86例小肠癌的病理观察

本文报告８６例小肠癌，其中６１例原发，２５例继发。小肠癌的内涵有争议，本报告包含壶腹部癌而不包括回盲部癌。原发性小肠癌肉眼分四类：息肉型、浸润溃疡型、缩窄型和弥漫型。前三型是肿瘤发展的不同阶段，与肿瘤发生部位有关。本文还对小肠癌的鉴别诊断进行了讨论。     

Combined laparoscopic resection of intestinal stenosis of Garré and open preperitoneal mesh repair for irreducible femoral hernia

Intestinal stenosis of Garré is a rare condition caused by a benign fibrous bowel stricture due to complicated strangulated hernia. We present a case of intestinal stenosis of Garré associated with right femoral hernia in an 85‐year‐old woman. The patient visited our hospital with a 2‐day history of vomiting. Her abdomen was slightly distended. A mass was palpated in the right groin region. CT showed prolapse of the small intestine in the right groin region. An incarcerated right femoral hernia was diagnosed and manually reduced. Thirteen days later, the patient complained of abdominal pain. CT revealed dilatation and caliber change in part of the small bowel, indicating a small bowel obstruction due to intestinal stenosis of Garré. Laparoscopic release of the bowel obstruction and femoral hernia repair via an anterior approach were performed simultaneously. No recurrence of femoral hernia or bowel obstruction was noted at the 15‐month follow‐up.     

Radiographic features in ischemic jejunoileitis: Serial changes and comparison with pathologic findings

Serial radiographic examinations of the small intestine, including double-contrast studies, were performed in 13 patients with ischemic jejunoileitis, nine with the stricturing form and four with the transient form. Thumbprinting was observed in five (38%) patients and thickening of the folds in four (31%) at the acute stage of the disease. Tubular narrowing with irregular contours and dilated proximal bowel was observed in six (46%) patients and appeared on day 27 or later. Pathologic findings of the resected specimen in eight patients with the stricturing form revealed annular stricture with relatively shallow ulcers; the irregular contours of the tubular narrowing on radiographs were consistent with a granular or nodular appearance and/or multiple fissures on pathologic study. Eccentric deformity and sacculation were demonstrated in only one patient with the stricturing form. In addition, double-contrast study revealed small ulcers in three (23%) patients. Our results indicate that radiographic findings accurately reflect the clinical course and pathologic findings in this disease.     

Imaging features of small intestinal amyloidosis: a case report

Amyloidosis is a rare disease characterized by forming pathological protein deposits in organs or tissues. The localized form of amyloidosis affecting small intestine is rare. We report a case of small intestine amyloidosis which presented gastrointestinal bleeding and abdominal pain. We also display radiologic features of amyloidosis of the small bowel which will add evidence to accurate diagnosis and management.     

'Metachronous' adenocarcinoma of the small intestine

Adenocarcinoma of the small intestine accounts for less than 1% of primary gastrointestinal malignancies (1). Small intestine contains 75% of the length of the gastrointestinal tract with 90% of the surface mucosal area, and yet carcinoma is rare. Symptoms of small bowel adenocarcinoma are vague and non-specific, and this region is relatively inaccessible which together contributes to their late diagnosis and poor prognosis. The authors report a case of two primary adenocarcinomas of the small intestine in the same patient.     

Usefulness of color doppler sonography and 99m Tc-RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2-year-old child

Venous malformations of the small intestine are rare in children, and the preoperative diagnosis of a venous malformation in the small bowel can be very difficult. We report the case of a 2-year-old girl with a solitary cavernous venous malformation of the small intestine that caused gastrointestinal bleeding and anemia and review the usefulness of the combination of color Doppler sonography and 99m Tc-RBC scintigraphy for the diagnosis of venous malformation of the small intestine.     

Characteristics of nonsteroidal anti-inflammatory drugs-induced colopathy

Nonsteroidal anti-inflammatory drugs (NSAIDs) induce a broad spectrum of toxicologic manifestations throughout the gastrointestinal tract, including the large intestine. Even though several studies indicated that NSAIDs can cause perforation and bleeding of diverticula or they exacerbate inflammatory bowel disease, NSAIDs possibly damage the normal large intestine; such involvement has been characterized by ulceration, stricture and colitis. And NSAIDs might be an etiological factor in collagenous colitis. While severe stricture, which has been referred to as "diaphragm-like stricture", has been known to be the most characteristic phenotype of the colonic involvement, NSAIDs-induced colonic ulceration should be regarded as a preceding stage for the stricture formation. Further epidemiological studies and therapeutic trials are warranted to clarify NSAIDs-induced colopathy.     

Clinical features of nonsteroidal anti-inflammatory drug-induced colopathy

NSAID induce a broad spectrum of toxicologic manifestations throughout the gastrointestinal tract, including the large intestine. Even though several studies indicated that NSAIDs can cause perforation and bleeding of diverticula or they exacerbate inflammatory bowel disease, NSAIDs possibly damage the normal large intestine; such involvement has been characterized by ulceration, stricture, colitis and the suppository induced rectal ulcer or proctitis. While severe stricture, which has been referred to as "diaphragm-like stricture", has been known to be the most characteristic phenotype of the colonic involvement, NSAID-induced colonic ulceration should be regarded as a preceding stage for the stricture formation. Further epidemiological studies and therapeutic trials are warranted to clarify NSAID-induced colopathy.     

The use of MRI in bowel obstruction

Nine patients with clinical or radiographic evidences of bowel obstruction were examined by magnetic resonance imaging. Retrograde insufflation of 1000–1200 ml of air through a Foley catheter placed in the rectum was employed. Scopolamine was used to inhibit bowel peristalsis and possibly relax the ileocecal valve. The administered air successfully distended the colon and the small bowel distal to the obstruction in seven of the nine cases. The air-filled small bowel loops were useful in delineating the obstruction sites and adjacent lesions in these seven cases. The diagnosis was established by means of surgery in six cases and by clinical course in three cases. The causes of obstruction included four peritoneal carcinomatoses, and one each of supravesical hernia, intussusception, adhesive band, benign granulomatous stricture, and radiational stricture. The site of obstruction was the distal small bowel in eight cases, and the rectosigmoid colon in one case.     

Distal common bile duct stenosis secondary to benign duodenal ulceration: Report of a case

Obstructive jaundice is a very rare complication of peptic ulcer disease. We report a patient who presented with symptoms suggestive of malignant distal common bile duct stenosis. A final diagnosis of benign duodenal ulcer with stricture of the common bile duct was made. A short review of the literature is also presented.     

改良式囊肿切除肝总管空肠Roux-Y吻合术治疗小儿先天性胆总管囊肿

目的探讨治疗小儿先天性胆总管囊肿的手术方法。方法对15例小儿先天性胆总管囊肿患儿,男性6例,女性9例,年龄1月至3岁,采用改良式囊肿切除、肝总管空肠Roux-Y吻合术治疗。结果15例均痊愈出院,其中小肠应激性溃疡穿孔1例,经再次进腹并行肠切除吻合后获愈。8例随访3个月至2年,未出现腹痛、黄疸、发热等症状,且获访的8例经B超检查,未见胆管狭窄,6例经消化道造影检查未见造影剂返流入肝管空肠吻合口。结论改良囊肿切除、肝总管空肠Roux-Y吻合术是治疗先天性胆总管囊肿的较好方法。     

Algorithm for the diagnosis of small intestinal disease

This article describes algorithm for the diagnosis of small intestinal disease. In case of massive small intestinal bleeding, angiography or double balloon endoscopy should be done firstly under the observation of vital sign and general condition. On the other hand, we have to select capsule endoscopy as a first-line examination in patients with mild or moderate small intestinal bleeding, and thereafter, double balloon endoscopy would be done for the decision of the diagnosis. If the patients are suspected of having stricture of the small intestine, they will initially undergo small intestinal radiography associated with or without abdominal ultrasonography and computed tomography. In addition, small intestinal radiography will be performed as a first-line examination in patients having abdominal symptom or occult blood stool without overt gastrointestinal bleeding, and as a subsequent examination, double balloon endoscopy and capsule endoscopy may be done.     

Emergent embolotherapy of small intestine hemorrhage

The efficacy of emergent embolotherapy was evaluated in six patients suffering hemorrhage from the small intestine. Hemorrhage was from the jejunum in four patients, from the ileum in one, and from Meckel's diverticulum in one. Superselective embolization of the arcade of the small intestine artery branch was performed in all patients with a coaxial catheter. Embolic materials used were Gelfoam particles alone or Gelfoam particles plus coils in earlier cases and microcoils in recent cases. Complete hemostasis was immediately achieved in all patients, but one patient died of disseminated intravascular coagulation. After stabilization of the patient's condition by hemostasis, elective surgery was performed on three patients suffering small intestine ulcer. Histopathologically, no bowel infarction was noted but mild mucosal inflammation with submucosal edema was found in the jejunum of two patients. We recommend embolization for life-threatening small intestine hemorrhage, preferentially in situations where the blood vessel involved can be superselectively occluded at the nearest level of the arcade of the vasa recta, lest the vasa recta should be occluded.     

Intestinal mast cell progenitors require CD49dbeta7 (alpha4beta7 integrin) for tissue-specific homing.

Mast cells (MCs) are centrally important in allergic inflammation of the airways, as well as in the intestinal immune response to helminth infection. A single lineage of bone marrow (BM)-derived progenitors emigrates from the circulation and matures into phenotypically distinct MCs in different tissues. Because the mechanisms of MC progenitor (MCp) homing to peripheral tissues have not been evaluated, we used limiting dilution analysis to measure the concentration of MCp in various tissues of mice deficient for candidate homing molecules. MCp were almost completely absent in the small intestine but were present in the lung, spleen, BM, and large intestine of beta7 integrin-deficient mice (on the C57BL/6 background), indicating that a beta7 integrin is critical for homing of these cells to the small intestine. MCp concentrations were not altered in the tissues of mice deficient in the alphaE integrin (CD103), the beta2 integrin (CD18), or the recombination activating gene (RAG)-2 gene either alone or in combination with the interleukin (IL)-receptor common gamma chain. Therefore, it is the alpha4beta7 integrin and not the alphaEbeta7 integrin that is critical, and lymphocytes and natural killer cells play no role in directing MCp migration under basal conditions. When MCp in BALB/c mice were eliminated with sublethal doses of gamma-radiation and then reconstituted with syngeneic BM, the administration of anti-alpha4beta7 integrin, anti-alpha4 integrin, anti-beta7 integrin, or anti-MAdCAM-1 monoclonal antibodies (mAbs) blocked the recovery of MCp in the small intestine. The blocking mAbs could be administered as late as 4 d after BM reconstitution with optimal inhibition, implying that the MCp must arise first in the BM, circulate in the vasculature, and then translocate into the intestine. Inasmuch as MCp are preserved in the lungs of beta7 integrin-deficient and anti-alpha4beta7 integrin-treated mice but not in the small intestine, alpha4beta7 integrin is critical for tissue specific extravasation for localization of MCp in the small intestine, but not the lungs.     

A duodenal ampullary tumor with malignant transformation of papillary polyps: a case report and literature review

Periampullary carcinoma refers to a malignant tumor within 2 cm of the duodenal ampulla. Primary ampullary carcinoma is very rare, accounting for only 0.2% of malignant gastrointestinal tumors. The small intestine accounts for 75% of the length of the gastrointestinal tract, and primary tumors in the small intestine account for only 2% of all gastrointestinal tumors. Here, we report the case of a duodenal ampullary tumor with malignant transformation of parapapillary polyps. The patient had both a primary ampullary tumor and high-grade intraepithelial neoplasia of juxtapapillary adenomatous duodenal polyps.     

Glucagon-induced small intestinal hypotonia demonstrating bleeding lymphoma

While a patient was being evaluated for melena, a glucagon-induced hypotonic examination of the small intestine demonstrated a small ulcerated mass in the jejunum. The tubeless hypotonic examination was performed after multiple gastrointestinal series, small intestinal series, barium enemas, and visceral arteriography—including celiac and superior mesenteric arteriograms—failed to identify a bleeding site. Surgical exploration revealed three ulcerated lymphomatous lesions in the jejunum. The lack of side effects, rapidity of onset, and shortness of duration of intravenous glucagon suggest that this type of hypotonic examination of the small intestine may prove useful as an adjunct to the small intestinal series.     

A case of indirect inguinal bladder hernia treated by laparoscopic hernia repair

Inguinal bladder hernia is a rare clinical condition, and only a small number of reported cases have been treated by laparoscopic surgery. In the present case, the patient was a 78-year-old man who presented to our emergency department with a chief complaint of right inguinal bulge and pain. CT imaging revealed an incarcerated right inguinal hernia containing the small intestine and a portion of the urinary bladder. We performed manual reduction of the incarcerated intestine, and he was admitted to the surgical ward for follow-up. On the 19th day after discharge, recurrence of incarceration developed, and he was readmitted after manual reduction. A laparoscopic transabdominal preperitoneal repair was performed. After careful reduction of the protruding bladder from the hernial orifice, we repaired the right inguinal hernia with a mesh prosthesis. We experienced a rare case of right indirect inguinal bladder hernia that was treated successfully with laparoscopic repair.     

Early-stage small-bowel adenocarcinoma: a review of local endoscopic therapy

Early adenocarcinomas in the small intestine are a rare entity. Most adenocarcinomas in the small intestine are diagnosed at a more advanced stage. After surgical resection, only 3 - 10 % are found in stage T1 and 0 - 3 % in stage Tis (high-grade intraepithelial neoplasia), resulting in an overall 3 - 13 % rate of early-stage small-intestinal adenocarcinomas. The diagnosis of early small-intestinal carcinoma by endoscopy is still very rare, although it will probably improve with the development of new endoscopic techniques. At present there have been only two studies and a few case reports on the treatment of early duodenal carcinoma by endoscopic resection. No major complications such as massive bleeding or perforation occurred in the studies and case reports, which show that endoscopic resection is a safe and effective treatment for early duodenal cancers that have not invaded the submucosa. Endoscopic resection can be carried out with reduced costs and lower morbidity and mortality rates in comparison with surgery.     

Barium studies in diffuse eosinophilic gastroenteritis

We report the findings on barium examinations from 20 patients with eosinophilic gastroenteritis. Thickening of mucosal folds in the stomach (seven cases), small intestine (four patients), or both (two cases) was the most common finding. Nodular fold enlargement was present in the stomach in three cases and in the small intestine in four cases. One patient had discrete antral polyps. Multiple gastric erosions, to our knowledge not previously reported in eosinophilic gastroenteritis, were seen in two patients. Although the stomach and small bowel are most commonly affected, any portion of the gastrointestinal tract may be involved.     

以肠梗阻为首发表现的成人IgA血管炎一例

IgA血管炎即过敏性紫癜,是一种主要累及皮肤、胃肠道、肾脏、关节等多系统的自身免疫性疾病,儿童和青少年多见,成人累及胃肠道相对少见。以肠梗阻为首发表现的成人IgA血管炎且累及整个小肠发生炎性改变的报道较少。该例患者为50岁男性,首先表现为不完全性肠梗阻,一般治疗效果不佳,腹部CT提示由累及部分小肠逐渐发展为几乎整个小肠...