Diagnóstico de divertículo de Meckel mediante cápsula endoscópica / Diagnose of Meckel's diverticulum through endoscopic capsule

Meckel's diverticulum can be present in up to 1.2% of the population. It is usually diagnosed as an imaging finding, but it can present with complications such as digestive bleeding, intestinal obstruction, diverticulitis, ulcers, and perforation, more frequently in childhood or infancy. The diagnosis workup for this condition will depend on their clinical manifestation, the most frequent being gastrointestinal bleeding of obscure origin or small intestinal bleeding. In this context, although capsule endoscopy is the preferred technique, its diagnostic yield for the detection of Meckel's diverticulum is not entirely clear and it has not been compared in a controlled studies with other diagnostic methods. Here we report the diagnosis of a Meckel diverticulum and its intestinal complications by means of capsule endoscopy in a patient with iron deficiency anemia and gastrointestinal bleeding

El divertículo de Meckel puede estar presente en el 1,2% de la población general. Usualmente es diagnosticado como un hallazgo, pero puede presentarse con mayor frecuencia en la niñez o infancia por sus complicaciones como hemorragia digestiva, obstrucción intestinal, diverticulitis, úlceras y perforación. El enfrentamiento diagnóstico de esta condición dependerá de la manifestación clínica, siendo lo más frecuente hemorragia digestiva de origen oscuro o de intestino delgado. En este contexto, si bien la cápsula endoscópica es la técnica de elección, su rendimiento diagnóstico para la detección del divertículo de Meckel no es del todo claro y no ha sido comparado de forma controlada con otras técnicas diagnósticas. En el presente caso se reporta el diagnóstico de un divertículo de Meckel y sus complicaciones intestinales mediante cápsula endoscópica en una paciente con anemia ferropriva y hemorragia digestiva.

Clinical analysis of 180 cases of primary small intestinal tumor / 中华消化杂志

Objective To improve the knowledge and early diagnostic rate of primary small intestinal tumor.Methods From August 2012 to August 2017,hospitalized patients with pathological diagnosis of primary small intestinal tumor (excluding duodenal neoplasm) from Peking Union Medical College Hospital were retrospectively enrolled.The data of clinical manifestations,laboratory examinations,imaging,endoscopy examination,pathological findings and treatment were collected and analyzed.Results A total of 180 patients with primary small intestinal tumor were enrolled.The common clinical manifestations included abdominal pain (76 cases,42.2 ％),gastrointestinal bleeding (64 cases,35.6％),and abdominal distension (30 cases,16.7％),and 22 (12.2％) patients had no overt clinical symptoms.The sensitivity of carbohydrate antigen 19-9 (CA19-9) in the diagnosis of small bowel adenocarcinoma was 57.1％ (12/21).The diagnostic rates of computed tomography enterodysis (CTE),positron-emission computed tomography (PET)/computed tomography (CT),and abdominopelvic enhanced CT were 96.5％ (83/86),100.0％ (29/29),and 91.5％ (43/47),respectively.The diagnostic small intestinal tumor patients of barium radiography (14 cases),abdominopelvic magnetic resonance imaging (MRI) (eight cases),small bowel endoscopy (18 cases) and capsule endoscopy (eight cases) were seven,six,fifteen and six cases,respectively.Among 180 patients,14 (7.8％) patients were considered gynecological tumors by imaging examination before surgery,seven (3.9％) patients underwent emergency operation because of intestinal obstruction,four (2.2％) patients underwent emergency surgery due to gastrointestinal bleeding,and four (2.2％) patients underwent emergency surgery because of intestinal perforation.Histopathological type included gastrointestinal stromal tumor (117 cases,65.0％),lymphoma (25 cases,13.9％) and adenocarcinomas (21 cases,11.7％).Except seven patients with intestinal lymphoma who received chemotherapy,the rest 173 patients underwent surgical resection.Conclusions Primary small bowel tumor has no specific clinical manifestations.It should be alert on patients without positive findings by regular gastroendoscopy and colonendoscopy examination but with symptoms of abdominal pain,gastrointestinal bleeding and intestinal obstruction.CTE should be the first choice for patients with symptoms but unclear diagnosis.

Lymphocytic colitis complicated by a mass in the terminal ileum

Lymphocytic colitis is a chronic inflammatory disease affecting the bowel. The clinical course of lymphocytic colitis is believed to be benign with watery diarrhoea. We report herein what is, to the best of our knowledge, the first case of lymphocytic colitis complicated by a terminal ileal mass. A 23-year-old man presented with diarrhoea. Blind biopsies of samples taken from the terminal ileum, caecum and ascending colon showed features of lymphocytic colitis. He declined treatment with budesonide or 5-aminosalicylates. He presented 14 months later with pain over the right lumbar region and nausea. Computed tomographic enteroclysis showed a focal soft tissue enhancing mass at the terminal ileum. Excision of the soft tissue mass revealed that it was reactive nodular lymphoid hyperplasia with fibrous granulation tissue. In conclusion, an untreated lymphocytic colitis may result in the formation of an inflammatory mass lesion.

Application of oral administration of mannitol and intramuscular injection of anisodamine in magnetic resonance enteroclysis / 现代临床护理

ObjectiveTo study the effects of oral administration of mannitol and intramuscular injection of anisodamine in magnetic resonance enteroclysis.Methods After complete intestinal cleaning,29 patients undergoing magnetic resonance enteroclysis were orally administered with 5% oral isotonic mannitol solution 2000 mL and treated with intramuscular injection of anisodamine before the operation.The adverse reactions were observed,the image quality was inspected and the dilatation of small bowel was detected.Results All of the patients lived through the magnetic resonance enteroclysis.Two patients contracted Crohn’s disease with mild nausea consciousness.Conclusion For magnetic resonance imaging,preoperative oral administration of 2.5% oral isotonic mannitol solution and intramuscular injection of anisodamine after complete intestinal cleaning is beneficial for fully expanding the small intestine,achieving quality imaging and therefore improving the diagnosis of small intestinal lesions.

La Tomografía Computarizada en la evaluación de la afección inflamatoria intestinal / Computed Tomography in the assessment of inflammatory bowel disease

Introducción: las técnicas de imagen tienen un importante papel en el diagnóstico de la enfermedad inflamatoria intestinal constituyendo la Tomografía Computarizada una técnica novedosa por su amplia perspectiva. Objetivos: describir la importancia de la Tomografía Computarizada en la valoración de la enfermedad inflamatoria intestinal e identificar los principales signos tomográficos de esta condición mediante la caracterización de la Enfermedad de Crohn. Material y Métodos: se realizó una búsqueda bibliográfica automatizada consultando las bases de datos de sistemas MEDLINE (motor de búsqueda PubMed) seleccionando aquellas más recientes y de mayor relevancia, preferentemente publicadas en el período del 2007 al 2012 utilizando como descriptores: enterografía por Tomografía Computarizada, enteroclisis por Tomografía Computarizada y Enfermedad de Crohn. Posteriormente, tras un proceso de análisis y síntesis se realizó la redacción del artículo. Desarrollo: se efectúa enfoque comparativo de las principales técnicas por imagen utilizadas en la enfermedad inflamatoria intestinal resaltando la utilidad de la Tomografía Computarizada en la valoración de la pared y lesiones extraluminales asociadas. Además son enunciados los principales hallazgos tomográficos en el diagnóstico, evolución y complicaciones de las mismas teniendo como entidad tipo la Enfermedad de Crohn. Conclusiones: la Tomografía Computarizada constituye una técnica novedosa en la valoración de la enfermedad inflamatoria intestinal, al superar las técnicas convencionales. Además nuevas generaciones de tomógrafos multicorte permitirán mejor valoración de los cambios morfológicos estructurales.

Introduction: image techniques play an important role in the diagnosis of inflammatory bowel diseases and computerized tomography constitutes a novel technique due to its wide scope. Objectives: to describe the importance of computed tomography in the assessment of inflammatory bowel disease and identify the tomographic findings by means of characterising features of Crohn´s disease. Material and Methods: it was made a review through automatized data base MEDLINE (PubMed as search engine) using computed tomography enterography, computed tomography enteroclysis and Crohn´s disease as descriptors. The review was based on the critical analysis of relevant publications, most appearing from 2007 to 2012 . Development: in the present revision article, we carried out a comparative approach of the main imaging techniques used in the inflammatory bowel disease pointing out the usefulness of computed tomography to evaluate the wall and extraluminal lesions and the main tomographic findings in the diagnosis, evolution and their complications were stated taking the Crohn´s disease as an entity type. Conclusions: computed tomography is a novel imaging study in the assessment of inflammatory bowel disease which goes beyond conventional imaging investigations. New generations of multislice computed tomography may provide a better assessment of structural morphologic changes.

Application value of MDCT double period enhanced scanning with low-tension water enteroclysis pres-entations for colon cancer preoperative staging / 实用肿瘤学杂志

Objective This paper is mainly to discuss accuracy and clinical application value of MDCT double-period enhanced scanning with low -tension water enteroclysis for colon cancer preoperative TNM stag-ing.Methods Sixty-two colon cancer patients with complete images and pathological data were selected in our hospital from January 2012 to May 2013 .We retrospectively analyzed CT image changes of the tumor location ,the extent of tumor invasion,the surrounding fat space,lymph node metastasis and distant metastasis.We compared them with postoperative pathology to prove the accuracy of MDCT double -period enhanced scanning with low -tension water enteroclysis.Results The results showed that its accuracy rate reached to 90.32%(56/62)in co-lon cancer preoperative Stage T,80.64%(50/62)in Stage N,and 100%(62/62)in Stage M respectively.Con-clusions MDCT double-period enhanced scanning with low -tension water enteroclysis can accurately display the site of colon cancer and determine the scope of tumor invasion ,lymph node metastasis and distant metastasis , and give more precise diagnosis of colon cancer and preoperative staging assessments .In conclusion , it can be used as the preferable method of preoperative examination in the colon cancer .

CT Enteroclysis and Intraoperative Endoscopic Polypectomy for Peutz-Jeghers Syndrome with Advanced Rectal Carcinoma: A Case Report

Patients with Peutz-Jeghers syndrome often suffer from complications of polyps, such as intussusception, bowel obstruction, and bleeding. Another major problem of these patients is malignancy through the hamartoma-adenoma-carcinoma sequence. If the complications and the cancer risk of small intestinal polyps are to be reduced, early detection of these polyps and a polypectomy are important. Traditionally, a small bowel series, small bowel enteroclysis, and conventional endoscopy have been used for the proper evaluation, and management of polyps. Recently, several reports showed the advantages of enteroscopy and intraoperative endoscopy for achieving a more complete polypectomy of the small intestine. However, CT enteroclysis, which has been introduced as a reliable, less invasive, and tolerable diagnostic tool for small intestinal disease, may be useful for the evaluation of patients with gastrointestinal polyposis. We report the case of a patient with Peutz-Jeghers syndrome who had small-bowel polyposis and a rectal adenocarcinoma and who underwent preoperative CT enteroclysis and intraoperative endoscopy.

Enteroclisis por tomografia computada / Enteroclysis by computed tomography

CT Enteroclysis is a new technique consisting in a MDCT of the abdomen and pelvis after the administration of water, through a nasojejunal tube, and intravenous contrast, resulting in adecuate distension and visualisation of the small bowel wall. The use of this technique is especially recommended in patients with gastrointestinal bleeding of unknown etiology, possible neoplastic process of the small bowel, partial small bowel obstruction and inflammatory bowel disease. It is fast, has a high accuracy and has the capability of depicting extraintestinal findings.

La enteroclisis por tomografia computada (E-TC) es una técnica de reciente uso que consiste en la realización de una tomografia computada (TC) multidetector de abdomen y pelvis, posterior a la administración de 2 litros de agua a través de una sonda nasoenteral e inyección de medio de contraste endovenoso. Ello permite una adecuada distensión y visualización de las asas de intestino delgado. Sus principales indicaciones son: Sospecha de en-fermedad inflamatoria intestinal, neoplasias de intestino delgado, hemorragia digestiva con estudio endoscópico negativo y obstrucción parcial intestinal. Se ha reportado un alto rendimiento, es rápida y agrega sobre otras técnicas de estudio de intestino la ventaja de poder visualizar alteraciones extraintestinales.

Dieulafoy's Lesion of Jejunum: Presenting Small Bowel Mass and Stricture

Dieulafoy's lesion is an uncommon cause of gastrointestinal bleeding. Hemorrhage occurs through mucosal erosion from an abnormally dilated submucosal artery. Although Dieulafoy's lesion is usually located in the stomach, it may occur anywhere in the gastrointestinal tract. We report here on a case of jejunal Dieulafoy's lesion presenting as a mass and short segment stricture on CT and enteroclysis.

Discussion on effect and proper time of enteroclysis in treating chronic renal failure / 中华中医药杂志

Objective:To investigate the clinical effect of enteroclysis of Chinese crude drug in treating different stages of chronic renal failure(CRF).Methods:Forty one inpatients with CRF in the nephrology were summarized,who had taken on the treatment with enteroclysis.At the end of the treatment,the change of symptoms and BUN,Scr,Ccr of the inpatients with CRF were recorded and statistically analyzed retrospectiveiy.Results:The total effective rate of enteroclysis in treating CRF was 58.54%,the patients whose Ccr was at the stage of 20-10ml/min reached 75.00%,while Scr,BUN decreased signifi cantly and Ccr rose markedly(P

Double balloon enteroscopy in diagnosis of small bowel Crohn’s disease / 中华消化内镜杂志

Objective To evaluate the diagnostic efficiency of double-balloon enteroscopy in small bowel Crohn’s disease. Methods In sixty five patients with suspected small bowel Crohn's disease double-balloon enteroscopy were performed, and some of them received enteroscopy and enteroclysis, capsule endoscopy as well.Results The first enteroscopy was performed via mouth in 20 of 65 cases, and the lesions were detected in 11 cases (55%), 5 of 9 cases(55.6%) had lesions detected in enteroscopy via anus while nothing was found in mouth route. Among 45 cases examed by enteroscopy firstly via anus, 34 cases had lesions detected (75.6%), 8 of 11 cases(72.7%) had lesions found in following exam via mouth. Totally 58of 65 had lesions detected through enterosocpy examination, the overall diagnostic yield was 89.2%. Twenty four of 46 cases had positive findings with enteroclysis. The diagnosis of Crohn's disease was comfirmed in 14 of 22 patients(63.6%) underwent capsule endoscoy. The diagnosis was finally confirmed by enteroscopy only in 11 patients(78.6%).Conclusion The entire small intestine could be examined by enteroscopy with combination of mouth and anus route. Double-balloon enteroscopy was an ideal diagnostic modality for small bowel Crohn's diseases, which was also valuable in assessment on extent and severity of the disease. Small bowel enteroclysis was a useful screening alternative for selecting procedure route in DBE.

Barium Study of Incomplete Small Bowel Obstruction(An Analysis of 23 Cases) / 实用放射学杂志

Objective To investigate the diagnostic value of barium stury of small bowel obstruction due to various bowel diseases.Methods Barium meal study and enteroclysis (small bowel enema)were performed in 23 patients with incomplete small bowel obstruction due to small bowel diseases confirmed by operation.The imaging data were retrospectively analysed.Results Of the 23 patients,14 cases were malignancy,9 cases were benignant.Conclusion Both barium meal study and enteroclysis( small bowel enema) with air-barium double-contrast technique are of diagnostic value in incomplete small bowel obstruction due to small bowel diseases.

Comparative study on diagnostic yield and accuracy of double balloon enteroscopy with barium enteroclysis and capsule endoscopy in patients suspected with small bowel tumors / 中华消化杂志

Objective To investigate the diagnostic yield and accuracy of double balloon enteroscopy, barium enteroclysis and capsule endoscopy in patients with suspicion of small bowel tumors. Methods Double balloon enteroscopy were performed in fifty nine patients with suspicion of small bowel tumors.The route of enteroscopy could be either via mouth or via anus.At the same time,34 and 17 out of 59 subjects received either barium enteroclysis or capsule endoscopy.The results of exams were analyzed independently and final diagnosis of each case was compared thereafter.Results Nineteen of 34 patients undergone the enteroclysis were diagnosed as small bowel tumor.The diagnostic yield was 55.9%.The diagnosis was finally confirmed by the enteroscopy in 12 cases,which indicated the accurate rate of enteroclysis was 63.2%(12/19).Double balloon enteroscopy detected tumors in 3 of 15 subjects with negative enteroclysis finding.The diagnostic yield of capsule endosocpy was 47.1%(8/17),and among the 8 cases diagnosis was comfirmed by the enteroscopy in 4 cases.Small bowel tumors were detected in 2 of 9 cases with negative capsule endoscopy findings.Thirty-six cases of small bowel tumor were detected by double balloon enteroscopy via a route(mouth or anus),and 16 patients were diagnosed after both route procedure.No small bowel tumor was found in 7 paitents.The overall diagnostic yield of enteroscopy was 88.1%.The diagnosis were all finally confirmed by pathological examination.No procedure-related complication were observed.Conclusion Double balloon enteroscopy is superior to enteroclysis and capsule endoscopy in diagnostic yield and accuracy for small bowel tumors.

Oral Use of Folium Cassiae with Routine Enema for Preoperative Intestinal Cleansing / 广州中医药大学学报

[Objective] To search a suitable preoperative intestinal cleansing method for the operation of colon and rectum. [Methods] A randomized controlled trial was applied in 70 cases before colic and rectal operations. Group A was give:n decoction of Folium Cassiae for oral use and saline enema and Group B was treated with saline enema only. The effect on intestinal cleansing was observed during the operation. [Results] In Group A, 26 cases were remarkably effective in intestinal cleansing, 8 effective, and 1 ineffective and 14, 16 and 5 in Group B respectively ( P

Small Bowel Enteroclysis Using a Hemodialysis Blood Pump

PURPOSE: To describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. MATERIALS AND METHODS: Over a 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in132 patients using a hemodialysis blood pump. Following intubation of the proximal jejunum, barium at a dilutionof 50% and 0.5% methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spotfilms of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopitime and complications were evaluated. RESULTS: Only two of 135 examinations (1.5%) failed due to lack ofcooperation by the patient. Rates of good distensability were 97.6% in the proximal portion, 91.2% in the minportion and 52% in the distal portion and rates of good transparency were 96%, 84% and 56% respectively.Transparency and distensability of the small intestine were better in proximal than distal small bowel. Theradiographs showed positive findings in 25% of cases. The mean fluoroscopic time was 21 min, 10 sec(8min,22sec-57min, 30sec). No major complication was found during or after exam ination. CONCLUSION: It spite of thelong fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation ofsmall bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographsof good quality.

Modified Small Bowel Follow-through Using Methylcellulose After Administration of Barium Suspension :Comparison with Conventional Series

PURPOSE: To compare modified small bowel follow-through (SBFT) using methylcellulose after the administrationof barium suspension with a conventional series. MATERIALS AND METHODS: In order to evaluate small bowelpathology, modified SBFT was performed in 155 patients during a 15 month period. All patients received 600mL ofmethylcellulose ; 98 had taken 250mL of 40% wt/vol barium suspension and 57 had taken 150mL of 70% barium. For thegroup of 98, the barium suspension was prepared by mixing barium powder with water (n=46) or with methylcellulosein(n=52). For comparison with a modified series, 49 patients who underwent conventional SBFT using 500mL of 40%wt/vol barium were lso included. Image quality was rated by three radiologists as "poor", "fair", "good", or"excellent". We analyzed the relationship between image quality, transit time and small bowel pathology;the sensitivity and specificity of each technique was also determined. RESULT: Among the four techniques, modifiedSBFT with 250mL of 40% wt/vol barium suspension, prepared by mixing barium powder with methylcellulose, showed thebest image quality ["excellent" result in 33 of the 52 patients (63%)] and shortest transit time to the cecum. Thehigh image quality of this technique was not affected by the presence of small bowel pathology;its use resulted inthe lowest incidence and slowest development of flocculation. The sensitivity (91-95%) of the three modified SBFTprocedures was superior to that of a conventional series(76%), but there was no difference in specificity. CONCLUSION: Modified SBFT using methylcellulose after administering barium suspension with barium powder as amixing agent is a simple technique. Its use easily improves the image quality and diagnostic accuracy of peroralSBFT.

Qualitative Analysis of Barium Particles Coated in Small Intestinal Mucosa of Rabbit by Using Scanning ElectronMicroscopy

PURPOSE: To qualitatively analyse barium coating status in the intestinal mucosa, we used scanning electronmicroscopy to observe barium particles coated in the small intestinal mucosa of rabbit, and we attempted to assessthe relationship between electron microscopic findings and radiographic densities. MATERIALS AND METHODS: Sixdifferent combinations of barium and methylcellulose suspensions were infused into the resected small intestinesof 15 rabbits. Barium powders were mixed with water to make 40% and 70% w/v barium solutions, and also mixed with0.5% methylcellulose solution to make 40% and 70% w/v barium-methylcellulose mixtures. 0.5% methylcellulosesolutions were used as a double contrast agent. After the infusion of barium suspensions, a mammography unit wasused to obtain radiographs of the small intestine, and their optical densities were measured by a densitometer.Thereafter, photographs of barium-coated small intestinal mucosa were obtained using a scanning electronmicroscope (x8,000), and the number of barium particles in the unit area were measured. To compare therelationship between the electron microscopic findings and optical densities, statistical analysis using Spearmancorrelation was performed. RESULTS: With a Spearman coefficient of-0.544, correlation between the number of smallbarium particles of less than 1 micrometer and optical densities was statistically significant(p<0.05). CONCLUSION: Thisstudy shows that by using scanning electron microscopy, barium particles coated on the small intestinal mucosa canbe qualitatively analysed. It also shows that the number of small barium particles measured by scanning electronmicroscopy is related to optical densities.

Use of methylcellulose in Small-Bowel Follow-Through Examination: Comparison with Enteroclysis and Conventional Series in Normal Subjects

PURPOSE: To evaluate the efficacy of a modified small bowel follow-through (SBFT) and to optimize this technique. MATERIALS AND METHODS: Ninety-nine subjects without small bowel pathology underwent modified SBFT using oral administration of methylcellulose after taking 100ml of 120% or 100, 150, or 200ml of 70% barium. Thirty-three and 39 normal subjects undergoing enteroclysis or conventional SBFT, respectively, were also evaluated for comparison of image qualities and transit time. RESULTS: Enteroclysis was the most successful ofthree types of small bowel examination for obtaining the best quality of bowel transradiency and distension. Modified SBFT was, however much superior to the conventional series for obtaining good bowel transradiency and rapid transity time (mean, 37-49 minutes). The use of 150ml of 70% barium was better than the other three modified techniques in achieving good bowel transradiency, rapid transit time, and less flocculation. CONCLUSION: Our modified SBFT is a simple and safe method for easily improving bowel transradiency and transit time.