Ileo-ileal and ileocecal invagination due to intestinal lipomatosis

Intestinal lipomatosis is a rare entity and few cases have been reported in the literature. The condition is usually asymptomatic. Symptomatic cases usually present as obstruction or, less frequently, as bleeding. Intestinal barium studies, ultrasonography and computed tomography are useful diagnostic techniques. We present the case of a 47-year-old man with no relevant medical history who presented with intestinal obstruction of several months' duration. Complementary investigations yielded a diagnosis of intestinal obstruction due to ileocecal invagination secondary to endoluminal tumors of the ileum. Surgery and pathological analysis revealed the latter to be intestinal lipomatosis. This rare clinical entity has been associated with diverticulosis and intestinal volvulus.     

Recurrent intussusception as initial manifestation of primary intestinal melanoma:Case report and literature review

Enteric intussusception caused by primary intestinalmalignant melanoma is a very rare cause of intestinalobstruction.We herein present a case of a 42-yearold female patient with no prior medical history ofmalignant melanoma,who was admitted with persistentabdominal pain,nausea,and vomiting.A computedtomography scan revealed an intestinal obstruction dueto ileocolic intussusception.An emergency laparoscopy and subsequent laparotomy revealed multiple small solid tumors across the whole small bowel.An oncologic resection was not feasible due to the insufficient length of the remaining small bowel.Only a small segment of ileum,which included the largest tumors causing the intussusception,was resected.The pathologic examination revealed two intestinal malignant melanoma lesions.A systematic clinical examination,endoscopic procedures,and fluorodeoxyglucose positron emission tomography-computed tomography scan all failed to reveal any indication of cutaneous,anal,or retinal melanoma.Hence,the tumor was classified as a primary intestinal malignant melanoma with multiple intestinal metastases.Since a complete oncologic resection of tumors was not possible,in order to prevent future intestinal obstruction,a surgical resection of the largest lesions was performed with palliative intention.The epidemiology,clinical m a n i fe s t a t i o n s,d i a g n o s i s a n d m a n a g e m e n t o f primary intestinal malignant melanoma,and intestinal intussusception in adults are discussed along with a review of the current literature.     

Intestinal invagination in adults: preoperative diagnosis and management

Background and aims Intestinal invagination in adults is an uncommon but potentially serious condition that is usually diagnosed during surgery by the presence of a mechanical obstructive syndrome. We report a series of adults with intestinal invagination and discuss preoperative diagnosis and surgical procedures.Patients and methods We analyzed the files of all the seven patients aged over 18 years with a postoperative diagnosis of intestinal invagination and treated at our center between 1996 and 2000.Results Preoperative causal diagnosis was established in six cases by ultrasonography and computed tomography. All the patients received surgery, three as emergency and four programmed. The lesions causing the invagination were: three benign (Meckel's diverticulum, inflammatory pseudotumor, fibroid polyp) and one malignant (degenerative villous adenoma polyp) located in the terminal ileum, two malignant lesions in the cecum (both adenocarcinomas over a polyp), and in the remaining case a double lymphoma of the jejunum and ileum. The intussusceptions were ileoileal in three cases and ileocolic in four. We performed intestinal resection in six cases and one excision of Meckel's diverticulum.Conclusion Preoperative diagnosis of intussusception was possible in most cases. Sonography and computed tomography proved the most effective and useful preoperative diagnostic methods. In adults colonic invagination is almost always malignant while small bowel is almost always benign. Invagination in adults must be clarified by surgery, and intestinal resection is the procedure of choice.     

Malignant melanoma metastatic to the common bile duct

Metastatic melanoma is renowned for its propensity to spread to almost every organ of the body; however, symptomatic metastases within the biliary tree are very rare. We report two cases of bile duct obstruction from metastatic melanoma. The first case was caused by an intraluminal metastatic melanoma to the common bile duct, while the second case was caused by extraluminal involvement. The unique aspects of these cases include clinical presentations masquerading as biliary colic, cholangitis and obstructive jaundice. Management and follow up for 3 years is presented. Aspects of medical and surgical management, as well as a review of the world's literature are discussed.     

腹腔镜技术在急性肠梗阻治疗中的应用

目的　探讨腹腔镜技术在急性肠梗阻治疗中的应用价值。方法　采用电视腹腔镜设备与器械为３２ 例急性肠梗阻患者实施了腹腔镜手术治疗。结果　腹腔镜手术３０ 例（腹腔镜肠粘连松解术２２例,腹腔镜小肠扭转复位术６ 例,腹腔镜辅助乙状结肠切除术２ 例）,术中肠管损伤２ 例,均于腹腔镜下修补成功。因粘连严重与腹膜后脂肪肉瘤中转开腹手术２例。术后均恢复顺利,无手术并发症。腹腔恶性肿瘤漏诊２ 例,经再次开腹手术切除。结论　腹腔镜急性肠梗阻手术具有微创外科的优点,可以部分代替开腹手术治疗机械性肠梗阻,但对腹膜间位或后位脏器病变的观察与严重粘连病例的治疗有一定的局限性。     

Phasic study of intestinal homeostasis disruption in experimental intestinal obstruction

AIM: To investigate the phasic alteration of intestinal homeostasis in an experimental model of intestinal obstruction.METHODS: A rabbit model of intestinal obstruction was established by transforming parts of an infusion set into an in vivo pulled-type locking clamp and creating a uniform controllable loop obstruction in the mesenteric non-avascular zone 8 cm from the distal end of the ileum. The phasic alteration of intestinal homeostasis was studied after intestinal obstruction. The changes in goblet cells, intraepithelial lymphocytes, lamina propria lymphocytes, and intestinal epithelium were quantified from periodic acid-Schiff-stained sections. Ornithine decarboxylase (ODC) activity and serum citrulline levels were measured by high-performance liquid chromatography. Claudin 1 mRNA expression was examined by real-time polymerase chain reaction analysis. Intestinal microorganisms, wet/dry weight ratios, pH values, and endotoxin levels were determined at multiple points after intestinal obstruction. Furthermore, the number and ratio of CD3⁺, CD4⁺ and CD8⁺ T cells were determined by flow cytometry, and secretory IgA levels were measured with an enzyme-linked immunosorbent assay.RESULTS: A suitable controllable rabbit model of intestinal obstruction was established. Intestinal obstruction induced goblet cell damage and reduced cell number. Further indicators of epithelial cell damage were observed as reduced serum citrulline levels and claudin 1 gene expression, and a transient increase in ODC activity. In addition, the wet/dry weight ratio and pH of the intestinal lumen were also dramatically altered. The ratio of Bacillus bifidus and enterobacteria was reversed following intestinal obstruction. The number and area of Peyer’s patches first increased then sharply decreased after the intestinal obstruction, along with an alteration in the ratio of CD4/CD8⁺ T cells, driven by an increase in CD3⁺ and CD8⁺ T cells and a decrease in CD4⁺ T cells. The number of lamina propria lymphocytes also gradually decreased with prolonged obstruction.CONCLUSION: Intestinal obstruction can induce disruption of intestinal homeostasis.     

回肠末端弥漫性大B细胞淋巴瘤并肠梗阻1例报道

原发性肠道淋巴瘤临床很少见,易误诊。     

Lower intestinal bleeding due to aorto-enteric fistula

The case is described of a man who complained of intermittent fever and fatigue. After three digestive endoscopies and computed tomography, a 99m technetium-HM-PAO-labelled white cell scan was usefully employed to establish diagnosis. Anaerobic aortic Graft infection and anaemia due to lower intermittent occult intestinal bleeding were found. The intestinal bleeding was caused by secondary aorto-jejunal fistula. This condition is rare, but should be suspected whenever a patient with aortic prosthesis presents with occult digestive bleeding and unexplained fever.     

Paracecal hernia: A cause of intestinal obstruction

During a two-year period, five patients were treated by us for acute intestinal obstruction caused by an incarcerated paracecal hernia. All patients underwent surgery early, so none required bowel resection. The possibility of an internal hernia as a cause of intestinal obstruction and a profound knowledge of the pericecal anatomy, however, are necessary for successful diagnosis and treatment of paracecal hernias.     

使用谷氨酰胺治疗术后早期炎性肠梗阻疗效的观察

目的 探讨添加谷氨酰胺双肽的肠外营养对术后早期炎性肠梗阻患者治疗效果及蛋白质合成的影响.方法 对添加谷氨酰胺双肽营养支持的患者(2004年1月～2007年12月)与未添加谷氨酰胺双肽的患者(2000年1月～2003年11月)的治疗情况进行对比研究.结果 与对照组比较,予以营养支持12天后谷氨酰胺组血浆白蛋白、前白蛋白水平明显升高(P<0.05),感染发生率明显降低(P<0.05).结论 含谷氨酰胺双肽的肠外营养支持的方法能明显提高早期炎性肠梗阻患者机体蛋白的合成,降低感染发生率.     

手术治疗老年人急性肠梗阻183例临床分析

目的 总结老年人急性肠梗阻的临床特点。方法 回顾性分析我院1992年10月至2001年10月经手术治疗183例老年急性肠梗阻患者的临床资料。结果 183例经手术治疗老年人急性肠梗阻中，嵌顿性疝占首位(43．2％)。本组同期收治老年人结肠癌中，40．6％(43／106)以急性肠梗阻为人院始发原因。本组19例左半结肠癌中，手术切除17例，其中12例行Ⅰ期吻合，2例并发吻合口瘘(16．7％)。围手术期病死率3．3％(6／183)，皆因手术过晚所致。结论 积极有效手术干预，可使大多数老年急性肠梗阻患者得到治愈或不同程度缓解。     

Diverticulosis of the jejunum with intestinal obstruction： A case report

A diagnosis of intestinal diverticulosis is difficult to make pre-operatively because the clinical symptoms are usually non-specific. We report the case of a 70-year-old man who had suffered from three episodes of intestinal obstruction in 1 year. He experienced dull pain and a sensation of fullness over the whole abdomen. The symptoms did not improve after conservative treatment. The presumptive diagnosis was intestinal obstruction, and an exploratory laparotomy found diverticulosis of the proximal jejunum, with an adhesion band formed from the base of one diverticulum. Strangulation of a segment of the jejunum resulted from the internal herniation caused by the band. The band was removed and the proximal jejunum segmentally resected. His postoperative course was uneventful.     

成人美克尔憩室所致急性肠梗阻的临床特点

目的 分析成人美克尔(Meckel)憩室所致急性肠梗阻的临床特点和诊治体会.方法 对9例美克尔憩室所致急性肠梗阻病例的临床资料和病理学特点进行回顾性分析.结果 9例患者均行手术治疗,经腹腔探查证实为美克尔憩室所致急性肠梗阻.术前仅1例患者确诊为美克尔憩室所致急性肠梗阻,8例仅诊断为肠梗阻;5例行憩室楔形切除术,4例行包括憩室在内的部分回肠切除术.术后病理学检查显示9例患者美克尔憩室均有炎性改变,部分病例憩室伴有黏膜糜烂、微小溃疡、出血或穿孔,4/9憩室中含有异位组织;全部患者术后均痊愈.结论 美克尔憩室是导致急性肠梗阻的少见病因,术前诊断困难,易发生肠绞窄,部分病例憩室中含有异位组织,应及时手术治疗.

Abstract：

Objective To analyze the clinical features of adult patients with acute intestinal obstruction secondary to Meckel's diverticulum and the experience in management of the disease.Methods The clinical data and pathological features of 9 patients with acute intestinal obstruction secondary to Meckel' s diverticulum were retrospectively analyzed. Results All patients were diagnosed with acute intestinal obstruction secondary to Meckel's diverticulum via abdominal cavity exploration and underwent surgical treatment. Before surgical treatment, 1 out of 9 patients was correctly diagnosed as acute intestinal obstruction secondary to Meckel's diverticulum, and the other 8patients were diagnosed as acute intestinal obstruction. Diverticulum was resected in 5 cases and the rest 4 cases received partial excision of small intestine including the diverticulum. Pathological examination showed that all patients had inflammatory changes in diverticulum. Some patients were complicated with mucosal erosion, small ulcers, bleeding or perforation. Forty-four percent (4/9) of diverticula contained ectopic tissue. All patients were cured. Conclusion Meckel's diverticulum is a rare cause of acute intestinal obstruction and preoperative diagnosis is difficult. Diverticulum,howere,is likelihood to develop strangulation or contains ectopic tissue, so that the surgical treatment should be performed early.     

Ileum perforation due to delayed operation in obturator hernia:A case report and review of literatures

A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening ...     

Congestive heart failure due to aortic incompetence with intestinal infarction due to endarteritis obiliterans

A 27-year-old man with congestive heart failure due to aortic incompetence and subsequent intestinal infarction was found at laparotomy to have extensive necrosis of the bowel due to proliferative endarteritis. Symptoms resolved following treatment with prednisolone and cyclophosphamide, and replacement of the aortic valve. The sub-total occlusion produced by endarteritis obliterans may lead to acute end-organ infarction if cardiac output is reduced.     

Acute abdomen due to small bowel anisakiasis

The popularity in Western countries of dishes based on raw fish has led to an increased incidence of anisakiasis, a human parasitic disease caused by the ingestion of live anisakid larvae. The entire digestive tract may be involved, but the stomach and the small intestine are the most frequently affected sites. We report a case of acute abdomen due to Anisakis simplex infection that caused small bowel obstruction.     

Ileum perforation due to delayed operation in obturator hernia:A case report and review of literatures

A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h.The pain localized over the periumbilical area with radiation along the medial side of the thigh.Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately,her family refused surgery because of her worsening ...     

Midgut volvulus due to jejunal diverticula: A case report

Jejunal diverticulosis is uncommon and often asymptomatic. It can produce significant complications, and some complications are potentially life threatening and require early surgical treatment, such as obstruction, hemorrhage and perforation. There is no consensus on the management of this disease. Only a few cases of jejunal diverticulosis with midgut volvulus have been reported. We herein report a case of 57-year-old woman with jejunal diverticulosis causing small bowel volvulus who complained of intermittent upper abdominal pin-prick for 5 years that eventually progressed to a complete obstruction. The computed tomography scans revealed a mesenteric vessel "whirlpool" and laparotomy showed midgut volvulus secondary to jejunal diverticula. This case highlights jejunal diverticulosis causing small bowel volvulus as an uncommon mechanism of small bowel obstruction, which should be included in the differential diagnosis of small bowel obstruction.     

复方泛影葡胺对粘连性小肠梗阻早期手术的预测

目的:探讨口服76％复方泛影葡胺24小时后腹部平片对粘连性小肠梗阻治疗方法的选择是否可作为一个可靠指征。方法:对171例无绞窄情况的粘连性肠梗阻患者进行了本研究。40ml 76％复方泛影葡胺×40ml蒸馏水口服或经胃管注入。4、8、16、24小时拍腹部平片。如果4小时腹部平片升结肠显影,后序平片无需再拍。结果:24小时内造影剂到达结肠120例(70％),这些病人均成功地进行了保守治疗。51例病人24小时内造影剂未到达结肠,49例进行了手术治疗,2例保守治疗。结论:24小时内结肠显影的病人均成功地进行了保守治疗。提示口服复方泛影葡胺后24小时造影剂未到达结肠者需急诊手术治疗。