Flebectasia yeyunal como causa de hemorragia digestiva media masiva / Jejunal phlebectasia as a cause of massive gastrointestinal hemorrhage

Las anormalidades vasculares del tracto gastrointestinal son una causa común de sangrado digestivo. La mayoría se localizan al alcance de la endoscopía digestiva alta y/o colonoscopía, una vez descartado ello, obliga a considerar al intestino delgado como causa de la hemorragia. El manejo exitoso de una hemorragia digestiva depende principalmente de la localización oportuna de la fuente del sangrado, sin embargo esta tarea puede ser difícil, cuando la causa no está al alcance de los métodos convencionales. Presentamos el caso de un paciente varón de 21 años cuyo diagnóstico fue una flebectasia yeyunal sangrante, luego de una cuidadosa evaluación de los hallazgos de la cápsula endoscópica y laparoscopía.

Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.

Enfermedad diverticular yeyuno-ileal complicada tratada quirúrgicamente: serie de 12 casos y revisión de literatura / Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review

Objetivo: Realizar un análisis retrospectivo de una serie de casos de diverticulitis yeyuno-ileal complicadas tratadas quirúrgicamente en nuestro servicio durante el periodo comprendido entre los años 2002 al 2015. Materiales y métodos: Se trató quirúrgicamente 12 casos de diverticulosis yeyuno-ileal complicadas, 7 mujeres y 5 varones. La edad media fue 76 años. La presentación clínica en todos los casos fue dolor abdominal agudo, uno de ellos con hemorragia digestiva. Todos presentaron leucocitosis, neutrofilia y aumento de reactantes de fase aguda. A todos los pacientes se les realizó TAC abdominal urgente. Resultados: En 11 casos hubo congruencia entre estudio de imagen y hallazgos quirúrgicos. La localización de los divertículos fue yeyuno (9) e íleon (3). Siempre se realizó laparotomía exploradora urgente encontrándose perforación diverticular con peritonitis (7 casos), perforación diverticular con absceso (4 casos) y en un caso un área isquémica con perforación diverticular tras embolización. Se realizó siempre resección intestinal y anastomosis. En ningún caso se conocía previamente el diagnóstico de diverticulosis yeyuno-ileal. Nuestras complicaciones fueron: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusiones: La diverticulitis yetuno-ileal es una entidad infrecuente, suele ser la forma de debut de una enfermedad diverticular no conocida previamente. El TAC abdominal es de gran utilidad diagnóstica. La resección del segmento afecto es el tratamiento de elección

Objective: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. Materials and methods: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. Results: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusions: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice

A Case of Dieulafoy Lesion of the Jejunum Presented with Massive Hemorrhage / 대한소화기학회지

The Dieulafoy lesion is a rare cause of severe gastrointestinal hemorrhage. Although it may occur anywhere in the gastrointestinal tract, the lesion is most commonly located in the stomach, and the small bowel is an extremely uncommon site. Since Dieulafoy lesion in the small bowel is difficult to access by endoscopy, it seems impossible to diagnose and treat by initial endoscopy unlike the lesions in stomach. We experienced a case of Dieulafoy lesion of jejunum with massive hemorrhage in 54-year-old male. Active jejunal bleeding was shown by computed tomography scan and mesenteric angiography. Partial resection of the jejunum was performed. Final pathologic finding revealed Dieulafoy lesion of the jejunum.

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.

A Case of Jeujunogastric Intussusception Presented with Hematemesis after Distal Gastrectomy / 대한소화기학회지

Adult intussusception represents 5% of all cases of intussusception and accounts for only 1-5% intestinal obstructions. Intussusception is a rare complication after gastric surgery with an incidence estimated at 0.1%. Early diagnosis of the acute onset intussusception is critical because mortality rates increase abruptly with delay in surgical treatment. We present here a case of jejunogastric intussusception diagnosed by gastroscopy in a patient with a history of distal gastrectomy due to early gastric cancer who had experienced hematemesis.

Angiodisplasia yeyunal como causa de sangrado de origen desconocido / Jejunal angiodysplasia as a cause of obscure gastrointestinal bleeding

BACKGROUND: Obscure gastrointestinal bleeding secondary to jejunal angiodysplasia is uncommon. Diagnostic approach is difficult and represents a challenge for the surgeon because of the inaccessibility of the small bowel for evaluation. When the diagnostic work-up has been completed and the bleeding source has not been found, it is mandatory to perform a surgical exploration with transoperative enteroscopy in order to locate the source of the hemorrhage and for further treatment. CASE REPORT: We report the case of a 24-year-old male with massive gastrointestinal bleeding secondary to jejunal angiodysplasia in whom an intraoperative enteroscopy was done to locate the source of bleeding and subsequently resect the affected small bowel. There are actually some non-surgical therapies for patients with high risk of complications. When patients' conditions are optimal, surgical resection is mandatory to avoid recurrence of future bleeding.

A rare complication of jejunal diverticulosis.

Jejunal diverticulae are rare and usually asymptomatic, Jejunoileal diverticulae are generally thought to be acquired and are estimated to occur in 1-5% of the population of which only 10% developed complications which include diverticulitis, perforation, hemorrhage, enterolith formation and obstruction. We present a case of jejunal diverticulosis associated with stricture formation resulting in obstruction of the jejunum, the first reported case of this kind so far.

Intestinal ischamemia in a child due to polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a rare type of childhood vasculitis. We report the case of a 10-year-old boy who was referred to our hospital following an appendicectomy with fever, abdominal pain, vomiting, diarrhoea, weight loss, joint pains and skin rash. Shortly after admission, he developed peritonitis, and an emergency laparotomy revealed ischaemia of the jejunum which required partial resection. Histologic examination of the resected bowel showed features consistent with PAN. He was treated with steroids and cyclophosphamide. Nineteen months later, he is asymptomatic and thriving. PAN should be included in the differential diagnosis if a child with constitutional symptoms also has gastrointestinal complaints or develops an acute abdomen.

Massive gastrointestinal bleeding in a patient with AIDS.

Cytomegalovirus enteritis can lead to gastrointestinal bleeding in patients with the acquired immune deficiency syndrome. The commonest site of involvement is the colon, followed by the stomach and terminal ileum. Most of these lesions can be diagnosed by colonoscopy or gastroscopy. We present our experience of a patient with cytomegalovirus infection involving only the proximal jejunum causing massive lower gastrointestinal bleeding. Conventional endoscopy and imaging had failed to locate the source of bleeding. Enteroscopy performed at the time of laparotomy showed an ulcerated lesion in the jejunum. Resection followed by histological examination of the resected area confirmed the diagnosis of cytomegalovirus infection. In addition to highly active antiretroviral therapy, ganciclovir was given for 14 days in a dose of 5 mg/kg twice a day and tapered over a period of 3 months. There has been no further episode of gastrointestinal bleeding over a follow up of 9 months.

Inflammatory fibroid polyp of jejunum causing jejuno-jejunal intussusception.

Intussusceptions originating in the jejunum are rare. We report a 20-year-old woman who had a chronic jejuno-jejunal intussusception due to an inflammatory fibroid polyp manifesting in the post-partum period as peritonitis. Resection-anastomosis of the intussuscepted segment was done. She is well one year later.

Laparoscopy in eosinophilic jejunitis presenting as subacute bowel obstruction: a case report.

Eosinophilic gastroenteritis is rare, seen in approximately 1 in 10,000 hospital admissions. The diagnosis is often retrospective and histopathological. Abdominal pain and obstructive symptoms associated with weight loss are the usual presenting complaints. We report a patient with symptoms of proximal bowel obstruction in whom diagnosis could not be made with conventional radiology and endoscopy. Laparoscopy showed that an intensely thickened proximal jejunum to be the cause of the obstruction. A laparotomy and resection anastomosis were done. The biopsy showed eosinophilic jejunitis. The patient did well post-operatively. The literature of this disease entity has been reviewed. Full-thickness laparoscopic biopsy and a course of steroids might avoid a laparotomy in these patients.

Jejunogastric intussusception presenting with outlet obstruction.

A 77-year-old man presented with sudden-onset epigastric pain and bilious vomiting following a light breakfast. Vagotomy and gastrojejunostomy for bleeding duodenal ulcer had been done 22 years ago. Barium meal study suggested jejunogastric intussusception. At laparotomy, a retrograde type II jejunogastric intussusception was confirmed and managed by reduction of the intussusception, disconnection of gastrojejunostomy and resection of the jejunum. Postoperative recovery was uneventful.

The endoscopic diagnosis of intestinal capillariasis in a child: a case report.

A 13-year-old boy was diagnosed as having intestinal capillariasis by gastroduodenoscopy. He presented with a 10-month history of chronic abdominal pain and diarrhea. The boy had stayed in central Thailand and had eaten uncooked fish and raw shellfish. Gastroduodenoscopy showed normal jejunal mucosa although histology revealed flattened villi, crypt proliferation, acute inflammation, and eosinophilic granulomata. An egg of Capillaria philippinensis was also seen. The child was treated with mebendazole for 30 days. He had gained six kilograms by the time of his last follow-up.

Acute intestinal obstruction due to solitary jejunal diverticulum.

We report a 26-year-old man who presented with acute intestinal obstruction. Laparotomy revealed a solitary jejunal diverticulum with a meso-diverticular band, through which a loop of bowel had herniated. He underwent wedge resection of the diverticulum and excision of the band.

Recurrent inflammatory pseudotumor of small bowel mesentery presenting as perforative peritonitis.

A 62-year-old man with recurrent inflammatory pseudotumor of the small bowel mesentery presented with perforative peritonitis; such a presentation has not been reported. The mass was excised successfully.

Inflammatory fibroid polyp of the jejunum presenting as intussusception.

Inflammatory fibroid polyp (IFP) of jejunnum is a rare nonneoplastic lesion of gastrointestinal tract. We report a case of a 45-year-old man presenting with small bowel obstruction due to jejuno-jejunal intussusception of an inflammatory fibroid polyp. To the best of our knowledges, this is the eighth reported case with such a presentation in English medical literature. Segmental resection of the jejunum was performed and histopathology confirmed the diagnosis.

Diverticulosis yeyunal una causa infrecuente de hemorragia digestiva: caso clínico / Jejunal diverticulosis as cause of gastrointestinal hemorrhages: case report

Jejunal diverticulosis is a very uncommon acquired disease. Clinical manifestations include acute life threatening complication such as perforation, obstruction and bleeding. Jejunal diverticulosis is an extremely rare site of origin of gastrointestinal bleeding, with fewer than seventy cases reported in the literature. We report a 77-year -old patient with a recurrent severe gastrointestinal bleeding manifested by melena and hematochaezia. During the hospitalization the tagged red blood cell scanning was positive for bleeding in the jejunum. At laparotomy, several large-mouthed diverticula at the proximal jejunum were identified. Approximately 30 centimeters of the involved segment was resected with primary end-to-end anastomosis. Postoperative 7 month evolution has been favorable, without any evidence of rebleeding. This report reviews the literature concerning this disease, discusses some diagnostic methods of studying small bowel bleeding and highlights the need to consider this diagnosis in old patients with a gastrointestinal hemorrhage of unknown origin