Síndrome de Wilkie: caso clínico / Wilkie syndrome: case report

Resumen Introducción: El síndrome de Wilkie es una causa poco frecuente de obstrucción del tracto digestivo superior, se caracteriza por una disminución del ángulo aorto-mesentérico que resulta en compresión de la tercera porción del duodeno que produce síntomas obstructivos altos. Caso Clínico: Presentamos el caso de una mujer de 64 años, con historia de dolor abdominal, pirosis, saciedad precoz e intolerancia a la vía oral, en quien los estudios iniciales mostraron esofagitis, pero en quien los síntomas no mejoraron con el tratamiento clásico para enfermedad ácido péptica y en quien estudios imagenológicos adicionales sugerían el síndrome de Wilkie como causa de los síntomas. Discusión y Conclusión: Se trata de una patología que debe conocerse y considerar en paciente con historia de pérdida de peso, marcada intolerancia a la vía oral y falta de respuesta al manejo.

Introduction: Wilkie syndrome is a rare cause of upper gastrointestinal tract obstruction, it is characterized by a decrease in the aorto-mesenteric angle that results in a compression of the third portion of the duodenum causing high obstructive symptoms. Case Report: We present the case of a 64-year-old woman, with a history of abdominal pain, heartburn, early satiety, and intolerance to the oral route, in whom initial studies showed esophagitis, but in whom symptoms did not improve with the classic treatment for peptic acid disease, additional imaging studies suggested Wilkie syndrome. Discussion and Conclusión: It is a pathology that must be known and suspected in patients with a history of weight loss, marked intolerance to oral intake, and lack of treatment response.

Fístula utero-yeyunal secundaria a migración de dispositivo intrauterino: reporte de un caso / Utero-jejunal fistula secondary to intrauterine device migration: a case report

RESUMEN El dispositivo intrauterino (DIU) es un método anticonceptivo muy popular, eficaz y seguro. Aunque posee complicaciones bien descritas como es la migración, la que puede ser a otros órganos dentro de la cavidad peritoneal. La fístula uteroyeyunal es un evento clínico poco frecuente, pero de gran repercusión si no es diagnosticada y tratada. Se presenta el caso de una paciente usuaria de DIU, el que migra a cavidad abdominal, con posterior formación de fístula uteroyeyunal.

ABSTRACT The intrauterine device is a popular, efficient and safe contraceptive. Although it has some well described complications, such as migration, which may be to the different organs inside of the peritoneal cavity. The uterus-jejunal fistula is a rare clinical event, but with great repercussion if it is not well assessed and treated properly. We present the clinical case of a patient with a migrated intrauterine device and a fistula uterus-jejunal formation.

Diverticulitis aguda de intestino delgado en un paciente con enfermedad de Crohn: Report of one case / Acute small bowel diverticulitis in a patient with crohn’s disease

Diverticular disease of the small intestine is rare, especially when it is located in the jejunum. It is generally asymptomatic, but in some patients it may have complications such as acute diverticulitis with peritonitis, gastrointestinal bleeding or obstruction. In such cases, the recommended treatment is surgery. We report a 77-year-old patient with ileal Crohn’s disease with a long-standing inflammatory phenotype, who developed acute diverticulitis of the jejunum presenting a severe septic shock and secondary multiple-organ failure. It resolved with medical treatment and prolonged antibiotic therapy.

Invaginación intestinal en adultos como manifestación de enfermedad celíaca: Caso clínico / Celiac disease presenting as an intestinal intussusception: Report of one case

Acute abdominal pain caused by perforation, intestinal lymphoma or intussusception is an uncommon manifestation in adult celiac disease. We report a 49 year-old female with history of irritable bowel syndrome and osteoporosis consulting for acute abdominal pain and severe abdominal distention. Abdominal CT scan and magnetic resonance imaging showed a jejunal intussusception and other radiological alterations that suggested the possibility of celiac disease. Serological antibodies (endomysial and transglutaminase antibodies), endoscopy and the pathological study of duodenal biopsies confirmed the diagnosis. With a gluten free diet, the patient remains asymptomatic.

Perfuração de intestino delgado por doença diverticular jejunal / Intestinal perforation in consequence of small intestine's diverticulitis

Small Intestine's diverticulosis is an uncommon pathology of intestine. It's more evident at jejune and can be complicated by intestinal perforation, obstruction or diverticulitis, increasing the mortality. We describe a forty years old female patient that arrived at emergency service complained of diffuse abdominal pain. There aren't signals of peritonitis and the radiological evaluation showed small intestine's distension. Surgical intervention was performed revealing multiples diverticulums at jejune and intestinal perforation. The aim of this article is present a case of Small Intestine's diverticulosis and its complications that had precise intervention resulting in a favorable resolution.

Hemorragia digestiva baja e intususcepción subsecuente a tumor del estroma gastrointestinal / Gastrointestinal bleeding and intussusception due to gastrointestinal stromal tumor (GIST)

Introducción: Los tumores del intestino delgado representan 25 % de las neoplasias gastrointestinales, de ellos 0.2 y 1 % corresponde a tumores del estroma gastrointestinal. Su presentación clínica más frecuente es la hemorragia digestiva, siendo los tumores del estroma gastrointestinal responsables en 1 % de los casos. Este tipo de neoplasias también puede ser el origen de intususcepción, proceso patológico infrecuente en la edad adulta por representar únicamente 5 % de todas las obstrucciones intestinales. Caso clínico: Mujer que acudió al servicio de urgencias por dolor abdominal y hemorragia digestiva baja. Las pruebas complementarias no resultaron concluyentes. Tras laparotomía exploradora se diagnosticó intususcepción y hemorragia digestiva baja subsecuente a tumor del estroma gastrointestinal. Conclusiones: La cirugía debe ser el último recurso diagnóstico y terapéutico, pero es necesaria en ocasiones debido a la dificultad para determinar la causa etiológica de la hemorragia y la obstrucción intestinal.

BACKGROUND: Small bowel tumors comprise 25% of gastrointestinal (GI) neoplasms, of which only between 0.2 and 1% correspond to gastrointestinal stromal tumors (GIST). GI bleeding is the most common presentation of GIST, being responsible in 1% of the cases. This type of neoplasm can also be the origin of an intussusception, which is an infrequent process during adult age, representing only 5% of all intestinal obstructions. CLINICAL CASE: We report a case of a patient who arrived at the emergency department due to abdominal pain and lower GI bleeding. The diagnostic process was not conclusive. After an exploratory laparotomy, the diagnosis was GI bleeding and intussusception due to GIST. CONCLUSIONS: Surgery must be the last diagnostic and therapeutic resource, but it is sometimes necessary to localize bleeding and intestinal obstruction site.

A Case of Dieulafoy Lesion in the Jejunum / 대한소화기학회지

No abstract availble.

Jejunal Intussusception with Gastrointestinal Bleeding Caused by Metastatic Lung Cancer / 대한소화기학회지

Intestinal intussusception caused by metastatic tumor is uncommon. Symptomatic small bowel metastases from lung cancer have been rarely reported. Here we report a case of intussusception with gastrointestinal bleeding induced by jejunal metastasis of non-small cell lung cancer with a review of the literature. A 52-year-old man was admitted to our hospital because of melena. He had underwent right pneumonectomy and received systemic chemotherapy with radiotherapy for squamous cell lung cancer. Esophagogastroduodenoscopy and colonoscopy failed to reveal bleeding focus. Abdominal CT scan revealed jejunal intussusception and histologic examination of resected jejunum showed metastatic mass from lung cancer. In patients with small bowel obstruction and history of malignancies, possibility of small bowel metastatic tumor should be considered.

Jejunogastric intussusception--a rare cause of recurrent upper gastrointestinal bleeding: case report and review of literature.

Jejunogastric intussusception is a known complication following gastrojejunostomy. However, only occasionally have they presented with haematemesis and we are unaware of any case where it led to recurrent haematemesis. We describe a case where the patient developed recurrent upper gastrointestinal bleeding due to recurrent episodes of jejunogastric intussusception following gastrojejunostomy performed 12 years earlier for duodenal ulcer disease.

Intussusception Secondary to Jejunal Lymphangioma in a 13-year-old Girl / 대한소화기학회지

Lymphangioma is a benign tumor composed of numerous small or large thin-walled lymphatic spaces. It shows a predilection for head, neck, and axilla. Jejunal lymphangioma in children is extremely rare. We present a case of 13-year-old girl with jejuno-jejunal intussusception secondary to lymphangioma in jejunum. To our knowledge, this is the second report of jejunal lymphangioma causing intussusception in a child.

Enteral feeding by fistuloclysis in a midjejunal fistula.

Enterocutaneous fistulas are potentially life-threatening complications of gastrointestinal surgery. Nutritional support is the mainstay of management. We report a 32-year-old man who developed an enterocutaneous fistula following surgery for ulcerative colitis. Enteral feeding was attempted by introducing a Foley's catheter through the midjejunal fistula.

Unusual causes of mechanical small bowel obstruction

We herein report our experience regarding unusual causes of bowel obstruction to increase the awareness of surgeons regarding this disease. From 1991 to 2003, we had experience at the University affiliated hospitals, northern Jordan with 24 patients with small bowel obstruction resulting from unusual causes. We retrospectively reviewed the medical records of these patients with regards to the mode of presentation, cause of obstruction, radiological and operative findings, management and outcome. We recorded 15 patients who underwent previous abdominal surgery. Preoperative diagnosis was correct in only one patient with an internal hernia, but the abdominal CT scan suggested the diagnosis in 5 of the 9 patients who had the scan. The final diagnosis was internal hernias in 11 patients, foreign bodies in 5, ischemic strictures in 3, carcinoid tumors in 2, endometriosis in 2, and metastatic deposit from interstitial bladder carcinoma in one patient. Nine of the 12 patients with recurrent obstruction had either short course or recurrence obstruction during the same hospital admission. W carried out bowel resections in 15 patients [5 resections were due to bowel strangulation]. Post operative death occurred in 4 patients. Awareness of these rare causes of intestinal obstruction even in patients with previous abdominal operation might improve the outcome. The tentative diagnosis of adhesion obstruction in patients with unusual obstructive etiology might lead to a higher rate of gangrenous complications. Rigorous preoperative evaluation including careful history and early abdominal CT may show the obstructive cause

Perforation of jejunal non Hodgkin's lymphoma.

Primary gastrointestinal lymphomas are rare. Jejunal non Hodgkin's lymphoma presenting as perforative peritonitis is extremely rare. We report a 51-year-old man who presented with perforative peritonitis and was detected to have jejunal non Hodgkin's lymphoma. He was treated with resection of the affected segment with its mesentery and postoperative chemotherapy, and was asymptomatic 5 months later.

Primary Malignant Fibrous Histiocytoma (MFH) of the Small Bowel Presenting as an Intussusception Causing Small Bowel Obstruction / 대한소화기학회지

Adult intussusception secondary to primary sarcoma is a rare cause of small bowel obstruction. Only a few cases of malignant fibrous histiocytoma (MFH) of small bowel presenting as an intussusception have been reported in the literatures. We report a case of small bowel obstruction associated with jejuno-ileal intussusception caused by MFH. A 75-year-old man was admitted with an one-month history of vomiting and epigastric pain aggravated with meals. He was diagnosed as an jejuno-ileal intussusception based on CT scanning and underwent small bowel resection and anastomosis. Resected specimens revealed a polypoid tumor in the ileum and the histology of the tumor was consistent with MFH.

Leakage of Jejunal End of Roux Limb after Total Gastrectomy: Management with a Placement of a Covered Metallic Stent: Case Report

Postoperative leakage is a serious complication in patients after gastric surgery. It can lead to a rapid deterioration in the patient's condition and quality of life. Treatment is guided by the type of anastomosis and the patient's clinical status. The role of interventional radiology in gastrointestinal tract is evolving. Metallic stent placement has shown encouraging results for the palliation of gastrointestinal tract obstruction and fistula in malignant patients. We encountered a case of the leakage of jejunal end of Roux limb after total gastrectomy. This patient required a drainage procedure with long-term parenteral nutrition. We performed peroral placement of a covered metallic stent to avoid surgery and long-term parenteral nutrition, and he resumed adequate oral intake immediately after stent placement. This minimally invasive procedure is very promising for the treatment of a gastrointestinal fistula to avoid surgery and long-term parenteral nutritional support in selected cases.

Gastrojejunocolic fistula following surgery for peptic ulcer complications: two case reports.

Two patients were admitted in the surgical unit--I of Mymensingh Medical College Hospital on January 2001 and March 2001 with the complaints of epigastric pain and discomfort, feculent eructation and fecal vomiting, diarrhoea with lienteric stools, weight loss and weakness. Both of them had previous history ulcer complications. The diagnoses of gastrojejunocolic fistula were made on the basis of history, barium enema examination and upper gastrointestinal endoscopy. Early resuscitation with correction of nutritional deficiencies, fluid and electrolyte imbalance was attempted along with blood transfusion, antibiotics and other supportive measures. But the first patient was too ill to cope up with the treatment and developed cardio-respiratory symptoms. A single stage procedure comprising of partial gastrectomy along with resection of the fistula and restoration of bowel continuity (by jejunojejunostomy, colocolostomy and closure of duodenal stump) was adopted in both patients. Early postoperative recovery was good in both but the first patient expired on 8th postoperative day from acute myocardial infarction, while the second one developed anastomotic leakage and wound infection, which were managed conservatively. On follow up the second patient was found in sound health till to date after his discharge from the hospital.