Intussusception/surgery
Rev. cuba. cir ; 59(2): e911, abr.-jun. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1126420


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)

Humans , Male , Aged , Fistula/surgery , Gastrointestinal Hemorrhage/diagnostic imaging , Ileum/surgery
ABCD arq. bras. cir. dig ; 33(4): e1570, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152630


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.

Humans , Animals , Male , Rats , Gastric Bypass/adverse effects , Colonic Diseases/etiology , Rats, Wistar , Ki-67 Antigen/metabolism , Ileum , Intestinal Mucosa , Intestine, Small , Intestines , Jejunum/surgery
Bol. latinoam. Caribe plantas med. aromát ; 19(6): 555-568, 2020. tab, ilus
Article in English | LILACS | ID: biblio-1284299


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.

Animals , Rats , Phenols/administration & dosage , Reperfusion Injury/drug therapy , Cyclic AMP/metabolism , Glycyrrhiza , Isoflavones/administration & dosage , Phenols/pharmacology , Rats, Wistar , Cyclic AMP/analysis , Cyclic GMP/metabolism , Oxidative Stress/drug effects , NG-Nitroarginine Methyl Ester , Ileum/drug effects , Ileum/chemistry , Isoflavones/pharmacology , Malondialdehyde/analysis , Muscle, Smooth/drug effects
Article in Chinese | WPRIM | ID: wpr-826334


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.

Animals , Cystectomy , Female , Ileum , Peritoneum , Postoperative Complications , Surgical Flaps , Swine , Urinary Bladder Neoplasms
Horiz. méd. (Impresa) ; 19(4): 70-73, Dic. 2019. ilus
Article in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-1048873


Se presenta un caso de perforación de íleon distal, posterior a la ingesta de una espina de pescado. Se realiza la presentación del caso, en relación a la sintomatología clínica, estudios realizados para el diagnóstico conciso, ecografía abdominal. Se describe técnica operatoria y se realiza una discusión del asunto y de la información obtenida en la bibliografía.

Distal ileum perforation caused by a fish bone: a case reportABSTRACT We present a case of distal ileum perforation after the ingestion of a fish bone. This case report includes the symptomatology, studies conducted for reaching a concise diagnosis, abdominal ultrasound results, and description of the operative technique. In addition, a discussion of the topic and information gathered from the literature is carried out.

Male , Intestinal Perforation , General Surgery , Ileum
Pesqui. vet. bras ; 39(4): 263-270, Apr. 2019. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1002815


Extensive literature is available about the intrinsic denervation of segments of the digestive tube through the application of CB in the serosa of the viscera. However, this technique has some disadvantages like causing peritonitis, flanges and high mortality, limiting its use in humans. The aim of the present study was to evaluate the feasibility of benzalkonium chloride (CB) to induce intrinsic chemical denervation, through applications of CB in the intramural ileum of wistar rats, as well as deepen the knowledge about the evolution of neuronal injury caused in the process. We used 40 rats, divided into two groups (control-GC and benzalkonium-GB) of 20 animals each, divided into four sub-groups according to the time of postoperative assessment of 24, 48 hours, 30 and 90 days. The animals were submitted to intramural microinjections of sterile saline solution 0.9% (GC) or benzalkonium chloride (GB) in ileal portion, and subsequent histopathological analysis and immunohistochemistry for evaluation of neuronal injury. A significant decrease (p<0.05) was found of the neuronal myenteric count over time in groups, GB3, GB4 and GB2. The specific positive immunolabeling for H2AX and Caspase-3 confirmed the results obtained in the histopathological evaluation, denoting the ignition of irreversible cell injury in 24 hours, evolving into neuronal apoptosis in 48 hours after application of the CB 0.3%. Under the conditions in which this work was conducted, it can be concluded that the application of CB 0.3% by means of microinjections intramural in the ileal wall is able to induce intrinsic chemical denervation of the diverticulum of wistar rats and that the main mechanism of neuronal death is induction of apoptosis.(AU)

Existe vasta literatura sobre a desnervação intrínseca de segmentos do tubo digestório através da aplicação de CB na serosa da víscera. Entretanto, essa técnica tem a desvantagem de causar peritonite, formação de bridas e alta mortalidade, não sendo factível para eventuais utilizações em humanos. O objetivo do presente estudo foi avaliar a viabilidade do Cloreto de benzalcônio (CB) induzir desnervação química intrínseca, por meio de aplicações intramurais em íleo de ratos wistar, além de aprofundar o conhecimento sobre a evolução da lesão neuronal causada neste processo. Foram utilizados 40 ratos, distribuídos em dois grupos (controle- GC e benzalcônio- GB) de 20 animais cada, subdivididos em quatro subgrupos de acordo com o tempo de avaliação pós-operatória de 24, 48 horas, 30 e 90 dias. Os animais foram submetidos à microinjeções intramurais de solução salina estéril 0,9% (GC) ou de cloreto de benzalcônio (GB) em porção ileal, e posterior análise histopatológica e imuno-histoquímica, para avaliação da lesão neuronal. Houve diminuição significativa (p<0,05) na contagem neuronal mientérica ao longo do tempo nos grupos GB2, GB3 e GB4. A imunomarcação específica positiva para H2AX e Caspase-3 confirmou os resultados obtidos na avaliação histopatológica, denotando início da lesão celular irreversível em 24 horas, evoluindo para apoptose neuronal em 48 horas após a aplicação do CB 0,3%. Nas condições em que este trabalho foi conduzido, é possível concluir que a aplicação de CB 0,3% por meio de microinjeções intramurais na parede ileal é capaz de induzir desnervação química intrínseca da porção ileal de ratos wistar e que o principal mecanismo de morte neuronal é a indução de apoptose.(AU)

Animals , Rats , Models, Animal , Ileum/innervation , Short Bowel Syndrome/rehabilitation , Benzalkonium Compounds/therapeutic use , Rats, Wistar , Muscle Denervation/veterinary
ABCD arq. bras. cir. dig ; 32(3): e1451, 2019. tab
Article in English | LILACS | ID: biblio-1038028


ABSTRACT Background: Hypovolemic shock is a common disease in polytrauma patients and may develop ischemia in various organs, increasing morbidity and mortality. The bowel is usually most affected by this condition. Aim: To evaluate the effects of copaiba oil on the intestinal mucosa's injury of rats submitted to hypovolemic shock. Method: Fifteen rats were divided into three groups: sham - simulated surgery; ischemia - animals submitted to hypovolemic shock; and copaiba - animals submitted to hypovolemic shock previously treated with copaiba oil. Mean blood pressure, arterial blood gas after shock induction, degree of intestinal lesion and villus length were evaluated. Results: The sham presented the lowest values of lactate and PaCO2 and the highest values of mean arterial pressure, pH and bicarbonate in relation to the other groups. The degree of mesenteric lesion was zero in the sham group; 3.00±1.00 in the ischemia group; and 3.00±0.71 in the copaiba group. The villus length was 173.60±8.42 in the sham, 142.77±8.33 in the ischemia and 143.01±9.57 in the copaiba group. There was a significant difference between the sham and the other groups (p<0.05); however, there not significant difference between groups Ischemia and copaiba. Conclusion: Administration of copaiba oil did not reduce the intestinal mucosa lesion of rats after hypovolemic shock.

RESUMO Racional: O choque hipovolêmico é situação comum em pacientes politraumatizados, podendo acarretar isquemia de vários órgãos, aumentando a morbimortalidade. O intestino é geralmente um dos órgãos mais afetados por essa condição. Objetivo: Avaliar os efeitos do óleo de copaíba na lesão da mucosa intestinal de ratos submetidos ao choque hipovolêmico. Métodos: Quinze ratos foram distribuídos em três grupos: Sham - operação simulada; isquemia - submissão ao choque hipovolêmico; e copaíba - submissão ao choque hipovolêmico previamente tratados com óleo de copaíba. A pressão arterial média, a gasometria arterial após a indução do choque, o grau da lesão intestinal e o tamanho das vilosidades foram avaliados. Resultados: O grupo sham apresentou os menores valores de lactato e PaCO2 e os maiores valores de pressão arterial média, pH e bicarbonato em relação aos demais grupos. O grau de lesão mesentérica foi de zero no sham; 3,0±1,00 no grupo isquemia; e 3,0±0,71 no da copaíba. O comprimento dos vilos foi de 173,60±8,42 no grupo sham, 142,77±8,33 no da isquemia e 143,01±9,57 no da copaíba. Houve diferença significante entre o grupo sham e os demais grupos (p<0.05); contudo, não houve diferença estatística entre os grupos submetidos ao choque hipovolêmico. Conclusão: A administração do óleo de copaíba não reduziu a lesão da mucosa intestinal de ratos submetidos ao choque hipovolêmico.

Animals , Male , Shock/drug therapy , Plant Oils/pharmacology , Intestinal Mucosa/drug effects , Fabaceae/chemistry , Anti-Inflammatory Agents/pharmacology , Plant Oils/therapeutic use , Plant Oils/chemistry , Random Allocation , Rats, Wistar , Disease Models, Animal , Ileum/pathology , Intestinal Mucosa/pathology , Ischemia/drug therapy , Anti-Inflammatory Agents/therapeutic use , Anti-Inflammatory Agents/chemistry
VozAndes ; 30(1): 37-38, 2019.
Article in Spanish | LILACS | ID: biblio-1048025


Bile ileus represents 1-4% of mechanical intestinal obstructions with greater incidence in people over 65 (25%), predominantly in women (ratio 3.5: 1) (1,2), it is characterized by the impact of a Large gallstone (≥3cm) in the intestinal lumen through a fistula (1,2). This is a 77-year-old female patient with high blood pressure controlled, which comes from diffuse abdominal pain type 24 colic hours of evolution On physical examination the distended, painful abdomen at deep palpation, without peritonism, absent hydro sounds. The abdomen x-ray with uneven levels. It was initially handled by conservative way. Tests revealed leukocytosis, and ultrasound Abdominal showed an intestinal loop occupied by hyperechogenic imaging with posterior acoustic shadow (Figure 1); it is decided to perform tomography contrasted abdominal-pelvic, evidencing lobe pneumobilia left hepatic, dilated bile duct (11 mm), duodenal distention, jejunal and transition zone with 3.2cm calcified intraluminal image (Figure 2). With these findings the behavior was surgical exploration, finding jejunal mass, located 40cm from the angle of Treitz. In the enterotomy was removed large litho causing complete obstruction (Figure 3). Next, enterorrafa was performed and the procedure concluded without complications. The patient evolved favorably and She was discharged on the third day.

Bile Ducts , Gallstones , Ileum , Intestinal Diseases
Acta cir. bras ; 34(7): e201900705, 2019. graf
Article in English | LILACS | ID: biblio-1038115


Abstract Purpose: The denervation of the intestine with benzalkonium chloride (BAC) reduces mortality and improves weight gain in rats with short bowel syndrome (SBS). Nevertheless, translating these promising findings from bench to bedside is not feasible because BAC promotes peritonitis and irreversible denervation which may be followed by an uncontrolled dilatation of the viscera. The use of botulinum toxin (BT) instead of BAC to achieve the denervation of the remaining small intestine in SBS could be an interesting option because it leads to a mild and transient denervation of the intestine. Methods: Here we evaluated the effects of the ileal denervation with BT in rats with SBS by verifying the body weight variation and intestinal morphological parameters. Four groups with 6 animals each were submitted to enterectomy with an ileal injection of saline (group E) or BT (group EBT). Control groups were submitted to simulated surgery with an ileal injection of BT (group BT) or saline (group C - control). Results: We observed that the treatment of the remaining ileum with BT completely reversed the weight loss associated to extensive small bowel resection. Conclusion: This may provide a new promising approach to the surgical treatment of SBS.

Animals , Rats , Short Bowel Syndrome/surgery , Botulinum Toxins/pharmacology , Denervation/methods , Ileum/innervation , Short Bowel Syndrome/pathology , Benzalkonium Compounds/pharmacology , Body Weight/drug effects , Rats, Wistar , Muscle Weakness/pathology , Disease Models, Animal , Ileum/pathology , Jejunum/innervation