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1.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 560-567, 01-dic-2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1357659

ABSTRACT

Introducción: el sangrado gastrointestinal de origen oscuro es una entidad poco frecuente y se reserva a los casos en los que ya se ha realizado exploración del intestino delgado (endoscópica/radiológica) sin encontrar la causa. Actualmente el estándar de oro es la videocápsula, que se ha descrito como una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las enfermedades del intestino delgado. Objetivo: describir variables demográficas, indicaciones, hallazgos, segmento explorado, tratamiento y tiempo de procedimiento quirúrgico de la enteroscopía transoperatoria en 15 pacientes con diagnóstico de sangrado de tubo digestivo de origen oscuro. Material y métodos: se incluyeron 15 pacientes adultos con el diagnóstico de sangrado de origen oscuro con panendoscopía y colonoscopía negativa a sangrado. A todos se les realizó laparotomía exploradora y enteroscopía transoperatoria con un gastroduodenoscopio. Resultados: se realizaron 15 enteroscopías transoperatorias con gastroduodenoscopio; 10 en mujeres y 5 en hombres, con promedio de edad de 67.2 años. Se exploró la tercera y cuarta porción del duodeno, yeyuno e íleon terminal. Los diagnósticos encontrados fueron enfermedad de Crohn en 1 paciente (6.66%), adenomas en 2 (13.3%), divertículo yeyunal en 6 (40%) y angiectasias en 6 casos (40%). La localización fue en yeyuno [12 casos (80%)] e íleon [3 casos (20%)]. Conclusiones: la enteroscopía intraoperatoria es una alternativa diagnóstica en el sangrado de origen oscuro cuando no se cuente con la enteroscopía doble balón o la videocápsula endoscópica.


Background: Bleeding of dark origin is a rare entity and it is reserved for cases in which exploration of the small intestine has already been performed (endoscopic / radiological) without finding the cause. Currently, the gold standard is the videocapsule which has been described as a safe, useful and effective technique for the diagnosis and treatment of diseases of the small intestine. Objective: The objective was to describe demographic variables, indications, findings, explored segment, treatment and time of the surgical procedure of the intraoperative enteroscopy in 15 patients with a diagnosis of gastrointestinal bleeding of dark origin. Material and methods: 15 adult patients with the diagnosis of bleeding of dark origin with panendoscopy and negative colonoscopy to bleeding were included. All of these underwent exploratory laparotomy and intraoperative enteroscopy with a gastroduodenoscope. Results: 15 intraoperative enteroscopies were performed with a gastroduodenoscope; 10 women and 5 men with an average age of 67.2 years. Third and fourth portions of the duodenum, jejunum, and terminal ileum were explored. The diagnoses found were Crohn's disease 1 (6.66%), Adenomas 2 (13.3%), jejunal diverticulum 6 (40%) and angiectasias in 6 cases (40%). The location was in jejunum, 12 cases (80%) and ileum, 3 cases (20%). Conclusions: Intraoperative enteroscopy is a diagnostic alternative in bleeding of dark origin when there is no double balloon enteroscopy or endoscopic video capsule.


Subject(s)
Humans , Male , Female , Surgical Procedures, Operative , Crohn Disease , Colonoscopy , Endoscopes, Gastrointestinal , Mexico , Adenoma , Diverticulum , Gastrointestinal Tract , Duodenum , Endoscopy , Hemorrhage , Intestine, Small , Jejunum , Laparotomy
2.
Rev. colomb. obstet. ginecol ; 72(2): 202-209, Apr.-June 2021. graf
Article in Spanish | LILACS | ID: biblio-1289317

ABSTRACT

Resumen Objetivos: Reportar el caso de una paciente con diagnóstico prenatal de atresia de yeyuno y hacer una revisión de la literatura en torno al resultado y al diagnóstico de esta entidad, implementando el uso de métodos no convencionales: ecografía tridimensional (3D) o resonancia magnética fetal (RM). Materiales y métodos: Se reporta el caso de una gestante de 18 años, remitida a la Unidad de Medicina Materno-Fetal, Genética y Reproducción del Hospital Virgen del Rocío de Sevilla (España), por feto con imagen quística abdominal, peristáltica, compatible con atresia de yeyuno, la cual se confirmó con ecografía 3D modo HDlive. Se realizó una búsqueda bibliográfica en Medline/PubMed, LILACS y Google Scholar, restringiendo por tipo de idioma (inglés y español) y fecha de publicación (enero de 1995 a junio de 2020). Se incluyeron estudios primarios de reportes y series de caso, que abordaran el resultado y el diagnóstico prenatal de esta patología. Resultados: La búsqueda identificó 1.033 títulos, de los cuales cuatro estudios cumplieron con los criterios de inclusión, estos fueron reporte o series de casos. En total se reportaron doce fetos con diagnóstico prenatal de atresia de yeyuno detectada con métodos no convencionales. Una gestación finalizó con óbito a la semana 26 de gestación y en todos los demás casos, el diagnóstico se ratificó durante el periodo neonatal, requiriendo la resección del segmento comprometido. Dos neonatos desarrollaron síndrome de intestino corto como consecuencia de una resección intestinal amplia. El resto experimentó una evolución posoperatoria favorable. Conclusión: La literatura disponible en torno al diagnóstico prenatal de atresia de yeyuno utilizando métodos no convencionales es escasa y se limita a reporte o series de casos. La literatura revisada sugiere que, en presencia de dilatación intestinal, la ecografía 3D y la resonancia magnética fetal podrían tener cierta utilidad a la hora de caracterizar la porción atrésica y establecer el diagnóstico diferencial. Se requieren más estudios que evalúen la utilidad diagnóstica de estas dos alternativas.


Abstract Objectives: To report the case of a patient with a prenatal diagnosis of jejunal atresia and to review the literature regarding the results and prenatal diagnosis of this entity, implementing the use of non-conventional methods (3D ultrasound or magnetic resonance imaging). Material and methods: Report of a case of an 18-year-old pregnant woman referred to the Maternal-Fetal Medicine, Genetics and Reproduction Unit of the Virgen del Rocío Hospital in Seville due to fetus with abdominal peristaltic cystic image, consistent with jejunal atresia, confirmed with 3D HDLive mode ultrasound. A bibliographic search was carried out in Medline/PubMed, Google Scholar and LILACS, restricting by type of language (English and Spanish) and date of publication (January 1995 to June 2020). Primary studies of reports and case series relating to the outcome and prenatal diagnosis of this pathology were included. Results: The search identified 1,033 titles, of which four studies met the inclusion criteria, these being reports or case series. A total of twelve fetuses with a prenatal diagnosis of jejunal atresia detected with unconventional methods were reported. In all cases, the prenatal diagnosis was confirmed during the neonatal period, which required resection of the compromised segment; one of them died and two neonates developed short bowel syndrome because of a wide bowel resection. The postoperative course in the remaining cases was favorable. Conclusion: The available literature on the prenatal diagnosis of jejunal atresia using non-conventional methods is scarce and is limited to case reports or case series. The literature reviewed suggests that, in the presence of intestinal dilation, 3D ultrasound and magnetic resonance imaging could be of some use in characterizing the atretic portion and establishing the differential diagnosis. More studies are required to evaluate the diagnostic utility of these two alternatives.


Subject(s)
Humans , Female , Pregnancy , Intestinal Atresia , Jejunum/diagnostic imaging , Prenatal Diagnosis , Ultrasonography
3.
Braz. j. med. biol. res ; 54(11): e11215, 2021. tab, graf
Article in English | LILACS | ID: biblio-1285662

ABSTRACT

This study investigated the acute blockade of endogenous melatonin (MLT) using Luzindole with or without systemic lipopolysaccharide (LPS) challenge and evaluated changes in inflammatory and oxidative stress markers in the mouse jejunum. Luzindole is an MT1/MT2 MLT receptor antagonist. Both receptors occur in the small intestine. Swiss mice were treated with either saline (0.35 mg/kg, ip), Luzindole (0.35 mg/kg, ip), LPS (1.25 mg/kg, ip), or Luzindole+LPS (0.35 and 1.25 mg/kg, ip, respectively). Jejunum samples were evaluated regarding intestinal morphometry, histopathological crypt scoring, and PAS-positive villus goblet cell counting. Inflammatory Iba-1, interleukin (IL)-1β, tumor necrosis factor (TNF)-α, nuclear factor (NF)-kB, myeloperoxidase (MPO), and oxidative stress (NP-SHs, catalase, MDA, nitrate/nitrite) markers were assessed. Mice treated with Luzindole, LPS, and Luzindole+LPS showed villus height shortening. Crypt damage was worse in the LPS group. Luzindole, LPS, and Luzindole+LPS reduced the PAS-goblet cell labeling and increased Iba-1-immunolabelled cells compared to the saline group. Immunoblotting for IL-1β, TNF-α, and NF-kB was greater in the Luzindole group. The LPS-challenged group showed higher MPO activity than the saline and Luzindole groups. Catalase was reduced in the Luzindole and Luzindole+LPS groups compared to saline. The Luzindole group showed an increase in NP-SHs, an effect related to compensatory GSH activity. The acute blockade of endogenous MLT with Luzindole induced early changes in inflammatory markers with altered intestinal morphology. The other non-detectable deleterious effects of Luzindole may be balanced by the unopposed direct action of MLT in immune cells bypassing the MT1/MT2 receptors.


Subject(s)
Animals , Rats , Lipopolysaccharides , Melatonin , Tryptamines , Inflammation/chemically induced , Jejunum
4.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1321-1328, July-Aug. 2020. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1131480

ABSTRACT

Fifteen New Zealand adult rabbits were randomly allocated into three groups: Sham-operated (group A), Ischemia and Reperfusion (group B) and Carolina Rinse Solution (CRS) (group C). Groups B and C were subjected to one hour of ischemia and two hours of reperfusion. In group C, ten minutes before reperfusion, the bowel lumen was filled with CRS, and the segment immersed in CRS. Necrosis and loss of integrity of the villi were visible in groups B and C. Edema of the submucosa and circular muscle was observed in all groups. Hemorrhage was observed in different layers for groups B and C, but group C showed more severe hemorrhage in different layers during reperfusion. All groups showed polymorphonuclear leukocyte infiltration on the base of the mucosa, submucosa, and longitudinal muscle, in addition to polymorphonuclear leukocytes margination in the mucosal and submucosal vessels. Necrosis of enterocytes, muscles, crypts of Lieberkühn and myenteric plexus was observed in groups B and C during reperfusion. Topical and intraluminal Carolina Rinse Solution did not attenuate the effects of ischemia and reperfusion in the small intestine of rabbits.(AU)


Quinze coelhos da raça Nova Zelândia foram alocados em três grupos: instrumentado (grupo A), isquemia e reperfusão (grupo B) e solução de Carolina rinse (CRS) (grupo C). Os grupos B e C foram submetidos a uma hora de isquemia e a duas horas de reperfusão. No grupo C, 10 minutos antes da reperfusão, o segmento isolado foi imerso e teve seu lúmen preenchido com CRS. Os grupos B e C apresentaram necrose e perda progressiva da integridade das vilosidades. Foi observado edema na submucosa e na camada muscular circular em todos os grupos. Nos grupos B e C, foi observada hemorragia em diferentes camadas, mas, no grupo C, a hemorragia foi mais intensa durante a reperfusão. Todos os grupos apresentaram infiltrado de PMN na base da mucosa, na submucosa e na camada muscular longitudinal e marginação de PMN nos vasos da mucosa e da submucosa. Durante a reperfusão, foi observada necrose dos enterócitos, das camadas musculares, das criptas de Lieberkühn e do plexo mioentérico nos grupos B e C. O uso tópico e intraluminal de CRS não atenuou os efeitos da isquemia e da reperfusão no intestino delgado de coelhos.(AU)


Subject(s)
Animals , Rabbits , Reperfusion/veterinary , Allopurinol/administration & dosage , Deferoxamine/administration & dosage , Glutathione/administration & dosage , Ischemia/veterinary , Jejunum/surgery
5.
Rev. ciênc. farm. básica apl ; 41: [13], 01/01/2020. tab, graf
Article in English | LILACS | ID: biblio-1128583

ABSTRACT

Aim: Since other species of the Bignoniaceae Family presented of antispasmodic activity, it was decided, by chemotaxonomic criterion, to determine the antispasmodic activity of the leaves of Arrabidaea brachypoda. Methodology: the segments of the rat jejunum were suspended in glass vats containing specific saline solution, at an appropriate temperature, and after stabilization period, were stimulated by a contractile agent to observe the inhibitory or relaxing effect of EH-FAB. Results: EH-FAB showed the presence of 10 compounds, mainly rutin and it has an antispasmodic activity as it inhibits the phasic component and relaxes the tonic component of the contraction in isolated rat jejunum. To assess the mechanism of antispasmodic action, cumulative curves to the CCh were performed in which a non-competitive antagonism was observed, due to a displacement of the control curve to the right and reduction of the maximum contraction effect (Emax). Afterward, the participation of the calcium and/or potassium channels was evaluated by increasing the extracellular potassium, and it was observed that the EH-FAB relaxed the rat jejunum, suggesting the participation of the Ca2+ channels. To corroborate that hypothesis, the EH-FAB was tested against cumulative curves to Ca2+ in a free depolarizing solution of Ca2+, and it was observed that there was a shift of the curve to the right with a reduction in Emax. Conclusions: EH-FAB presents antispasmodic activity in isolated rat jejunum and it is suggested to block the influx of Ca2+ through voltage-gated calcium channels, signaling the therapeutic potential for the treatment of colic and/or diarrhea.(AU)


Subject(s)
Animals , Male , Rats , Parasympatholytics/therapeutic use , Plant Extracts/pharmacology , Calcium Channel Blockers/pharmacology , Bignoniaceae/chemistry , Potassium , Jejunum
6.
Article in Chinese | WPRIM | ID: wpr-828629

ABSTRACT

OBJECTIVE@#To evaluate the value of capsule endoscopy in children with small intestinal diseases with hematochezia as the chief complaint.@*METHODS@#A retrospective analysis was performed on the clinical data and capsule endoscopy findings of 93 children with hematochezia who were admitted to Children's Hospital of Fudan University from May 2015 to January 2019 and underwent capsule endoscopy. According to the capsule endoscopy findings of the jejunum and the ileum, they were divided into a positive lesion group with 39 patients and a negative lesion group with 54 patients. Related clinical data and the features of lesion on capsule endoscopy were analyzed for the two groups.@*RESULTS@#There were no significant differences in age, sex, duration of capsule endoscopy, gastric transit time, and small intestinal transit time between the positive lesion and negative lesion groups (P>0.05). The positive lesion group had a significantly lower level of hemoglobin than the negative lesion group (P<0.05). Hemoglobin level was negatively correlated with the rate of positive lesions on capsule endoscopy (r=-0.342, P=0.001). Among the 39 patients with positive lesions on capsule endoscopy, the detection of Meckel's diverticulum was the highest (41%), followed by inflammatory bowel disease (21%).@*CONCLUSIONS@#Capsule endoscopy has a certain value in detecting small intestinal diseases, especially diseases in the jejunum and the ileum, in children with lower gastrointestinal hemorrhage.


Subject(s)
Capsule Endoscopy , Child , Gastrointestinal Hemorrhage , Humans , Intestinal Diseases , Jejunum , Meckel Diverticulum , Retrospective Studies
7.
ABCD arq. bras. cir. dig ; 33(4): e1570, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152630

ABSTRACT

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.


Subject(s)
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
8.
Arq. gastroenterol ; 56(4): 405-411, Oct.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1055165

ABSTRACT

ABSTRACT BACKGROUND: Serotonin (5-HT) is present in the epithelial enterochromaffin cells (EC), mast cells of the lamina propria and enteric neurons. The 5-HT is involved in regulating motility, secretion, gut sensation, immune system and inflammation. OBJECTIVE: Evaluate the effects of diabetes and quercetin supplementation on serotoninergic cells and its cell loss by apoptosis in jejunal mucosa of streptozotocin-induced diabetic rats (STZ-rats). METHODS: Twenty-four male Wistar rats were divided into four groups: normoglycemic (C), normoglycemic supplemented with 40 mg/day quercetin (Q), diabetic (D) and diabetic supplemented with 40 mg/day quercetin (DQ). After 120 days, the jejunum was collected and fixated in Zamboni's solution for 18 h. After obtaining cryosections, immunohistochemistry was performed to label 5-HT and caspase-3. Quantification of 5-HT and caspase-3 immunoreactive (IR) cells in the lamina propria, villi and crypts were performed. RESULTS: The diabetic condition displayed an increase of the number of 5-HT-IR cells in villi and crypts, while decreased number of these cells was observed in lamina propria in the jejunum of STZ-rats. In the diabetic animals, an increased density of apoptotic cells in epithelial villi and crypts of the jejunum was observed, whereas a decreased number of caspase-3-IR cells was observed in lamina propria. Possibly, quercetin supplementation slightly suppressed the apoptosis phenomena in the epithelial villi and crypts of the STZ-rats, however the opposite effect was observed on the 5-HT-IR cells of the lamina propria. Quercetin supplementation on healthy animals promoted few changes of serotoninergic function and apoptotic stimuli. CONCLUSION: These results suggest that quercetin supplementation mostly improved the serotonergic function affected by diabetes maybe due to antioxidant and anti-inflammatory properties of quercetin.


RESUMO CONTEXTO: A serotonina (5-HT) está presente nas células epiteliais enterocromafins (CE), nos mastócitos da lâmina própria e nos neurônios entéricos. A 5-HT está envolvida na regulação da motilidade, secreção, nocepção intestinal, sistema imunológico e inflamação. Objetivo: Avaliar os efeitos do diabetes e da suplementação de quercetina sobre a função serotoninérgica e a perda celular por apoptose na mucosa jejunal de ratos diabéticos induzidos por estreptozotocina (ratos STZ). MÉTODOS: Vinte e quatro ratos Wistar machos foram divididos em quatro grupos: normoglicêmico (C), normoglicêmico suplementado com quercetina 40 mg/dia (Q), diabético (D) e diabético suplementado com quercetina 40 mg/dia (DQ). Após 120 dias, o jejuno foi coletado e fixado na solução de Zamboni por 18 horas. Após a obtenção de cortes em criostato, a imuno-histoquímica foi realizada para marcar 5-HT e caspase-3. A quantificação de células imunorreativas (IR) à 5-HT e caspase-3 foram realizadas na lâmina própria, vilosidades e criptas. RESULTADOS: A condição diabética ocasionou um aumento do número de células 5-HT-IR nas vilosidades e criptas, enquanto que na lâmina própria houve uma redução dessas células, no jejuno de ratos STZ. Nos animais diabéticos, foi observada uma densidade aumentada de células apoptóticas no epitélio do jejuno, tanto nas vilosidades quanto nas criptas, por outro lado um número reduzido de células caspase-3-IR foi observado na lâmina própria. Possivelmente, a suplementação de quercetina suprimiu ligeiramente os fenômenos de apoptose no epitélio de vilosidades e criptas do jejuno de ratos STZ, no entanto, o efeito oposto foi observado nas células 5-HT-IR da lâmina própria. A suplementação com quercetina em animais saudáveis promoveu poucas alterações na função serotoninérgica e nos estímulos apoptóticos. CONCLUSÃO: Estes resultados sugerem que a suplementação de quercetina melhorou principalmente a função serotoninérgica afetada pelo diabetes, talvez devido às propriedades antioxidantes e anti-inflamatórias da quercetina.


Subject(s)
Animals , Male , Rats , Quercetin/administration & dosage , Serotonin/metabolism , Apoptosis/drug effects , Dietary Supplements , Diabetes Mellitus, Experimental/drug therapy , Caspase 3/metabolism , Jejunum/pathology , Antioxidants/administration & dosage , Immunohistochemistry , Rats, Wistar , Diabetes Mellitus, Experimental/pathology , Interstitial Cells of Cajal/drug effects , Interstitial Cells of Cajal/pathology , Intestinal Mucosa/drug effects , Jejunum/drug effects
9.
Rev. colomb. gastroenterol ; 34(2): 202-206, abr.-jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013937

ABSTRACT

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


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


Subject(s)
Humans , Male , Aged , Diverticular Diseases , Intestinal Perforation , Jejunum , Abdominal Pain , Diverticulum
10.
Bol. latinoam. Caribe plantas med. aromát ; 18(2): 204-222, mar. 2019. ilus
Article in English | LILACS | ID: biblio-1007819

ABSTRACT

To explore the mechanistic basis behind smooth muscle relaxant prospective of Bismarckia nobilis in gastrointestinal, respiratory and cardiovascular ailments. The methanolic extract of B. nobilis and sub-fractions have been evaluated in vitro rabbit isolated tissues, in vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice. The B. nobilis extract relaxed spontaneous and K+(80 mM)- induced contractions in rabbit isolated jejunum preparations, CCh (1 µM) and K+ (80 mM)-induced contractions in tracheal and bladder preparations, PE (1 µM) and K+ (80 mM)-induced concentrations in aorta preparations, likewise verapamil. Spasmolytic activity of dichloromethane fraction is stronger as compared to aqueous fraction. In vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice further supported spasmolytic activity. B. nobilis extract possess anti-spasmodic, anti-diarrheal, airway relaxant and vasodilator activities possible mediated through calcium channel blocking mechanism, justifying therapeutic utility of B. nobilis in diarrhea, asthma and hypertension.


El objetivo de trabajo fue explorar el mecanismo de acción relacionado con el efecto relajante del músculo liso inducido por Bismarckia nobilis (B. nobilis) en enfermedades gastrointestinales, respiratorias y cardiovasculares. El extracto metanólico de B. nobilis y subfracciones fue evaluado in vitro en tejidos aislados de conejos. Además se evaluó diarrea in vivo inducida con aceite de ricino en ratas y la actividad de harina de carbón vegetal en ratones. El extracto de B. nobilis relajó tanto las contracciones espontáneas como las inducidas por K+(80 mM) en preparaciones de yeyuno aisladas de conejos, las contracciones inducidas por PE (1 µM) y K+(80 mM) inducidas en preparaciones de aorta; de manera similar a verapamilo. La actividad espasmolítica de la fracción de diclorometano es más potente en comparación con la fracción acuosa. La diarrea inducida in vivo por el aceite de ricino en ratas y la actividad de la harina de carbón vegetal en ratones apoyaron aún más la actividad espasmolítica. El extracto de B. nobilis posee actividades antiespasmódicas, antidiarreicas, relajantes de las vías respiratorias y vasodilatadoras, posibles a través del mecanismo de bloqueo de los canales de calcio, lo que justifica la utilidad terapéutica de B. nobilis en la diarrea, el asma y la hipertensión.


Subject(s)
Animals , Rabbits , Rats , Plant Extracts/pharmacology , Anti-Asthmatic Agents/pharmacology , Arecaceae , Antidiarrheals/pharmacology , Antihypertensive Agents/pharmacology , Aorta/drug effects , Asthma/metabolism , Trachea/drug effects , Calcium Channel Blockers/pharmacology , Diarrhea/metabolism , Methanol , Hypotension/metabolism , Jejunum/drug effects , Muscle Relaxation/drug effects , Muscle, Smooth/drug effects
11.
Rev. colomb. cir ; 34(1): 69-74, 20190000. fig
Article in Spanish | LILACS | ID: biblio-982077

ABSTRACT

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


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


Subject(s)
Humans , Jejunum , Diverticulum , Abdomen, Acute , Intestinal Obstruction
12.
Article in Korean | WPRIM | ID: wpr-742133

ABSTRACT

After gastrojejunostomy, a small space can occur between the jejunum at the anastomosis site, the transverse mesocolon, and retroperitoneum, which may cause an intestinal hernia. This report presents a rare case of intestinal ischemic necrosis caused by retroanastomotic hernia after subtotal gastrectomy. A 56-year-old male was admitted to Kangwon National University Hospital with melena, abdominal pain, and nausea. His only relevant medical history was gastrectomy due to stomach cancer. Endoscopic findings revealed subtotal gastrectomy with Billroth-II reconstruction and a bluish edematous mucosal change with necrotic tissue in afferent and efferent loops including the anastomosis site. Abdominopelvic CT showed strangulation of proximal small bowel loops due to mesenteric torsion and thickening of the wall of the gastric remnant. Emergency laparotomy was performed. Surgical findings revealed the internal hernia through the defect behind the anastomosis site with strangulation of the jejunum between 20 cm below the Treitz ligament and the proximal ileum. Roux-en-Y anastomosis was performed, and he was discharged without complication. Retroanastomotic hernia, also called Petersen's space hernia, is a rare complication after gastric surgery, cannot be easily recognized, and leads to strangulation.


Subject(s)
Abdominal Pain , Anastomosis, Roux-en-Y , Emergencies , Gastrectomy , Gastric Bypass , Gastric Stump , Hernia , Humans , Ileum , Ischemia , Jejunum , Laparotomy , Ligaments , Male , Melena , Mesocolon , Middle Aged , Nausea , Necrosis , Stomach Neoplasms
13.
Article in English | WPRIM | ID: wpr-740769

ABSTRACT

BACKGROUND/AIMS: High-resolution methods have advanced esophageal and anorectal manometry interpretation but are incompletely established for intestinal manometry. We characterized normal fasting duodeno-jejunal manometry parameters not measurable by standard techniques using clustered closely-spaced recordings. METHODS: Ten fasting recordings were performed in 8 healthy controls using catheters with 3–4 gastrointestinal manometry clusters with 1–2 cm channel spacing. Migrating motor complex phase III characteristics were quantified. Spatial-temporal contour plots measured propagation direction and velocity of individual contractions. Coupling was defined by pressure peak continuity within clusters. RESULTS: Twenty-three phase III complexes (11 antral, 12 intestinal origin) with 157 (95% CI, 104–211) minute periodicities, 6.99 (6.25–7.74) minute durations, 10.92 (10.68–11.16) cycle/minute frequencies, 73.6 (67.7–79.5) mmHg maximal amplitudes, and 4.20 (3.18–5.22) cm/minute propagation velocities were recorded. Coupling of individual contractions was 39.1% (32.1–46.1); 63.0% (54.4–71.6) of contractions were antegrade and 32.8% (24.1–41.5) were retrograde. Individual phase III contractions propagated > 35 fold faster (2.48 cm/sec; 95% CI, 2.25–2.71) than complexes themselves. Phase III complexes beyond the proximal jejunum were longer in duration (P = 0.025) and had poorer contractile coupling (P = 0.025) than proximal complexes. Coupling was greater with 1 cm channel spacing vs 2 cm (P < 0.001). CONCLUSIONS: Intestinal manometry using clustered closely-spaced pressure ports characterizes novel antegrade and retrograde propagation and coupling properties which degrade in more distal jejunal segments. Coupling is greater with more closely-spaced recordings. Applying similar methods to dysmotility syndromes will define the relevance of these methods.


Subject(s)
Catheters , Fasting , Intestines , Jejunum , Manometry , Muscle Contraction , Myoelectric Complex, Migrating , Periodicity
15.
Article in English | WPRIM | ID: wpr-786095

ABSTRACT

PURPOSE: To report our initial experience with laparoscopic mini-gastric bypass (LMGB) in Korean obese patients.MATERIALS AND METHODS: From July 2016 to February 2018, 14 male patients underwent LMGB for morbid obesity at a single institution. Five trocars were placed in a U-shape formation and 1 trocar was placed at the epigastrium as a liver retractor; a window was created between the vagal nerve and lesser curvature at the gastric angle for entering the lesser sac; a narrow gastric tube (~100–120 ml volume) was made; a linear-stapled gastrojejunostomy was created after bypassing the jejunum 200 cm from the Treitz' ligament; and the Petersen defect was closed to prevent internal hernia. Patient demographics, operative time, estimated blood loss, postoperative hospital stay, complications, weight loss, and resolution of comorbidities were evaluated during 1 year of follow-up.RESULTS: All procedures were successful by laparoscopy. The average age was 29 (19–49) years; weight, 164.9 (127-250) kg; and body mass index, 51.0 (42.4–81.6) kg/m². In 1 case, nephrectomy was simultaneously performed for early renal cell carcinoma. The mean operative time was 148.8 (120-175) min. The mean postoperative hospital stay was 1.9 (1–4) days. The percentage excess weight loss at 1, 3, 6, 9, and 12 months was 16.6%, 31.0%, 41.4%, 45.4%, and 50.4%, respectively. The resolution rate of type 2 diabetes mellitus, hypertension, and dyslipidemia was 75%, 40%, and 66.7%, respectively. There was no major complication including mortality during the follow-up.CONCLUSION: LMGB is a technically simple, safe, and effective procedure in Korean obese patients.


Subject(s)
Bariatric Surgery , Body Mass Index , Carcinoma, Renal Cell , Comorbidity , Demography , Diabetes Mellitus, Type 2 , Dyslipidemias , Follow-Up Studies , Gastric Bypass , Hernia , Humans , Hypertension , Jejunum , Laparoscopy , Length of Stay , Ligaments , Liver , Male , Mortality , Nephrectomy , Obesity, Morbid , Operative Time , Peritoneal Cavity , Postoperative Hemorrhage , Surgical Instruments , Weight Loss
16.
Article in Chinese | WPRIM | ID: wpr-774427

ABSTRACT

OBJECTIVE@#To explore the safety, feasibility and short-term efficacy of intracavitary uncut Roux-en-Y (URY) anastomosis in digestive tract reconstruction following laparoscopic total gastrectomy (LTG).@*METHODS@#From November 2015 to January 2018, 67 gastric cancer patients underwent intracavitary URY following LTG to reconstruct the digestive tract at Oncological Surgery Department of Fujian Provincial Hospital. There were 41 males and 26 females with age of 50 to 81 (61.9±7.4) years and body mass index (BMI) of (23.4±3.2) kg/m². Among 67 patients, 19 were gastric cardia carcinomas, 33 were gastric body carcinomas, and 15 were gastric fundus carcinomas; tumor size was (3.4±2.3) cm; 22 were Borrmann type I, 15 were type II, 21 were type III, and 19 were type IV; 29 were highly or moderately differentiated adenocarcinoma, 23 were lowly differentiated adenocarcinoma, and 15 were signet-ring cell carcinoma. After conventional laparoscopic D2 radical gastrectomy, the duodenum was closed and dissociated at 2 cm below the pyloric ring using the Echelon-flex endoscopic articulated linear Endo-GIA stapler, and the esophagus was dissociated above the esophagogastric junction (EGJ).URY and digestive tract reconstruction were performed under the direct vision of laparoscope: (1) Side-to-side esophagojejunostomy: An incision of 0.5 cm was made in the left lower edge of the esophageal closed end; jejunum about 25 cm distal away from the Treitz ligament was elevated to the lower end of esophagus; another incision of 0.5 cm was made in the contralateral of mesenteric side; both arms of the linear Endo-GIA stapler were inserted into the windows opened through esophagus and jejunum respectively to complete side-to-side anastomosis. The common opening of esophagus and jejunum was closed to complete esophagojejunostomy, forming the chyme outflow tract. (2) Side-to-side Braun jejunojejunostomy: Incisions of 0.5 cm were made in the proximal jejunum about 10 cm away from the esophagojejunal anastomosis and 35-40 cm away from the contralateral of mesenteric side of distal jejunum respectively for proximal-distal side-to-side jejunojejunostomy. The common opening was closed to form the biliopancreatic duodenal juice outflow tract. (3) Closure of the input loop jejunum in the esophagojejunal anastomosis: The input loop jejunum 2-3 cm away from the esophagojejunal anastomosis was closed using the non-blade linear stapler (ATS45NK), and the biliopancreatic duodenal juice reflux was blocked. Clinical data of these patients were collected for retrospective case series study. Surgical and digestive tract functional recovery, perioperative complications, as well as postoperative nutritional status were observed. Moreover, related indexes, such as anastomosis function and tumor recurrence were evaluated through endoscopic and imaging examinations during postoperative follows-up.@*RESULTS@#All the 67 patients completed the surgery successfully. The mean operative time was (259.4±38.5) minutes, digestive tract reconstruction time was (38.2±13.2) minutes, intraoperative blood loss was (73.4±38.4) ml, and number of harvested lymph node was 36.2±14.2. The mean distance from upper resection margin to upper tumor edge was (3.3±1.2) cm, distance from upper resection margin to dentate line was (1.2±0.7) cm, and 1 case had positive upper incisal margin, which became negative after the second resection. Moreover, the average length of the auxiliary incision was (3.2±0.4) cm. The mean postoperative intestinal exhaust time was (52.8±26.4) hours, time to liquid diet was (64.8±28.8) hours, and postoperative hospital stay was (8.4±2.5) days. The morbidity of postoperative complication was 10.4%(7/67). Among these 7 cases, 4 cases were grade IIIa of Clavien-Dindo classification, including 2 with esophagojejunal anastomosis leakage, 1 with duodenal stump leakage, and 1 with abdominal infection, and all these patients were recovered after conservative treatment. All the 67 patients were followed up. The mean nutrition index 12 months after surgery was 53.4±4.2, diameter of esophagojejunal anastomosis was (3.9±0.6) cm, the incidence of Roux-en-Y stasis syndrome was 3.0% (2/67), and the incidence of reflux esophagitis was 4.5% (3/67). No patient had recanalization of the closed input loop of esophagojejunal anastomosis, anastomotic stenosis, obstruction, or tumor recurrence at anastomosis.@*CONCLUSION@#Intracavitary URY anastomosis following LTG for digestive tract reconstruction is safe and feasible, leading to fast postoperative recovery of digestive tract function and favorable short-term efficacy.


Subject(s)
Anastomosis, Roux-en-Y , Methods , Anastomosis, Surgical , Female , Gastrectomy , Methods , Humans , Jejunum , Laparoscopy , Male , Retrospective Studies , Stomach Neoplasms , General Surgery
17.
Article in Korean | WPRIM | ID: wpr-787173

ABSTRACT

A trichobezoar is a type of bezoar that is composed of hair. In most cases, it is confined to the stomach, but in rare cases, it may extend to the small intestine. This condition is referred to as Rapunzel syndrome. The therapeutic method for bezoar removal depends on its type, location, and size. Generally, the treatment for Rapunzel syndrome involves surgical laparotomy. Endoscopic removal has also been effective in some cases. On the other hand, complications, such as respiratory difficulty and esophageal impaction may be encountered during endoscopic removal. Until now, the successful endoscopic removal of trichobezoars has been limited to the stomach or duodenum. This paper reports the case of a 4-year-old female patient with Rapunzel syndrome whose trichobezoar reached the proximal jejunum. The trichobezoar was removed without complications using an electrosurgical knife and snare through a single-balloon enteroscopy. The trichobezoar can be removed successfully using enteroscopy under general anesthesia without abdominal laparotomy in young children. Therefore, this method of removal can be considered preferentially for children with Rapunzel syndrome.


Subject(s)
Anesthesia, General , Bezoars , Child , Child, Preschool , Duodenum , Female , Hair , Hand , Humans , Intestine, Small , Jejunum , Laparotomy , Methods , SNARE Proteins , Stomach
18.
Article in English | WPRIM | ID: wpr-765948

ABSTRACT

BACKGROUND/AIMS: Motility disorders are common and may affect the entire gastrointestinal (GI) tract but current treatment is limited. Multilocular sensing of GI electrical activity and variable electrical stimulation (ES) is a promising option. The aim of our study is to investigate the effects of adjustable ES on poststimulatory spike activities in 5 GI segments. METHODS: Six acute porcine experiments were performed with direct ES by 4 ES parameter sets (30 seconds, 25 mA, 500 microseconds or 1000 microseconds, 30 Hz or 130 Hz) applied through subserosal electrodes in the stomach, duodenum, ileum, jejunum, and colon. Multi-channel electromyography of baseline and post-stimulatory GI electrical activity were recorded for 3 minutes with hook needle and hook-wire electrodes. Spike activities were algorithmically calculated, visualized in a heat map, and tested for significance by Poisson analysis. RESULTS: Post-stimulatory spike activities were markedly increased in the stomach (7 of 24 test results), duodenum (8 of 24), jejunum (23 of 24), ileum (18 of 24), and colon (5 of 24). ES parameter analysis revealed that 80.0% of the GI parts (all but duodenum) required a pulse width of 1000 microseconds, and 60.0% (all but jejunum and colon) required 130 Hz frequency for maximum spike activity. Five reaction patterns were distinguished, with 30.0% earlier responses (type I), 42.5% later or mixed type responses (type II, III, and X), and 27.5% non-significant responses (type 0). CONCLUSIONS: Multilocular ES with variable ES parameters is feasible and may significantly modulate GI electrical activity. Automated electromyography analysis revealed complex reaction patterns in the 5 examined GI segments.


Subject(s)
Colon , Duodenum , Electric Stimulation , Electrodes , Electromyography , Gastrointestinal Tract , Hot Temperature , Ileum , Jejunum , Needles , Stomach , Theranostic Nanomedicine
19.
Article in English | WPRIM | ID: wpr-760867

ABSTRACT

Waardenburg syndrome (WS) type IV is characterized by pigmentary abnormalities, deafness and Hirschsprung's disease. This syndrome can be triggered by dysregulation of the SOX10 gene, which belongs to the SOX (SRY-related high-mobility group-box) family of genes. We discuss the first known case of a SOX10 frameshift mutation variant defined as c.895delC causing WS type IV without Hirschsprung's disease. This female patient of unrelated Kuwaiti parents, who tested negative for cystic fibrosis and Hirschsprung's disease, was born with meconium ileus and malrotation and had multiple surgical complications likely due to chronic intestinal pseudo-obstruction. These complications included small intestinal necrosis requiring resection, development of a spontaneous fistula between the duodenum and jejunum after being left in discontinuity, and short gut syndrome. This case and previously reported cases demonstrate that SOX10 gene sequencing is a consideration in WS patients without aganglionosis but with intestinal dysfunction.


Subject(s)
Cystic Fibrosis , Deafness , Duodenum , Female , Fistula , Frameshift Mutation , Hirschsprung Disease , Humans , Ileus , Intestinal Pseudo-Obstruction , Jejunum , Meconium , Necrosis , Parents , Waardenburg Syndrome
20.
Article in Korean | WPRIM | ID: wpr-761586

ABSTRACT

The prevalence of small bowel cancer is relatively low. The abdominal pain that patients with small bowel cancer present as a symptom is non-specific and often interpreted as a normal finding on radiographic studies. To prevent delayed diagnosis of small bowel cancer, practitioners must maintain a certain level of suspicion. We report a case of delayed diagnosis of jejunal cancer as it was misdiagnosed as gastroparesis. A 69-year-old woman complained of recurrent nausea and vomiting. At the beginning of her hospitalization, we could not diagnose mechanical obstruction through esophagogastroduodenoscopy and abdominal computed tomography. A gastric emptying study revealed delayed gastric emptying. Although the patients received treatments, including administration of prokinetics and botulinum toxin injection, for gastroparesis, her symptoms aggravated. Subsequently, plain radiography of the abdomen revealed a double-bubble sign. Abdominal computed tomography was performed under the suspicion of small bowel obstruction; however, the diagnosis was not clear. Consequently, exploratory laparoscopy was performed. She underwent surgical management, including small bowel segmental resection and duodenojejunostomy, due to the jejunal mass with involvement of the stomach, pancreatic head, and mesentery of the transverse colon. The postoperative pathological results revealed a moderately differentiated adenocarcinoma of the jejunum.


Subject(s)
Abdomen , Abdominal Pain , Adenocarcinoma , Aged , Botulinum Toxins , Colon, Transverse , Delayed Diagnosis , Diagnosis , Endoscopy, Digestive System , Female , Gastric Emptying , Gastroparesis , Head , Hospitalization , Humans , Jejunal Neoplasms , Jejunum , Laparoscopy , Mesentery , Nausea , Prevalence , Radiography , Stomach , Vomiting
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