Malignant hemangioendothelioma of the small intestine: Report of a case

(Received for publication on Feb. 18, 1998; accepted on Sept. 11, 1998)     

Myoepithelial hamartoma of the small bowel: Report of a case

Benign small bowel tumors seldom cause symptoms, due to the fluid content and distensibility of the small bowel. We herein present the case of a solitary ileal hamartoma causing melena and abdominal pain in a 24-year-old man. The diagnosis of a submucosal ileal tumor was made after performing small bowel barium studies. Surgical treatment was undertaken, and a histological examination of the excised lesion, which showed a partially ulcerated tumor surface and extended from the submucosa to the subserosa, revealed numerous cystic glands of various sizes together with bundles of proliferating smooth muscle cells. Histochemical and immunohistochemical investigations were performed for differential diagnosis, and the tumor features were consistent with a diagnosis of ileal myoepithelial hamartoma. In the literature, small intestinal myoepithelial hamartomas are quite rare and this is the first report of a myoepithelial hamartoma causing melena.     

Ileal duplication presenting as perforation: Report of a case

(Received for publication on Apr. 9, 1999; accepted on Nov. 11, 1999)     

A case of hemangioendothelioma of the small intestine

An 81-year-old female was admitted to hospital with anemia and abdominal discomfort, however, various pre-operative diagnostic workups for the gastro-intestinal tract revealed no significant change. At the time of surgery, a small intestinal tumor was discovered by means of endoscopy and seven centimeters of ileum was radically resected. The tumor was subsequently diagnosed histopathologically as hemangioendothelioma. The patient recovered quickly and now, 6 years later, has had no sign of tumor recurrence. The incidence of this tumor is reportedly less than 3 per cent of all tumors found in the small intestine and the prognosis of this tumor in the small intestine is poor. A five-year-survival rate can be referred to only 33.3 per cent of the reported cases.     

小肠大出血的诊断和治疗

文章对近１０年收治的３８例小肠大出血予以回顾性分析。因小肠冗长，活动度大，急性大出血时无特异症状，又缺乏特检手段，本组术前确诊率仅２４％。本组３８例中，３例术后死亡；３５例治愈，并均获随访（平均４年３月），无１例再发出血。通过本组治疗经验，作者认为应尽可能发挥各项检查优势，详细分析病史，注意治疗反应，若经综合治疗仍持续出血者，宜尽早施行手术。根治性手术效果理想。     

Advanced primary non-Hodgkin's lymphoma of the small intestine in childhood: Report of four cases

Primary non-Hodgkin's lymphoma of the small intestine (PLI) is an uncommon malignancy in childhood which carries a poor prognosis. Consideration of the possible diagnosis of PLI is important when children have vague abdominal symptoms, since thoughtful multidisciplinary treatment can result in a better prognosis. This paper reports the cases of four children who have presented to our hospital since 1985 with advanced stage III or IV PLI. All the children had a huge abdominal mass but none of them had complete intestinal obstruction. Regarding the diagnosis, ultrasonography frequently reveals a hypoechoic thickening of the intestinal wall with dilated intestinal loops. A delayed primary or second-look operation may be the treatment of choice following adequate chemotherapy, while total parenteral nutritional support may prevent gastrointestinal complications. Three of the four patients have been in complete remission for 2 to 4 1/2 years since their initial treatment.     

Nitric oxide-related neural components in the rat small intestine after transplantation

The changes in nitric oxide (NO)-related neural components in the transplanted small intestine are unknown. In this study, the NO neural component was examined using electrophysiological and NADPH-diaphorase histochemical techniques in a rat small bowel transplantation model. Syngeneic total small bowel transplantation was performed in 26 male Lewis rats using microsurgical techniques. The rats were divided into four groups: an untreated control group and animals at 1 (G1), 2 (G2), and 4 (G4) weeks after transplantation. Jejunal strips were mounted in a superfusion apparatus for examination. In the presence of atropine and guanethidine, the effect of the NO synthesis inhibitor L-N^G-vitro-arginine (L-NNA, 100 M) relaxation mediated by the nonadrenergic, noncholinergic (NANC) neural system was assessed following electrical stimulation at 2 Hz. The inhibitory effect of L-NNA on relaxation was taken as an indicator of NO production. The percentage of inhibition in the control group, and in G1, G2, and G4 was 43.30% ± 6.08% (mean ± SE), 42.10%± 6.69%, 43.62±10.00%, and 52.46% ± 6.00%, respectively. Inhibition in G4 was significantly higher than in the other groups (P< 0.01). The percentage of NADPH-diaphorase-positive fibers in the control group, G1, G2, and G4 was 25.06 % ± 4.70% (mean ± SE), 26.27% ± 2.17% , 24.73% ± 2.87%, and 30.76% ± 3.19%, respectively. Again, G4 showed a significantly higher level than the other groups (P < 0.01). We conclude that increased NO production may play a significant role in maintaining the intrinsic nervous system of the small intestine after transplantation.     

Nitric oxide-related neural components in the rat small intestine after transplantation

Abstract The changes in nitric oxide (NO)-related neural components in the transplanted small intestine are unknown. In this study, the NO neural component was examined using electrophysiological and NADPH-diaphorase his-tochemical techniques in a rat small bowel transplantation model. Syngeneic total small bowel transplantation was performed in 26 male Lewis rats using microsurgical techniques. The rats were divided into four groups: an untreated control group and animals at 1 (G1), 2 (G2), and 4 (G4) weeks after transplantation. Jejunal strips were mounted in a superfusion apparatus for examination. In the presence of atropine and guanethidine, the effect of the NO synthesis inhibitor L-N^G-nitro-arginine (L-NNA, 100 µM) relaxation mediated by the nonadrenergic, noncholinergic (NANC) neural system was assessed following electrical stimulation at 2 Hz. The inhibitory effect of L-NNA on relaxation was taken as an indicator of NO production. The percentage of inhibition in the control group, and in G1, G2, and G4 was 43.30 %+ 6.08 % (mean ± SE), 42.10 %± 6.69 %, 43.62 ± 10.00 %, and 52.46 %+ 6.00 %, respectively. Inhibition in G4 was significantly higher than in the other groups ( P< 0.01). The percentage of NADPH-diaphorase-positive fibers in the control group, G1, G2, and G4 was 25.06%+4.70% (mean ± SE), 26.27 %± 2.17 %, 24.73%±2.87%, and 30.76 %± 3.19 %, respectively. Again, G4 showed a significantly higher level than the other groups ( P < 0.01). We conclude that increased NO production may play a significant role in maintaining the intrinsic nervous system of the small intestine after transplantation.     

The effects of diet on the residual small intestine following massive resection

The midportions of rat small intestines were resected by 90 per cent, and the residual intestines studied for the effects of diet on mucosal morphology, nutrition and gastrointestinal hormones. Groups of rats were fed chow, an elemental diet (ED), or an ED+dietary fiber (EDF) for 1 or 3 weeks. Nonresected rats which were fed chow or ED for 3 weeks were used as controls. Nutritional parameters, such as concentrations of serum total protein, albumin and transferrin were favorable but gain in body weight was not. The parameters indicated that resected rats fed EDF fared better than resected rats fed ED. Mucosal villous height in the residual jejunum, similar in all the resected groups after 1 week, was significantly increased in the resected rats fed chow or EDF after 3 weeks, but did not differ between 1 and 3 weeks in the resected rats fed ED. Changes in the number of villous epithelial cells and villous width were also examined. The level of plasma enteroglucagon was high in the rats fed chow or EDF after both 1 and 3 weeks, and was positively correlated with the increases in villous height. Levels of serum gastrin were not affected by dietary change. Luminal nutrients were significantly associated with the adaptive changes in the mucosa of the residual intestine, and mucosal morphology was also considerably influenced by dietary change.     

The development of a small bowel volvulus in the early postoperative period following a distal gastrectomy: Report of a case

A 51-year-old Japanese man who underwent a standard distal gastrectomy for cancer of the stomach developed abdominal pain when oral intake was commenced on the 6th postoperative day after an uneventful postoperative course. Complete obstruction of the jejunum led to a sudden deterioration in his general condition and a laparotomy was performed, revealing counterclockwise rotation of the mesenterium. The necrotic portion of the small intestine was removed, while 10 cm of the upper jejunum and 100 cm of the terminal ileum were preserved. His second postoperative course was uneventful apart from the development of intestinal hurry, which is now under medical control 9 months after his second laparotomy.     

Prolapse of the small intestine through a ruptured vagina caused during sexual intercourse: Report of a case

We report herein the rare case of a 56-year-old woman who suffered vaginal rupture into the peritoneal cavity during sexual intercourse, through which the small intestine prolapsed out from the vaginal opening. The patient had undergone abdominal hysterectomy 4 years earlier. An emergency laparotomy was performed which revealed rupture in the posterior fornix of the vagina and peritonium through which prolapse of the small intestine had occurred. The prolapsed intestine was pulled back into the pelvic cavity, and the vagina and peritonium were repaired. Macroscopically, the operative findings revealed no inflammatory changes or evidence of malignancy in the abdominal cavity. Thus, although rare, a ruptured vagina caused by sexual intercourse should also be considered in the field of surgery, even when a middle-aged woman presents with acute abdominal symptoms without a history of any other traumatic episode.     

Physiologic properties of small intestine submucosa

BACKGROUND: Porcine small intestine submucosa (SiS) has been introduced as a bioprosthesis in herniorrhaphy. This study evaluates in vivo properties of SiS that would affect clinical use. MATERIALS AND METHODS: Twelve pigs underwent implantation of SiS (perforated and nonperforated) on the peritoneal surface. Gross characteristics were evaluated and random samples harvested for histological study at 2 (n = 6) and 8 (n = 6) weeks. Collagen deposition was determined by polarized microscopy. Neovascularity (percent area blood vessels, %A(bv)) was determined by immunohistochemical staining with a polyclonal CD-31 antibody. RESULTS: Perforated SiS had a higher density of capillary ingrowth compared with nonperforated at both 2 (5.6%A(bv) versus 1.4%A(bv), P < 0.05) and 8 weeks (6.0%A(bv) versus 1.6%A(bv), P < 0.05). Compared with 2 weeks, 8-week SiS had a larger proportion of incorporation (25% versus 83%, P < 0.05) and new collagen deposition (50% versus 94%, P < 0.05). Significant contraction was observed in SiS 8 weeks after implantation (preimplant area 98 cm2 versus post-implant area 50 cm2, P < 0.05). CONCLUSION: SiS incorporated well 8 weeks after implantation, with deposition of new collagen. Perforated SiS demonstrated a more rapid and greater amount of neovascularity. The degree of contraction suggests that larger areas of SiS should be selected for herniorrhaphy than would be necessary if synthetic materials were used.     

Jejunal Lipomatosis with Diverticulosis: Report of a Case

(Received for publication on Nov. 25, 1996; accepted on July 8, 1997)     

Small intestinal metastasis from esophageal carcinoma associated with small intestinal obstruction: Report of a case

The small intestine is rarely involved with metastatic tumors from outside the abdomen, and few case reports have been documented in the literature. We describe herein what to our knowledge is the third case of a solitary metastasis from squamous cell carcinoma (SCC) of the esophagus being found in the jejunum, causing small intestinal obstruction.     

胃和小肠胃肠道间质瘤临床病理特征差异性分析

目的探讨胃和小肠胃肠道间质瘤(GIST)患者临床病理特征的差异性。方法经手术治疗的GIST患者164例,其中男75例,女89例,年龄50—70岁。比较胃及小肠GIST的临床病理特点。结果肿瘤最常发生于胃(127例),其次为小肠(27例);肿瘤已出现肝或腹腔转移6例,淋巴结转移1例,伴发胃肠道恶性肿瘤或癌前病变8例。复发风险极低度47例,低度50例,中度24例,高度37例。胃和小肠各组的肿瘤大小、肿瘤出血、坏死、CD34表达阳性率比较,差异有统计学意义(P0.05)。结论胃及小肠GIST的首发症状、肿瘤大小、CD34阳性率以及坏死出血概率有差异。     

腹腔镜小肠内异物取出术6例报告

目的:总结腹腔镜下小肠内异物取出术的手术经验及技巧.方法:回顾分析为6例患者施行腹腔镜小肠内异物取出术的临床资料.结果:6例均于腹腔镜下成功取出小肠内异物,无术中大出血、术后肠漏等并发症发生.结论:腹腔镜小肠内异物取出术是安全可行的,具有明显的优势.     

A black perforated esophagus treated with surgery:Report of a case

A case of a perforated black esophagus treated with minimal invasive surgery is presented.A 68-year-old women underwent a right-sided hemihepatectomy and radio frequency ablation of two metastasis in the left liver lobe.Previous history revealed a hemicolectomy for an obstructive colon carcinoma with post-operative chemotherapy.Postoperatively she developed severe dyspnea due to a perforation of the esophagus with leakage to the pleural space.Video-assisted thoracoscopic surgery(VATS) to adequately drain the perforation was performed.Gastroscopy revealed a perforated black esophagus.The black esophagus,acute esophageal necrosis or Gurvits syndrome is a rare entity with an unknown aetiology which is likely to be multifactorial.The estimated mortality rate is high.To our knowledge,this is the first case published of early VATS used in a case of perforated black esophagus.     

Complications of porcine small intestine submucosa graft for Peyronie's disease

PURPOSE: We report outcomes and complications of the use of porcine small intestine submucosa for correcting penile curvature due to Peyronie's disease. MATERIALS AND METHODS: A retrospective study was performed in patients with severe penile curvature (greater than 60 degrees) requiring surgical correction for sexual function. Preoperatively all patients underwent evaluation, including history, physical and penile duplex ultrasound. Of these patients 19 underwent tunical grafting with 1-layer Surgisis small intestine submucosa. Postoperatively patients were evaluated with clinic visits and telephone interviews to assess results. RESULTS: A total of 19 patients 46 to 69 years old (mean age 54) were treated with tunical incision or excision and grafting with small intestine submucosa between March 2002 and July 2005. Average followup was 15 months (range 3 to 43). Patients reported less penile pain with intercourse after surgery. There was no difference in Sexual Health Inventory for Men scores. Preoperatively 12 men (63%) had erectile dysfunction, defined as Sexual Health Inventory for Men less than 21, while 10 (53%) reported postoperative erectile dysfunction. Seven of the 19 patients (37%) had recurrent penile curvature (greater than 10 degrees) and 5 (26%) had recurrent Peyronie's disease plaque. Our complication rate was 37%, including hematoma at the graft site in 5 cases (26%), graft infection in 1 (5%) and Peyronie's disease recurrence requiring plication in 1 (5%). CONCLUSIONS: Small intestine submucosa carries potential for grafting applications because it is easy to use and readily available. Our experience resulted in a 37% complication rate, which exceeds those previously reported with saphenous vein graft repair.     

Small bowel obstruction caused by anisakiasis of the small intestine: report of a case

Enteric anisakiasis is a relatively rare disease that is difficult to diagnose preoperatively. We report a case of small bowel obstruction caused by enteric anisakiasis in a 59-year-old Japanese man who presented with abdominal pain a few hours after eating sliced, raw fish. Because of signs of an intestinal obstruction, a laparotomy was performed. Focal thickening and stenosis of the ileocecal region were seen about 100 cm from the end of the ileum and the lesion was excised. We found a moving anisakis thrusting its head into the mucosa of the excised small intestine. Histopathological examination revealed the infiltration of eosinophils in all layers of the intestinal wall and severe edema. Enteric anisakiasis is very rare, and its diagnosis is usually only made after laparotomy. Nevertheless, when signs of acute abdomen develop after the ingestion of raw fish, such as sushi or sashimi, the possibility of enteric anisakiasis should be borne in mind. Received: February 25, 2002 / Accepted: July 2, 2002 Reprint requests to: T. Sasaki