Enteroliths Causing Intermittent Obstruction in a Patient with Crohn''s Disease

Calcified enteroliths as a cause of intermittent small bowel obstruction is an uncommon clinical entity. The pathophysiological mechanism involves stasis of intestinal contents and has been associated with Meckel's diverticulum, tuberculosis, and regional enteritis. This case describes prophylactic operative intervention in a symptomatic patient with enteroliths as a result of Crohn's disease.     

磁共振小肠造影对小肠疾病的诊断价值

目的 探讨磁共振小肠造影对小肠疾病的诊断价值。方法 对21例疑为小肠疾病的患者行磁共振小肠造影检查，并与小肠插管造影和(或)手术病理结果比较。结果 21例行磁共振小肠造影检查的患者中，20例与小肠插管造影相符，包括克罗恩病6例，小肠肿瘤4例，肠梗阻3例，肠结核1例，十二指肠结肠瘘1例，有5例经各项检查均未发现小肠有明显病变。另1例磁共振小肠造影诊断为克罗恩病，但小肠插管造影误诊为淋巴瘤。磁共振小肠造影与临床诊断符合率为100％，而小肠插管造影为95．2％。有8例行手术治疗，结果均与磁共振小肠造影表现相符，其中7例与小肠插管造影相符。结论 磁共振小肠造影对小肠疾病，尤其是对肠壁和肠腔外病变的诊断有较高的临床价值。     

Intestinal pseudo-obstruction due to neurofibromatosis responding to cisapride.

Gastrointestinal involvement in neurofibromatosis presenting with mechanical obstruction, hemorrhage or intussusception is known. Small bowel dysmotility and intestinal pseudo-obstruction due to neurofibromatosis is rare. A 23-year-old man with classical neurofibromatosis presented with intermittent episodes of intestinal pseudo-obstruction, small bowel bacterial overgrowth and steatorrhea. The patient had good symptomatic improvement with cisapride.     

Massive rectal bleeding due to ileal tuberculosis

A patient with massive rectal bleeding due to ileal tuberculosis is reported. Technetium-99m labelled red blood cell scintigraphy indicated hemorrhage from the ileum, and laparotomy was then carried out. A 70-cm segment of ileum containing ulcers and erosions was resected, and epitheloid granuloma with Langhans-type giant cell was found in the resected specimen. Massive rectal bleeding is considered a rare presenting symptom of intestinal tuberculosis. Intestinal tuberculosis, including small intestinal tuberculosis, although uncommon, should be taken into consideration as a cause of rectal bleeding. Received: September 16, 1998 / Accepted: February 26, 1999     

Small bowel tuberculosis diagnosed by the combination of video capsule endoscopy and double balloon enteroscopy

Small bowel tuberculosis is sometimes encountered in oriental countries, and because its symptoms are vague and present a nonspecific pattern, confirmative diagnosis is difficult to achieve. In 2001, two new innovative endoscopic techniques for the small bowel, video capsule endoscopy and double balloon enteroscopy, were introduced, thus advancing the diagnostic technology for small bowel disorders. Our asymptomatic patient with small bowel tuberculosis was diagnosed definitively using the combination of video capsule endoscopy and double balloon enteroscopy. The number of such cases will increase when those procedures become more widely used. At present, the endoscopic view of small bowel tuberculosis is difficult to differentiate from Crohn's disease and drug-induced enteropathy, but from now on it will be possible to distinguish them utilizing endoscopic and fluoroscopic images. On the basis of the characteristics of small bowel tuberculosis with its endoscopic images, referring to our case report and previous literature, we report a topical diagnostic procedure, the combination of video capsule endoscopy and double balloon enteroscopy.     

肠结核的影像学诊断

目的 探讨肠结核的CT与肠道X线造影的诊断价值及局限性,优化影像学组合检查。方法 收集经病理证实的肠结核22例,所有病例均经CT及肠道X线检查包括胃肠钡餐造影（GI）18例、十二指肠低张造影2例、小肠双对比造影3例、结肠双对比造影8例,分析两种检查的影像学表现。结果 CT对肠结核病灶检出的敏感性和定性论断如肠道X线检查,不易判断十二指肠水平段及空回肠病灶,但易于检出合并腹内肠外结核（特别是对诊断有帮助的特征性淋巴结结核）及侵犯肠道的肠外结核灶。肠道X线检查对肠结核的肠粘膜破坏和溃疡形成情况、肠道的累及范围、肠腔的狭窄程度及瘘管的显示有重要诊断价值。结论 各种影像学检查均有其优点及不足之处,根据肠结核不同部位行局部腹部CT扫描加相应的肠道X线检查中明显提高该病的诊断准确性。     

EBV-associated lymphoproliferative disorders misdiagnosed as Crohn's disease

Epstein–Barr virus (EBV) plays an etiological role in various diseases. EBV-associated lymphoproliferative disorder (LPD) is usually observed in individuals with congenital or acquired immune deficiencies but was also recently reported in non-immunocompromised individuals. Two cases of immunocompetent patients with EBV-associated T-cell LPD of the small bowel and colon who were initially misdiagnosed as Crohn's disease (CD) are reported here. EBV-associated T-cell LPD with primary gastrointestinal tract involvement can manifest as multiple discrete ulcers of the small and/or large bowel that are similar to the lesions found in CD or intestinal tuberculosis. However, when patients have multiple intestinal ulcers that are not typical of CD or intestinal tuberculosis and the clinical course is unusual, clinicians should consider the possibility of EBV-associated LPD that involves the gastrointestinal tract because the treatment strategy and prognosis are completely different.     

Sclerosing encapsulating peritonitis: differential diagnosis to peritoneal encapsulation and abdominal cocoon--a case report.

A 59 year old man presented with symptoms of partial bowel obstruction. Small bowel x-ray studies did not allow to identify the nature of the intestinal process in the upper ileum. At laparotomy small bowel encapsulation with a whitish membrane was encountered. Despite partial removal of this membrane small bowel obstruction persisted and two weeks postoperatively the patient died of peritonitis and cardiac insufficiency. Autopsy findings revealed massive fibrous adhesions in the abdomen with granulomatous inflammation. The presence of foreign body giant cells and bifringent crystals were characteristic for talcum powder. The latter suggested a causal role of an appendectomy 45 years earlier. The diagnosis of sclerosing encapsulating peritonitis as established in our patient needs to be separated from peritoneal encapsulation, a congenital malformation, and abdominal cocoon, which contains histological elements of inflammation. This case report should draw attention to these entities in the differential diagnosis and surgical management of small bowel obstruction.     

176例肠结核严重并发症的外科手术治疗分析

目的 探讨肠结核严重并发症的外科诊治经验。方法 回顾性收集解放军第三〇九医院2006年5月至2016年5月收治的176例肠结核严重并发症外科手术患者的临床资料,包括并发单一肠梗阻者132例(75.0%)、急性肠穿孔者16例(9.1%)、慢性肠瘘者7例(4.0%)、肠出血者4例(2.3%),以及肠梗阻+肠穿孔6例(3.4%)、肠梗阻+肠瘘者11例(6.3%)。分析所有患者的手术时机、手术方式、术后并发症及治疗、随访结果等。结果 本组行急诊手术者31例(17.6%);96例(54.5%)完全性肠梗阻患者经保守治疗48~72h后,梗阻症状无改善而行手术治疗;31例(17.6%)不完全性肠梗阻、18例(10.2%)慢性肠瘘患者经规范抗结核治疗效果不佳后行手术治疗。132例并发单一肠梗阻患者均行肠粘连松解及部分小肠切除术,4例因腹腔广泛致密粘连中途放弃手术,11例行部分小肠切除术患者先行小肠造口,二期再行还纳手术。40例并发肠梗阻+急性肠穿孔或慢性肠瘘的患者均行部分肠切除术,17例有肠梗阻者同时行肠粘连松解术,12例行小肠造口术。4例肠出血患者均行部分肠切除,均同时行小肠造口术。176例手术患者中,20例(11.4%)出现早期手术并发症,其中肠瘘2例、肠出血1例、腹腔或盆腔脓肿3例、肺部感染4例、下肢深静脉血栓2例、伤口感染8例,均通过抗感染、抗凝及换药等保守治疗后痊愈。术后死亡2例,死亡率为1.1%(2/176)。8例失访,166例随访12~18个月,平均随访时间(15.8±4.2)个月,随访率为95.4%(166/174)。术后3个月内肠结核临床症状完全缓解143例(86.1%,143/166),因再次肠梗阻、肠穿孔或肠瘘行二次手术8例(4.8%,8/166),随访期间出现腹痛、腹胀、腹泻、便秘症状长期不能缓解15例(9.0%,15/166)。结论 肠结核一旦出现严重并发症应及时手术治疗,准确的手术时机、合理的手术方式及规范的抗结核药物治疗是保证肠结核严重并发症救治成功的关键。     

Radiation-induced Recurrent Intestinal Pseudo-obstruction

The syndrome of intestinal pseudo-obstruction is a complex of signs and symptoms of intestinal obstruction without evidence of mechanical obstruction of the intestinal lumen. A patient with radiation-induced intestinal pseudoobstruction is described. The patient is a 74-year old woman with a history of chronic diarrhea, recurrent episodes of crampy abdominal pain, nausea and vomiting since receiving a 13,000 rad radiation dose to the pelvis in 1954. She has been hospitalized on many occasions for symptoms and signs of bowel obstruction. Upper gastrointestinal contrast roentgenograms with small bowel follow-through done during these episodes revealed multiple dilated loops of small bowel with no obstructing lesion. Barium enemas revealed no obstructing lesion. Each episode resolved with conservative therapy. Other secondary causes for intestinal pseudo-obstruction were ruled out in our patient. She gave no history of familial gastrointestinal disorders. Although postirradiation motility abnormalities have been demonstrated experimentally this is the first report of radiation induced intestinal pseudo-obstruction.     

Intestinal tuberculosis mimicking Crohn's disease: lessons relearned in a new era

Over 400 000 cases of tuberculosis existed in Europe in 2002, 1% of which were intestinal tuberculosis. With population migrations on the increase, physicians may have to face an increase in intestinal tuberculosis. One of the attributes of intestinal tuberculosis is its ability to present in nonspecific ways and to mimic other disorders, in particular inflammatory bowel disease. We present a case series of intestinal tuberculosis presenting as inflammatory bowel disease and referred for management to a specialized clinic in inflammatory bowel disease, followed by a discussion of the difficulties encountered with this condition. We highlight the consequences that misdiagnosis can have, in an era where population demographics are changing in Europe and where immunomodulators and biological agents have the potential to do more harm than good.     

Perforation of the Small Intestine Due to Eosinophilic Gastroenteritis

A 74-year-old woman with longstanding diarrhea and clinical symptoms of malabsorption and a raised peripheral eosinophilic count underwent an explorative laparotomy for small intestinal perforation. The resected specimen was consistent with the diagnosis of eosinophilic gastroenteritis. Despite corticosteroids, a second acute abdominal crisis occurred and the patient died. Small intestinal perforation due to transmural bowel wall involvement in eosinophilic gastroenteritis has to our knowledge not been described previously.     

Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction

AIM： TO evaluate the effectiveness and safety of capsule endoscopy （CE） in patients with recurrent subacute small bowel obstruction.METHODS： The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through.RESULTS： CE made a definitive diagnosis in 12 （38.7%） of 31 cases： four Crohn＇s disease （CD）, two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine,one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three （9.7%） of 31 patients, and was caused by CD （2） or tumor （1）. Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 too. No case had an acute small bowel obstruction caused by performance of CE.CONCLUSION： CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.     

Combined small bowel and reduced auxiliary liver transplantation：case report

AIM：To present a case of combined small bowel and reduced auxiliary liver transplantation.METHODS:A55-year-old patient with short bowel syndrome and TPN-related liver dysfunction received small bowel transplantation combined with a reduced auxiliary liver graft.A liver was added to restor the patient‘s liver function and to protect the intestinal allograft from rejection.His own liver was not removed.RESULTS:Without donor pretreatment and by conventional immunosuppresive therapy following transplantation,the patient exparienced had only one episode of mild intestinal rejection,which was easily reversed by treatment with Methylprednisolone,No liver rejection occurred.Unfortunately,the patient died of heart and lung failure 30d after transplantation,despite successful graft replacement,Histopathologic examination of specimens after death demonstrated normal structure in both intestinal and liver grafts.CONCLUSION:The auxiliary liver graft might play a role in preventing intestinal allograft rejection.However,the observation periol in this case is short.Further study is needed to determine the risks ,effect on the protecting the small-bowel from rejection,and feasibility of general application of this procedure.     

Anasarca and small bowel obstruction secondary to endometriosis

Intestinal involvement by endometriotic tissue occurs in up to 37% of patients with endometriosis. The vast majority of patients do not experience symptoms related to the gastrointestinal tract. In particular, the complications of intestinal obstruction and malabsorption secondary to endometriosis are exceedingly uncommon. We present a 42-year-old woman with intestinal obstruction, protein-losing enteropathy, and anasarca secondary to endometriosis. She had a 1-year history of watery diarrhea, bloating, and abdominal pain with a 30-lb weight-loss over 3 months. She had no previous history of endometriosis, and laboratory investigations showed severe hypoalbuminemia, hypokalemia, and metabolic acidosis. Abdominal x-rays revealed air-fluid levels and dilated loops of small bowel. She underwent surgical resection with primary anastomosis. Pathologic evaluation showed extensive endometriosis of the small bowel and appendix, which resulted in complete obstruction. Segments of ileum also demonstrated moderate-to-marked blunting of the villi. Postoperatively, the patient had a slow recovery with resolution of anasarca and a gradual increase in her weight. This report illuminates the rare, yet significant, complications of intestinal endometriosis, including small bowel obstruction, the development of a protein-losing enteropathy, and anasarca. One should consider the possibility of intestinal endometriosis in the differential diagnosis of bowel obstruction in women of childbearing age.     

无痛胃镜肠镜与胶囊内镜检查同日进行的可行性探讨

[目的]探讨无痛胃镜肠镜与胶囊内镜检查同日进行的可行性。[方法]接受胶囊内镜检查的患者中,32例为同日接受无痛胃镜肠镜检查后、接着行胶囊内镜检查的患者(同日组),81例为先行电子胃肠镜检查后、择日只接受胶囊内镜检查的患者(择日组)。观察2组胶囊的运行时间,病变检测率,不良反应。[结果]胃内运行的平均时间:同日组为(30.75±35.97)min,择日组(31.81±32.13)min,2组比较差异无统计学意义(P0.05);小肠内运行的平均时间:同日组(294.97±122.55)min,择日组(267.87±117.82)min,2组比较差异无统计学意义(P0.05)。2组均未发生无不良反应,无一例发生胶囊滞留。[结论]胶囊内镜检查操作安全、无创伤,有较高的诊断价值,与无痛胃镜、肠镜同日执行是可行的,并可避免多次肠道准备带来的不适。     

Diffuse intestinal polyangiomatosis as a cause of recurrent intestinal hemorrhage. Report of an unusual case

We observed a 38-year-old Italian male with recurrent intestinal bleeding and consecutive iron-deficient anemia. For search of the source of bleeding intensive clinical, endoscopic and radiological investigations had been performed. Multiple malformations of superior mesenteric artery with abnormal vascularisation of jejunum and ileum were established angiographically. In addition the lumen of small bowel loops was dilated and enlarged mucosa folds were found. Because of a prominent vascularized area in the cecum a resection of the right hemicolon had been performed with consecutive death of the patient. The post mortem investigation revealed dilated mesenteric arteries, multiple cavernous hemangiomata in the mesenterium, in the wall of the small bowel and solitary in the large bowel. Additionally angiodysplasias, phlebectasias, lymphangiectasias, and lymphangiomata in the large bowel and in the mesenterium were found. "Diffuse intestinal polyangiomatosis" is the proposed term of the syndrome consisting of recurrent intestinal bleeding and multiple intestinal vascular malformations.     

Success with intestinal failure: from adaptation to transplantation.

Intestinal failure can result from large resections of small intestine (short bowel syndrome) and from failure of normal intestinal motility. The medical management of short bowel syndrome centers around appropriate diet and use of specific medications including experimental trophic factors. Enteral tubes and prokinetic medications can be successfully used to treat patients with intestinal failure as a result of abnormal intestinal motility. Small bowel transplantation may be a treatment option in certain patients with intestinal failure. This article reviews the management of intestinal failure with a recent update on small bowel transplantation.     

Intestinal tuberculosis of the terminal ileum causing obstructive ileus and tuberculous peritonitis and presenting numerous peritoneal small red nodules: a case report

A 38-year-old woman suffering from lower abdominal pain was referred to our hospital. Abdominal computed tomography showed marked thickening of the terminal ileum to the cecum, localized collection of ascites, and multiple mesenteric lymphadenopathy. A barium contrast small bowel series showed solitary severe stenosis of the terminal ileum with marked swelling of the ileocecal valve, where colonoscopy could not pass through, suggesting that ileal stenosis was caused by intestinal tuberculosis. She also showed strongly positive tuberculin skin test. Laparoscopy-assisted ileocecal resection was performed for confirmation of diagnosis and removal of the stenotic intestinal lesion. Laparoscopically, numerous small red nodules scattered on the stenotic ileal serosa, peritoneum, and mesenterium. Histopathological examination revealed ileal tuberculosis causing ulcerative stricture, and mesenteric tuberculous lymphadenitis. The small red nodules were formed of hemorrhagic tuberculous nodules.     

Fibrotic entrapment of the small bowel in congenital intestinal lymphangiectasia

Congenital intestinal lymphangiectasia is a rare protein-losing enteropathy that is characterized by diarrhea and peripheral edema. This report presents a 37-yr-old woman who had suffered from recurrent diarrhea and peripheral edema since her early childhood and who was admitted for severe attacks of abdominal pain. A diagnosis of intestinal lymphangiectasia was made endoscopically, histologically, and radiographically. Laparotomy revealed complete fibrotic entrapment of the small bowel, which caused partial mechanical bowel obstruction. Surgical decortication led to recovery. To the best of our knowledge, this is the first report on fibrotic entrapment of the small bowel in a patient with long lasting intestinal lymphangiectasia.