Diverticulitis aguda del intestino delgado como causa infrecuente de abdomen agudo en el adulto mayor: Reporte de caso / Acute diverticulitis of small bowel as rare cause of acute abdomen inthe elderly: Case report

Introducción. El dolor abdominal es uno de los principales motivos de admisión a urgencias y una de las causas más frecuentes es la enfermedad diverticular, que aumenta su prevalencia en el adulto mayor. Sin embargo, la diverticulitis del intestino delgado es una enfermedad infrecuente y en la mayoría de casos es asintomática. No obstante, la perforación de un divertículo intestinal es una complicación común de esta patología, por lo que debe ser considerado como un diagnóstico diferencial de abdomen agudo en este grupo poblacional. Caso clínico. Paciente masculino de 71 años, quien consultó por dolor abdominal de inicio súbito, con signos de irritación peritoneal al examen físico. Dado su deterioro hemodinámico fue llevado a cirugía y en la laparotomía exploratoria se halló una diverticulitis aguda perforada de yeyuno e íleon distal. Resultados. El paciente cursó con una adecuada evolución postoperatoria, sin reingresos. Conclusión. La diverticulitis aguda yeyuno-ileal es una causa importante, pero no frecuente de perforación intestinal. Hay muy pocos casos reportados en la literatura, lo que la convierte en un reto diagnóstico para el médico de urgencias y el cirujano general. No obstante, debe ser considerado como un diagnóstico diferencial en adultos mayores con abdomen agudo.

Introduction. Abdominal pain is one of the main reasons for admission to the emergency room and one of the most frequent causes is diverticular disease, which increases its prevalence in the elderly. However, diverticulitis of the small bowel is rare and in most cases asymptomatic. However, perforation of an intestinal diverticulum is a common complication of this pathology and should be considered as a differential diagnosis of acute abdomen in this population group. Clinical case. A71-year-old male patient presented with abdominal pain of sudden onset, with signs of peritoneal irritation. Given his hemodynamic deterioration, he was taken to surgery and in the exploratory laparotomy an acute perforated diverticulitis of the jejunum and distal ileum was found. Results. The patient had an adequate postoperative evolution, without readmissions. Conclusion. Acute jejuno-ileal diverticulitis is an important but uncommon cause of intestinal perforation. There are very few cases reported in the literature, which makes it a diagnostic challenge for the emergency physician and general surgeon. However, it should be considered as a differential diagnosis in older adults with acute abdomen.

Dietary Hydroxytyrosol Supplementation on Growth Performance, Gut Morphometry, and Oxidative and Inflammatory Status in LPS-Challenged Broilers.

This study assessed the effects of hydroxytyrosol (HT) on 8- to 20-day-old broilers challenged with lipopolysaccharide (LPS); 180 Cobb500™ male chicks were randomly assigned to 3 treatment groups, each comprising 10 replicates with 6 birds per replicate. Treatments included a control diet (CON), CON with LPS administration, and CON + LPS supplemented with 10 mg of HT/kg of feed. LPS was administered intraperitoneally on days 14, 16, 18, and 20. Body weight (BW), body weight gain (BWG), and the feed conversion ratio (FCR) were measured. On day 20, ten birds per treatment were slaughtered for analysis. Bursa, spleen, and liver were collected, and their respective relative weight was determined. The jejunum was destined for morphological analyses of villus height (VH), crypt depth (CD), and their ratio (VH:CD), and for mRNA expression of nuclear factor kappa B (NF-κB), catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD), and interleukins 10 (IL-10), 1 beta (IL-1ß), and 8 (IL-8). HT improved BW, BWG, and FCR, and reduced crypt depth (CD) while increasing the VH:CD ratio in the jejunum. Moreover, HT downregulated mRNA expression of CAT, GPx, IL-10, and IL-1ß. In conclusion, HT enhances broiler growth performance, mitigates jejunal mucosa damage from LPS, and modulates antioxidant and immune responses.

Microbial colonization dynamics of the postnatal digestive tract of Bos indicus calves.

The rumen and the jejunum of calves have distinct functional roles; the former is in the storage and fermentation of feed, and the latter is in transporting digesta to the ileum. It is unknown how nutrition changes the evolution of the microbiome of these organs after birth. We sequenced and characterized the entire microbiome of the rumen and the jejunum from Bos indicus calves of the Mexican Tropics to study their dynamics at Days 0, 7, 28, and 42 after birth. Operational taxonomic units (OTUs) belonging to 185 and 222 genera from 15 phylum were observed in the organs, respectively. The most abundant OTUs were Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes. We observed that proteobacterial species were outcompeted after the first week of life by Bacteroidetes and Firmicutes in the rumen and the jejunum, respectively. Moreover, Prevotella species were found to predominate in the rumen (36% of total OTUs), while the jejunum microbiome is composed of small proportions of several genera. Presumably, their high relative abundance assists in specialized functions and is more likely in fermentation since they are anaerobes. In summary, the rumen and the jejunum microbiomes were outcompeted by new microbiomes in a dynamic process that begins at birth.

A Rare Complication of Gastrointestinal Bleeding: Jejunal Diverticulosis. A Case Report

Introduction: Small intestine diverticula are a rare condition with an incidence of 0.6% to 2%. Their location at the level of the jejunum is a rare alteration, and their diagnosis is often delayed due to low clinical suspicion. The clinical manifestation of this pathology is related to the development of complications -15% to 30% of patients, with approximately 10% requiring surgical intervention. Clinical case: We present a case of a middle-aged adult patient who experienced a complication due to a bleeding jejunal diverticulum. The patient underwent surgical management, which resulted in a satisfactory outcome. Objective: This article aims to describe jejunal diverticulosis, a rare condition that can have a significant impact on affected individuals. Emphasizing its clinical suspicion as a differential diagnosis for gastrointestinal bleeding is crucial. Additionally, we discuss diagnostic methods and highlight various therapeutic options, including surgical management.

Introducción: los divertículos del intestino delgado presentan una incidencia del 0,6% al 2%, su localización a nivel del yeyuno es una alteración poco frecuente y, dada su baja sospecha clínica, se retrasa el diagnóstico oportuno. La manifestación clínica de esta patología se encuentra relacionada con el desarrollo de complicaciones, las cuales ocurren entre el 15% y el 30% de los pacientes, y el 10% de estos pacientes requiere manejo quirúrgico. Caso clínico: un paciente adulto medio cursó con una complicación secundaria a la presencia de un divertículo del yeyuno sangrante, al cual se le dio un manejo quirúrgico con un resultado satisfactorio. Objetivo: este artículo tiene como objetivo describir la diverticulosis yeyunal que, aunque poco frecuente, puede generar un compromiso importante en quien la padece, lo que prioriza su sospecha clínica como diagnóstico diferencial causante de hemorragia gastrointestinal, así como dilucidar métodos diagnósticos y estar al tanto de las diferentes opciones terapéuticas que existen, incluido el manejo quirúrgico.

Massive Gastrointestinal Bleeding Caused by Multiple Small Intestinal Diverticula: A Case Study

We report the case of a 71-year-old woman with multiple comorbidities who was admitted to the hospital due to hematochezia, without hemodynamic instability. Initial investigations, including colonoscopy and upper endoscopy, did not reveal the cause of bleeding. However, the patient experienced increased bleeding, anemia, and hemodynamic instability during her hospital stay. Subsequent selective angiography did not show any signs of active bleeding. In light of the persistent shock, surgical intervention was performed, which revealed blood originating from multiple diverticula in the jejunum.

Se presenta el caso de una mujer de 71 años con múltiples comorbilidades que ingresó por hematoquecia sin inestabilidad hemodinámica. Se inició el estudio con una colonoscopia sin evidenciar la causa; durante la estancia hospitalaria presentó un aumento del sangrado, anemización e inestabilidad hemodinámica, por lo que se realizó una endoscopia digestiva alta sin hallazgos; posteriormente, se realizó una angiografía selectiva sin evidencia de sangrado activo. Ante el choque persistente se llevó a cirugía en la que se evidenció sangre proveniente del intestino delgado secundaria a la presencia de divertículos múltiples en el yeyuno.

Ultrasonography of the stomach and small intestine in healthy Mangalarga Marchador horses from birth to 5 years of age / Ultrassonografia de estômago e intestino delgado de equinos Mangalarga Marchador saudáveis desde o nascimento até cinco anos de idade

The aim of the study was to describe location, sonographic characteristics and measures of the stomach and small intestine of equines at different ages. Abdominal ultrasonography was performed on 88 healthy equines of either sex, aged 1, 7 and 15 days, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 months and 1, 3 and 5 years, with 20 animals per group. Location, characteristics and measurements of stomach, duodenum and jejunum were evaluated. Descriptive statistics were performed for each measurement and the percentile for each age was analyzed. The work showed the growth and characteristics of the organs evaluated over time. Adult animals showed a minimum of 4 duodenal movements per minute. It was possible to locate the organs evaluated in all animals. The detailed ultrasound examination of these organs allowed gathering information that could be used to assist in the care of future patients.

O objetivo deste estudo foi descrever localização topográfica, características e medidas ultrassonográficas de estômago e intestino delgado de equinos em diferentes idades. Foi realizado um exame ultrassonográfico abdominal em 20 equinos saudáveis de ambos os sexos, com idades de um, sete e 15 dias, um, dois, três, quatro, cinco, seis, sete, oito, nove, 10 e 11 meses e um, três e cinco anos. A localização, as características e as medidas de estômago, duodeno e jejuno foram avaliadas. Foi realizada a estatística descritiva para cada medida e analisado o percentil para cada idade. O trabalho mostrou o crescimento e as características dos órgãos avaliados ao longo do tempo. Animais adultos apresentaram um mínimo de quatro movimentos por minuto de duodeno. Foi possível localizar os órgãos avaliados em todos os animais. O exame ultrassonográfico detalhado desses órgãos permitiu agrupar informações que poderão ser usadas para auxiliar no atendimento a futuros pacientes.

Global cerebral ischemia followed by long-term reperfusion promotes neurodegeneration, oxidative stress, and inflammation in the small intestine in Wistar rats.

AIMS: Brain ischemia and reperfusion may occur in several clinical conditions that have high rates of mortality and disability, compromising an individual's quality of life. Brain injury can affect organs beyond the brain, such as the gastrointestinal tract. The present study investigated the effects of cerebral ischemia on the ileum and jejunum during a chronic reperfusion period by examining oxidative stress, inflammatory parameters, and the myenteric plexus in Wistar rats. MAIN METHODS: Ischemia was induced by the four-vessel occlusion model for 15 min with 52 days of reperfusion. Oxidative stress and inflammatory markers were evaluated using biochemical techniques. Gastrointestinal transit time was evaluated, and immunofluorescence techniques were used to examine morpho-quantitative aspects of myenteric neurons. KEY FINDINGS: Brain ischemia and reperfusion promoted inflammation, characterized by increases in myeloperoxidase and N-acetylglycosaminidase activity, oxidative stress, and lipid hydroperoxides, decreases in superoxide dismutase and catalase activity, a decrease in levels of reduced glutathione, neurodegeneration in the gut, and slow gastrointestinal transit. SIGNIFICANCE: Chronic ischemia and reperfusion promoted a slow gastrointestinal transit time, oxidative stress, and inflammation and neurodegeneration in the small intestine in rats. These findings indicate that the use of antioxidant and antiinflammatory molecules even after a long period of reperfusion may be useful to alleviate the consequences of this pathology.

Effects of time-dependent degradation and freezing on biomechanical properties of healthy bovine jejunum / Efeitos da degradação dependente do tempo e do congelamento sobre as propriedades biomecânicas do jejuno bovino saudável

Degradation of bovine small intestine and respective effects on biomechanics have not been described to date. Biomechanical testing of intestinal tissues is often carried out within a few hours of donor death and tissue deterioration is not accounted for. Freezing is efficient for the preservation of several tissues; however, it may cause cellular damage. This study investigated the morphologic and biomechanical changes of bovine jejunum at different postmortem moments. Effects of freezing and thawing on morphology and biomechanical behavior were also examined. Macroscopic changes were first noted within eight hours of death. At this time, histologic changes also started to set in, and biomechanical tests revealed lower bursting pressure (203.10±46.14mmHg). At 12 hours, tissue rearrangement was noted, and bursting pressure increased (238.43±31.04mmHg). A second drop in pressure was detected at 18 hours (235.20±38.21mmHg), followed by a progressive drop until the end of the experimental period. Histologic changes revealed progressive deterioration. Mechanical resistance did not differ between thawed and fresh specimens. It was concluded that bovine jejunal specimens retain biomechanical resistance up to 6 hours after death. Freezing and thawing did not affect the mechanical resistance of the intestinal wall in this experimental model.

A degradação do intestino delgado de bovinos e seu efeito biomecânico não são descritos na literatura. Trabalhos que envolvem a biomecânica intestinal realizam os ensaios em poucas horas após o óbito dos doadores, sem avaliação de seu estado de deterioração. O congelamento é eficiente na conservação de vários tecidos, porém pode provocar danos em nível celular. Este estudo teve por objetivo avaliar a degradação morfológica e biomecânica do jejuno de bovinos em diferentes tempos post mortem. O efeito do congelamento e do descongelamento sobre essas características também foi avaliado. As primeiras alterações macroscópicas foram observadas oito horas após o óbito. No mesmo momento, se iniciaram as alterações histológicas e a menor pressão suportada ao teste biomecânico (203,10±46,14mmHg). A partir de 12 horas, o tecido sofreu um rearranjo, suportando maior pressão (238,43±31,04mmHg). Uma segunda queda foi detectada após 18 horas (235,20±38,21mmHg), seguida de redução progressiva até o término do experimento. As lesões histológicas foram progressivas e graduais. As amostras testadas após descongelamento não apresentaram diferença estatística quanto à resistência mecânica em comparação com os espécimes frescos. Concluiu-se que as amostras mantêm sua resistência biomecânica até 6 horas após o óbito. Também se mostrou que o congelamento e o descongelamento, nas condições testadas, não alteraram a resistência mecânica da parede intestinal.

Síndrome de cascanueces acompañando un caso de síndrome de Wilkie: a propósito de un caso / Nutcracker Syndrome Combined with Wilkie Syndrome: Case Report

Resumen Objetivo: describir la presentación clínica, el diagnóstico y el tratamiento quirúrgico de un paciente con síndrome de la arteria mesentérica superior o síndrome de Wilkie combinado con síndrome de cascanueces o síndrome de compresión de la vena renal izquierda, en un centro de alta complejidad de un país latinoamericano. Descripción del caso: paciente masculino de 25 años, procedente de Estados Unidos, quien consultó por un año de pérdida de peso y episodios de obstrucción intestinal de etiología desconocida tras múltiples estudios de imagen. Se le realizaron estudios endoscópicos sin hallazgos; en la sala de recuperación desarrolló dolor abdominal que requirió ingreso al servicio de urgencias. La enterotomografía mostró dilatación de asas de colon e intestino delgado, con disminución del ángulo aortomesentérico y la serie gastrointestinal con paso filiforme del medio de contraste. Se intentó el manejo conservador como terapia inicial, con intolerancia al soporte nutricional entérico. Finalmente, se optó por el tratamiento quirúrgico, con un proceso de recuperación tórpido inicialmente, pero al final con resolución de los síntomas y aumento de peso. Conclusión: el síndrome de Wilkie es una enfermedad rara y un desafío diagnóstico en pacientes con pérdida de peso y dolor abdominal. Describimos un caso de compresión de la arteria mesentérica superior en el que se logró el diagnóstico con múltiples estrategias diagnósticas y resolución completa luego del tratamiento quirúrgico. La disminución del ángulo aortomesentérico puede comprimir la arteria mesentérica superior, así como la vena renal izquierda, que en ese caso resultó en un síndrome combinado de Wilkie y de cascanueces.

Abstract Objective: to describe the clinical presentation, diagnosis, and surgical treatment of a patient with superior mesenteric artery syndrome or Wilkie syndrome combined with the nutcracker syndrome or left renal vein compression syndrome in a tertiary referral center in a Latin American country. Case description: a 25-year-old male patient from the United States who attended for a year of weight loss and intestinal obstruction episodes of unknown etiology after multiple imaging studies. Endoscopic studies were performed without findings. While in the recovery room, he developed abdominal pain requiring admission to the emergency service. The CT enterography showed dilation of the colon loops and small intestine with a decrease of the aortomesenteric (AOM) angle and the gastrointestinal series with the filiform passage of the contrast medium. Conservative management was attempted as initial therapy with intolerance to enteric nutritional support. Finally, we initially opted for surgical treatment, with a slow recovery process, but in the end, with a resolution of symptoms and weight gain. Conclusion: Wilkie syndrome is a rare disease and a diagnostic challenge in patients with weight loss and abdominal pain. We described a superior mesenteric artery compression case in which diagnosis was achieved with multiple diagnostic strategies and complete resolution after surgical treatment. The decreased aortomesenteric angle may compress the superior mesenteric artery and the left renal vein. In this case, it resulted in a combined Wilkie and nutcracker syndrome.

Effects of Vitamin A and K3 on Immune Function and Intestinal Antioxidant Capacity of Aged Laying Hens

This study was conducted to investigate effects of vitamin A (VA) and vitamin K3 (VK3) on immune function and intestinal antioxidant capacity of aged laying hens. In a 3 × 3 factorial arrangement, the diets of 1080 Roman Pink laying hens (87 weeks old) was formulated with deficient, adequate and excess VA and VK3, including 0, 7000 and 14000 IU/kg VA and 0, 2.0 and 4.0 mg/kg VK3 for 8 weeks. Interactive effects between VA and VK3 were observed that VA and VK3 decreased the splenetic mRNA expression of inducible nitric oxide synthase (iNOS) and tumour necrosis factor α (TNF-α), but increased the plasma immunoglobulin G (IgG) content and jejunal mRNA expression of nuclear factor-like 2 (Nrf2). Hens fed adequate or excess VA had higher spleen index, mRNA expression of interleukin-10 (IL-10) in spleen, sIgA content, catalase (CAT), glutathione peroxidase and total dismutase (T-SOD) activity, and mRNA expression of polymeric immunoglobulin receptor (pIgR) in jejunum and lower mRNA expression of IL-1ß in jejunum and iNOS, TNF-α in spleen. Furthermore, adequate or excess VK3 significantly increased plasma IgG content, the CAT, T-SOD and total antioxidant capacity activities, up-regulated the mRNA expression of pIgR, Nrf2, SOD1 and CAT in jejunum and down-regulated the mRNA expression of iNOS and TNF-α in spleen.(AU)

Estudo da permeabilidade de fármacos por meio do modelo de saco intestinal de ratos / Study of drug permeability through the rat gut sac model

Os parâmetros de permeabilidade e solubilidade são fundamentais à absorção oral de fármacos e a partir dessas características, foi criado o Sistema de Classificação Biofarmacêutica, através do qual os fármacos são divididos em quatro classes. Atualmente, para a determinação da solubilidade de um fármaco, existem diversos métodos padronizados por agências regulatórias, no entanto, para a determinação da permeabilidade, os ensaios são passíveis de diversas variações em sua execução, diminuindo a confiabilidade dos resultados obtidos e impossibilitando a comparação dos mesmos quando realizados com técnicas diferentes umas das outras. O objetivo do presente trabalho é avaliar as variáveis experimentais do modelo do saco intestinal que podem influenciar nos resultados de permeabilidade aparente de fármacos e na viabilidade do tecido. O presente estudo foi aprovado pelo Comitê de Ética no Uso de Animais da FCF-USP (109.2018-P574). Foram utilizados 33 Rattus norvegicus da linhagem Wistar, machos, jovens adultos, com peso entre 200 g e 300 g. Para realização do procedimento, cada animal permaneceu em jejum por cerca de quatro horas e após adequada anestesia a porção do jejuno do intestino delgado foi retirada e dividida em seis segmentos de aproximadamente 8,5cm cada. Foram realizados experimentos com e sem inversão do saco intestinal, submetidos a diferentes tempos de banho de gelo após sua ressecção, na presença ou ausência de inibidor da glicoproteína-P (verapamil). Os fármacos naproxeno e famotidina foram empregados como marcadores de alta e baixa permeabilidade, respectivamente. A losartana foi utilizada como substrato da glicoproteína P. Cada um dos sacos intestinais foi colocado em um tubo de ensaio contendo tampão Krebs, a 37°C, saturado com gás carbogênio. Para avaliação da integridade e viabilidade dos segmentos intestinais, observou-se a presença de movimentos peristálticos e coletaram-se amostras do meio de incubação nos tempos 0, 30, 45, 60, 90 e 120 minutos para quantificação dos fármacos e de glicose, uma vez que esta é ativamente transportada para a serosa do intestino delgado. Determinou-se a permeabilidade aparente de cada fármaco e as concentrações de glicose nas diferentes condições experimentais, realizou-se planejamento fatorial multinível e os resultados foram analisados por análise variância (ANOVA), seguida de pós-teste de Tukey. Observou-se que as variáveis experimentais interferiram de forma significativa na viabilidade tecidual e na permeabilidade aparente dos fármacos. Não foram observadas diferenças significativas da permeabilidade de fármacos nos diferentes segmentos do jejuno. A glicose mostrou-se um bom marcador de viabilidade tecidual e foi constatado que a presença ou ausência de movimentos peristálticos não está relacionada diretamente com a viabilidade do tecido. Uma vez que foram constatadas tantas interferências nos resultados, é imprescindível que os procedimentos experimentais sejam padronizados, para que os resultados apresentem menor variabilidade e possam ser comparados entre si

The permeability and solubility parameters are fundamental to the oral absorption of drugs and from these characteristics, the Biopharmaceutical Classification System was created, through which drugs are divided into four classes. Currently, for the determination of the solubility of a drug, there are several methods standardized by regulatory agencies, however, for the determination of permeability, the tests are subject to several variations in their execution, reducing the reliability of the results obtained and making it impossible to compare the results obtained. same when performed with different techniques. The aim of this study is to evaluate if different experimental conditions can influence the results of apparent drug permeability and tissue viability on gut sac model. The present study was approved by the Ethics Committee for the Use of Animals of FCF-USP (109.2018-P574). Thirty-three male, young adult Rattus norvegicus were used, weighing between 200 g and 300 g. To perform the procedure, each animal fasted for about four hours and after adequate anesthesia, the portion of the jejunum of the small intestine was removed and divided into six segments of approximately 8.5 cm each. Experiments were performed with and without inversion of the gut sac, submitted to different times of ice bath after its resection, in the presence or absence of a P-glycoprotein inhibitor (verapamil). The drugs naproxen and famotidine were used as markers of high and low permeability, respectively. Losartan was used as a substrate for P-glycoprotein. Each of the gut sacs was placed in a test tube containing Krebs buffer, at 37°C, saturated with carbogen gas. To evaluate the integrity and viability of the intestinal segments, the presence of peristaltic movements was observed and samples of the incubation medium were collected at 0, 30, 45, 60, 90 and 120 minutes for quantification of drugs and glucose, as it is actively transported to the serosa of the small intestine. The apparent permeability of each drug and the glucose concentrations were determined under different experimental conditions, multilevel factorial design was performed and the results were analyzed by analysis of variance (ANOVA), followed by Tukey's post-test. It was observed that the experimental variables significantly interfered in the tissue viability and in the apparent permeability of the drugs. No significant differences in drug permeability were observed in the different segments of the jejunum. Glucose proved to be a good marker of tissue viability and it was found that the presence or absence of peristaltic movements is not directly related to tissue viability. Since so many interferences were found in the results, it is essential that the experimental procedures be standardized, so that the results show less variability and can be compared between different authors

Pneumoperitoneum secondary to non-specific intestinal cystic pneumatosis: A case report.

Intestinal cystic pneumatosis is a pathological entity of strange presentation, characterized by the presence of extraluminal gas located at the level of the submucosa and/or subserosa of the intestinal walls, forming cystic lesions that generally vary from 0.5 to 2.0 cm presenting an incidence around 0.03% in the general population. We present the case of a patient who presented to the emergency department for sudden abdominal pain, diffuse signs of peritoneal irritation, and a history of previous laparotomy for perforated gastric ulcer as the only relevant history. An X-ray was performed showing pneumoperitoneum, with subsequent histopathological diagnosis of cystic intestinal pneumatosis.

Características clínico-patológicas y manejo de tumores primarios de intestino delgado de localización yeyuno-ileal / Clinical-pathological characteristics and management of primary tumors of the small intestine of jejuno-ileal location

RESUMEN Introducción : Los tumores primarios del intestino delgado (TPID) representan aproximadamente el 5% de todas las neoplasias gastrointestinales primarias; estas últimas incluyen lesiones benignas y malignas, con diferentes subtipos histológicos. Objetivo : Describir las características clínico-patológicas y el manejo de tumores de localización yeyuno-ileal. Materiales y métodos : Se realizó un estudio descriptivo, retrospectivo, en un único centro. Resultados : Se incluyó 45 pacientes, la edad promedio al diagnóstico fue de 54,2 ± 8,2 años. 27 eran de sexo masculino (60%). En el algoritmo diagnóstico se utilizó la tomografía computarizada en todos los pacientes, la enteroscopia de doble balón en 41 (91,1%) y video cápsula endoscópica en 32 (71,1%). Se realizaron procedimientos endoscópicos como: biopsias, tatuajes, resección y dilatación en 40 (88,9%), 39 (86,7%), 4 (8,9%) y 1(2,2%) paciente respectivamente. La localización más frecuente fue yeyuno en 39 (86%). Se confirmó GIST en 18 (40%), seguido de linfoma en 16 (35,6%) y adenocarcinoma en 5 (11%) casos. Todos los tumores GIST, adenocarcinoma y neuroendocrinos se sometieron a tratamiento quirúrgico y quimioterapia; el tratamiento de los linfomas consistió en tratamiento combinado principalmente; tres harmartomas y un fibroangiolipoma fueron resecados endoscópicamente. Conclusiones : Los tumores de intestino delgado yeyuno-ileal más frecuentes fueron los GIST, seguidos de linfomas y adenocarcinomas. La enteroscopia de doble balón fue la principal herramienta diagnóstica y terapéutica.

ABSTRACT Introduction : Primary tumors of the small intestine (PTID) represent approximately 5% of all primary gastrointestinal neoplasms; the latter include benign and malignant lesions, with different histological subtypes. Objective : To describe the clinical-pathological characteristics and the management of tumors located in the jejunum-ileum. Materials and methods : A descriptive, retrospective study was carried out in a single center. Results : 45 patients were included, the average age at diagnosis was 54.2 ± 8.2 years. 27 were male (60%). In the diagnostic algorithm, computed tomography was used in all patients, double-balloon enteroscopy in 41 (91.1%) and video capsule endoscopy in 32 (71.1%). Endoscopic procedures such as: biopsies, tattoos, resection and dilation were performed in 40 (88.9%), 39 (86.7%), 4 (8.9%) and 1 (2.2%) patients, respectively. The most frequent location was the jejunum in 39 (86%). GIST was confirmed in 18 (40%), followed by lymphoma in 16 (35.6%) and adenocarcinoma in 5 (11%) cases. All GIST, adenocarcinoma, and neuroendocrine tumors underwent surgical treatment and chemotherapy; treatment of lymphomas consisted mainly of combined treatment; three harmartomas and one fibroangiolipoma were resected endoscopically. Conclusions : The most frequent jejunoileal small intestine tumors were GISTs, followed by lymphomas and adenocarcinomas. Double-balloon enteroscopy was the main diagnostic and therapeutic tool.

Ultrasonography of the gastrointestinal tract of toco toucans (Ramphastos toco).

Baseline data for wall thickness in healthy toucans can be used to diagnose disease in sick individuals. This study aimed to evaluate the use of ultrasonography for the examination of the gastrointestinal tract of healthy toco toucans (Ramphastos toco). Ten non-anaesthetized healthy adult toco toucans were evaluated. Food was withheld for 3 h prior to the ultrasound examination. Longitudinal and transverse images of the gastrointestinal tract were obtained using ventromedian cranial and ventromedian caudal approaches to evaluate the morphology and stratification. The wall thickness of the sections was measured: proventriculus and ventriculus, duodenum, jejunum/ileum, and cloaca. Additionally, the thickness of the mucosal layer of the duodenum and jejunum/ileum was also measured. Subsequently, the ratios of the duodenal wall thickness to the duodenal mucosa layer and the total wall thickness of the jejunum/ileum to the jejunum/ileum layer mucosa were stablished. The wall thickness of the proventriculus was significantly higher than the wall thickness of ventriculus. The wall thickness of the duodenum was significantly higher than the wall thickness of jejunum/ileum. The mean ratios of the duodenal wall thickness to the duodenal mucosa layer and the wall thickness of the jejunum/ileum to the jejunum/ileum layer were 83.15% and 80.07%, respectively. In conclusion, it was possible to assess the stomach and intestines using ultrasound examination in healthy toco toucans, due to their medium body size and no interference by surrounding air sacs.

Adenocarcinoma de yeyuno proximal: a propósito de un caso / Proximal jejunal adenocarcinoma, a case report

Resumen El adenocarcinoma de yeyuno es el tumor primario del intestino delgado más infrecuente y raro, y representa el 3 % de todos los cánceres gastrointestinales, con una incidencia anual estimada de 0,3 a 2 casos por cada 100 000 personas. En Estados Unidos y España representa el 0,4 % de los cánceres gastrointestinales y el 0,2 % de las muertes asociadas a malignidad, con síntomas inespecíficos como anemia de etiología inexplicable, dolor abdominal y pérdida de peso; la mayoría de ellos son diagnosticados en etapas avanzadas de la enfermedad. A continuación, se presenta el caso de una paciente femenina de 46 años con síntomas inespecíficos, pérdida de peso, dolor abdominal y vómito, cuya tomografía abdominal computarizada evidenció el sitio y extensión de la lesión neoplásica, mientras que la cápsula endoscopia y enteroscopia mostró una lesión neoplásica en el yeyuno proximal. La histopatología reportó un adenocarcinoma de yeyuno moderadamente diferenciado que presentó resultados favorables gracias a la resección quirúrgica curativa, lo cual mejoró el pronóstico de vida a 5 años y tuvo un seguimiento favorable hasta la actualidad.

Abstract Jejunal adenocarcinoma is the rarest primary small bowel tumor and represents 3% of all gastrointestinal cancers, with an estimated annual incidence of 0.3 to 2 cases per 100 000 people. This disease accounts for 0.4% of gastrointestinal cancers and 0.2% of deaths associated with malignancy in the United States and Spain, with nonspecific symptoms, such as anemia of unexplained etiology, abdominal pain, and weight loss; most cases are diagnosed in advanced stages of the disease. The following is the case of a 46-year-old female with non-specific symptoms, weight loss, abdominal pain and vomiting. A computerized tomography scan of the abdomen allowed determining the site and extension of the tumor, while a capsule endoscopy and an enteroscopy showed a neoplastic lesion in the proximal jejunum. A histopathology analysis reported moderately differentiated adenocarcinoma of jejunum with favorable results after a curative surgical resection that improved the prognosis of life at 5 years and with favorable follow-up until to date.

Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib. METHODS: We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed. RESULTS: JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05). CONCLUSIONS: The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib.

Intussusception due to intramural jejunal splenosis.

Splenosis is defined as the growth of ectopic splenic tissue, due to its direct seeding, usually seen after traumatic or surgical procedures to the spleen. It often occurs on highly vascularized surfaces such as the omentum or the mesentery, and grows in sessile form, supplied by adjacent vessels. Intestinal splenosis with endoluminal extension is extremely rare. We present a case of intestinal splenosis with endoluminal growth in a 14-year-old boy that provoked a small bowel intussusception requiring surgical resolution.

Orange essential oil in the diet of broilers: performance, organ biometrics, bone characteristics, and intestinal morphometry

Growth performance, organ biometrics, bone characteristics, and intestinal morphometry were evaluated in broilers fed a diet containing orange (Citrus sinensis L.) essential oil. A completely randomized design was used, with five treatments with orange essential oil (0, 100, 200, 300, and 400 mg kg−1 diet) and six replications with 20 birds per experimental unit. In the pre-starter phase, feed intake and weight gain of all birds linearly increased, while feed conversion decreased with the addition of orange essential oil in the feed. At day 21, bone density (Seedor Index) and body weight were higher in the birds that received the maximum level of essential oil (400 mg kg−1) compared with those not treated with essential oil. The observed effects resulted from the better functioning of the physiological mechanisms of digestion and absorption of nutrients, characterized by the increase in villus height. Glycemia and weights of gastrointestinal tract organs of broilers at 21 days of age were not influenced by the evaluated essential oil. The results show that the addition of phytogenic additives to the diet does not cause any physiological impairment in birds.

Valor de la tomografía abdominal para el diagnóstico del fibroleiosarcoma yeyunal / Abdominal tomography importance on the Leiomyosarcoma of jejunum diagnosis

RESUMEN Se presentó el caso de un paciente de 49 años de edad, que acudió a la consulta de Medicina Interna del Hospital General Docente "Dr. Agostinho Neto" por perder unas 20 libras de peso en dos meses y presentar heces fecales con aspecto aparente a "borra de café". El examen físico reveló desnutrición ligera y mucosas hipocoloreas. El ultrasonido abdominal mostró en hipocondrio y flanco izquierdo una imagen hipoecogénica heterogénea polilobulada que midió 68x61 mm con aspecto de paquete adenomegálico. En la tomografía computarizada de abdomen se identificó una imagen con densidad entre 33 y 57 UH, de 100 x 80 mm, polilobulada en topografía del yeyuno, que con el estudio contrastado realzó hasta 67 UH con aspecto tumoral. Se realizó resección quirúrgica del tumor con anastomosis termino-terminal. La biopsia informó fibroleiomiosarcoma. Se concluye que el estudio de las imágenes resulta útil para el diagnóstico de esta enfermedad.

ABSTRACT A 49-year-old patient presented to the internal medicine consultation office at the "Dr. Agostinho Neto" General teaching Hospital because of weight loss (20 pounds) and black stools in a period of 2 months before the evaluation. The physical examination revealed mild malnutrition and hypochlorous mucous membranes. The abdominal ultrasound image in the left hypochondrium showed a heterogeneous - polylobate - hypoechogenic mass measuring 68 x 61 mm with appearance of an adenomelagia. Computed tomography (CT) scan of the abdomen revealed an image with a density of 33 and 57 Hounsfield units (HU), measured 100 mm by 80 mm, polylobulated in jejunum topography, which with the contrasted study enhanced up to 67 UH with a tumor appearance. Surgical resection of the tumor with termino-terminal anastomosis was performed. Tumor biopsy diagnosed leiomyosarcoma. It was concluded that the study of the images was useful for the diagnosis of this disease.

Effects of acute fluoride exposure on the jejunum and ileum of rats: Insights from proteomic and enteric innervation analysis.

Fluoride (F) is largely employed in dentistry, in therapeutic doses, to control caries. However, excessive intake may lead to adverse effects in the body. Since F is absorbed mostly from the gastrointestinal tract (GIT), gastrointestinal symptoms are the first signs following acute F exposure. Nevertheless, little is known about the mechanistic events that lead to these symptoms. Therefore, the present study evaluated changes in the proteomic profile as well as morphological changes in the jejunum and ileum of rats upon acute exposure to F. Male rats received, by gastric gavage, a single dose of F containing 0 (control) or 25 mg/Kg for 30 days. Upon exposure to F, there was a decrease in the thickness of the tunic muscularis for both segments and a decrease in the thickness of the wall only for the ileum. In addition, a decrease in the density of HuC/D-IR neurons and nNOS-IR neurons was found for the jejunum, but for the ileum only nNOS-IR neurons were decreased upon F exposure. Moreover, SP-IR varicosities were increased in both segments, while VIP-IR varicosities were increased in the jejunum and decreased in the ileum. As for the proteomic analysis, the proteins with altered expression were mostly negatively regulated and associated mainly with protein synthesis and energy metabolism. Proteomics also revealed alterations in proteins involved in oxidative/antioxidant defense, apoptosis and as well as in cytoskeletal proteins. Our results, when analyzed together, suggest that the gastrointestinal symptoms found in cases of acute F exposure might be related to the morphological alterations in the gut (decrease in the thickness of the tunica muscularis) that, at the molecular level, can be explained by alterations in the gut vipergic innervation and in proteins that regulate the cytoskeleton.