Variation in small bowel length: factor in achieving total enteroscopy?

BACKGROUND AND AIM: Estimation of small bowel length is of interest following the recent development of device-assisted enteroscopy. This new technology allows access to the deep small bowel, but rates of examination of the entire small bowel (total enteroscopy) differ between study populations. Variation in small bowel length could factor into this observed irregularity in total enteroscopy rates. Medical literature contains limited information regarding small bowel length in living patients and conflicting data regarding small bowel length and its relationship to height and weight. We carried out small bowel measurements on surgical patients to further define the total length of the small bowel and its relationship to height, weight and body mass index (BMI). METHODS: Measurement of ileojejunal length on 91 surgical patients undergoing laparotomy for routine indications. Demographic data were collected for each subject, including height, weight and BMI. RESULTS: Small bowel length was found to vary widely between individuals (average 998.52 cm, range 630-1510 cm). Linear regression analysis demonstrated a statistically significant relationship between small bowel length and height (regression coefficient = 0.0561, P-value = 0.0238). A linear relationship between small bowel length and weight or BMI was not observed. CONCLUSIONS: Length of the small bowel in humans is pertinent to advances in deep enteroscopy and existing surgical applications such as intestinal bypass and prevention of short gut syndrome. If average small bowel length varies with height, total enteroscopy may be easier to achieve in patients who are short in stature.

Clinical case of the month: a 22-year-old man with AIDS presenting with shortness of breath and an oral lesion.

Since the development of combination antiretroviral therapy (cART), the incidence and mortality associated with Kaposi sarcoma (KS) have been reduced, although not eliminated. Clinical presentations of KS range from simple skin involvement to disseminated disease, including involvement of the oral cavity and viscera, which portends a more ominous prognosis. Multiple case reports and data from clinical trials indicate that administration of systemic corticosteroids may aggravate KS. We present a case of disseminated KS following administration of prednisone for presumed immune reconstitution inflammatory syndrome (IRIS) associated with fungal pneumonia in an HIV-infected individual. The discussion that follows outlines the pathophysiology and clinical presentations associated with KS and existing data for the role of corticosteroids in promoting KS progression.