No description available.

Abstract Superabsorbent water beads have found many uses as household decorative items, crafts, and other industrial uses. We report a case of ingestion of several LiquiBlock Rainbow brand superabsorbent beads by a ten month old girl leading to small bowel obstruction requiring laparotomy and removal of the beads.

A hollow viscus injury is an uncommon but potentially dangerous intra-abdominal injury that can result from blunt abdominal trauma. It can be misdiagnosed in patient, particularly when the patient has other concerning findings. Also, diagnosis can be increasingly difficult in a patient with a pre-existing ventral hernia and chronic abdominal pain. In this case we present a 66-year-old women, with a history of a large ventral hernia and chronic abdominal pain, who presented to the emergency department after a motor vehicle crash (MVC). Patient denied abdominal tenderness at the time of presentation and the initial computed tomography (CT) did not demonstrate any abnormal findings within the abdomen. Patient later began experiencing increased abdominal pain and presented with a small bowel perforation within the hernia that required a bowel resection and hernia repair. A review of the literature reveals that not only are hollow viscus injuries rare but there appears to be few documented cases of viscus injuries occurring within a existing ventral hernia.

Norovirus Gastroenteritis Leading to Partial Small Bowel Obstruction David Berry DO, Arthur Cecchini DO, Koushik Sanku MD, Bhavesh Gajjar MD Berrydw@etsu.edu, Cecchini@etsu.edu, Sankuk@etsu.edu, Gajjarb@etsu.edu Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University BACKGROUND Acute gastroenteritis (AGE) is a common problem in both inpatient and outpatient settings. Most cases are viral in origin, with norovirus being the most cited. Typical symptoms include low-grade fever, chills, nausea, vomiting, and abdominal discomfort. The physical examination is usually unremarkable, but abdominal tenderness or signs of volume depletion may be present in severe disease. Most patients have spontaneous remission within a few days and do not require hospitalization or diagnostic evaluation. Laboratory evaluation is often helpful in severe disease, immunocompromised patients, or when bloody or mucoid diarrhea is present. Polymerase chain reaction (PCR) gastrointestinal multiplex testing is often the preferred evaluation as it has a high sensitivity, specificity, and turnaround time when compared to traditional stool studies of enzyme-immunoassay studies. Treatment is often supportive, but specific bacterial and parasitic pathogens should prompt treatment with antimicrobial therapy. CASE PRESENTATION This case presents a 47-year-old male with no known previous medical history or history of intraabdominal surgeries. He presented with four days of progressive nausea, vomiting, diarrhea, and abdominal discomfort. The physical examination revealed a distended and tender abdomen. The metabolic panel did not show any electrolyte derangements. Computed tomography with intravenous contrast revealed partial small bowel obstruction versus less likely ileus. Gastrointestinal pathogen PCR returned positive for norovirus. The patient was given intravenous fluid, nausea control, and pain control, his diet was advanced, and his symptoms subsequently resolved. We believe this case to be unusual, as most cases of viral gastroenteritis are uncomplicated, and this patient presented with radiographic evidence of ileus versus partial small bowel obstruction. PCR testing revealed positivity for norovirus. He had no previous abdominal surgeries or family history of early intestinal malignancies, and the symptoms spontaneously resolved with several days of conservative management, making another etiology much less likely. CONCLUSION AGE is a common diagnosis seen in the primary care clinic, and most patients have an uneventful recovery. However, suspicion of partial obstruction or intestinal ileus should arise when severe abdominal pain and prolonged vomiting are present.

Peritoneal adhesions occur in up to 93% of adults after peritoneal trauma during surgery. Most adhesions are asymptomatic but can cause female infertility, small bowel obstruction (SBO) and chronic abdominal pain. Adhesion prophylaxis is needed to reduce the significant morbidity and increased health care costs resulting from peritoneal adhesions. This thesis aims to establish a relevant and reproducible experimental adhesion model to simultaneously study the healing processs and adhesion formation and later to examine whether carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl scavenger, can reduce adhesion formation or not; and, in a long-term follow-up, to investigate the incidence of and identify risk factors for adhesive SBO requiring surgical treatment after laparotomy during infancy and to survey the prevalence of self-reported chronic abdominal pain and female infertility. Male Sprague-Dawley rats were subjected to laparotomy, cecal abrasion, and construction of a small bowel anastomosis and examined at various time points after surgery. Early elevation of IL-6, IL-1β and TNF-α concentrations in peritoneal fluid but not in plasma correlate to adhesion formation in this rodent adhesion model, indicating that anti-adhesion treatment should be early, local and not systemic. The animals were treated with either peritoneal instillation of PVAC, or the anastomosis was sutured with PVAC-impregnated resorbable polyglactin sutures. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly evaluated using Kennedy- and Nair scoring systems. PVAC-impregnated sutures reduced adhesion formation without reducing bursting pressure. Infants who underwent laparotomy between 1976 and 2011 were identified (n=1185) and 898 patients were included with a median follow-up time of 14.7 (range 0.0-36.0) years. The median age at first laparotomy was 6 (range 1.0-365.0) days. There were 113 patients (12.6%) with adhesive SBO, with the highest incidence found in patients with Hirschsprung’s disease (19 of 65, 29%), malrotation (13 of 45, 29%), intestinal atresia (11 of 40, 28%) and necrotizing enterocolitis (16 of 64, 25%). Lengthy duration of surgery (hazard ratio (HR) 1.25, 95% CI, 1.07 to 1.45), stoma formation (HR 1.72, 1.15 to 2.56) and postoperative complications (HR 1.81, 1.12 to 2.92) were independent risk factors. Chronic abdominal pain was reported in 180 (24.0%) of 750 patients, and 17 (13.8%) of 123 women reported infertility. The morbidity after laparotomy in neonates and infants is high. Awareness of the risk factors may promote changes in surgical practice.

El objetivo de nuestro estudio fue evaluar si el fallo de la función intestinal absortiva observado después del trasplante de intestino delgado se debe a cambios en el tamaño de la superficie epitelial o bien proviene de un fallo en la función celular de los enterocitos. MATERIAL Y MÉTODOSSe realizaron trasplantes de intestino delgado (SBT) en ratas de acuerdo con la técnica de Monchik y Russell. Los animales fueron distribuidos en tres grupos (n=15 cada uno): Grupo A (control): asa simple de Thiry Vella; Grupo B: isotransplante heterotópico LEW-LEW; Grupo C: alotransplante heterotópico LBN-LEW. Se utilizó como solución de preservación Ringer lactato heparinizado a 4º C. Las ratas del grupo C se trataron con Ciclosporina (15mg/kg/24h IM). A los 21 dias del transplante heterotòpico, en 5 animales de cada grupo se realizó un segundo procedimiento quirúrgico para colocar el segmento de intestino transplantado en posición ortotópica. Mediante microscopía òptica y tinción H/E se observó la evolución micromorfológica de la mucosa intestinal, tomando muestras del intestino donante in situ antes de la perfusión y tras el transplante a los 7,14,21 y 36 dias. Estas muestras fueron procesadas mediante un sistema de analisis morfométrico de imagenes para quantificar cambios en el tamaño de las vellosidades en cuanto altura y anchura y asi determinar una posible modificacion en la superficie epitelial absortiva. En las series con transplante ortotópico, las muestras de intestino se estudiaron además por Microscopía Electrónica de Transmisión (TEM). Para determinar la evolución de la función absortiva del intestino transplantado se efectuaron pruebas de absorción de glucosa en los mismos intervalos de tiempo que las biopsias.RESULTADOS El estudio morfométrico muestra una disminución progresiva en la altura de las vellosidades tras el transplante, siendo más pronunciado en el grupo C. Una tendencia al aumento se observó en el ancho de las vellosidades. La superficie epitelial absortiva mostró una tendencia a la reducción, recuperando los valores iniciales tras la interposición ortotópica. Una reducción progresiva significativa de la absorción de glucosa se observó en ambos grupos de animales trasplantados respecto al grupo control. El estudio por TEM mostró la presencia de vacuolas citoplasmáticas en los enterocitos, así como una leve alteración en la morfología de las microvellosidades, mitocondrias y retículo endoplásmico. DISCUSIÓN Y CONCLUSIONES Una alteración de la fisiología celular parece ser la causa del fallo de la función de absorción intestinal después de SBT y este fracaso no dependería del tamaño de la superficie epitelial. Las alteraciones ultraestructurales observadas al TEM sugieren un daño celular grave que podría ser la causa de la insuficiencia absortiva. Pero el origen de estas alteraciones intracelulares sigue siendo desconocido pudiendo provenir tanto del efecto isquemia-reperfusión como de la respuesta inmunológica o de la toxicidad del propio tratamiento inmunosupresor. / The aim of our study was to asses if the failure of the absortive intestinal function observed after small bowel transplantation is due either to changes in the size of epithelial surface or caused by a failure in the cellular function of enterocytes.MATERIALS AND METHODSSmall bowel transplants (SBT) were performed in rats according to Monchik and Russell's technique. Animals were distributed into three groups (n=15 each):Group A (control):simple Thiry-Vella loop; Group B:heterotopic isograft LEW-LEW; Group C:heterotopic allograft LBN-LEW. Heparinized lactated Ringer's at 4ºC was a cold preservation solution. Cyclosporine dose 15mg/kg/24h IM was administered to group C rats. At day 21 of the initial surgery, a second operative procedure was carried out on 5 of the transplanted animals of each group to place the transplanted small bowel in orthotopic position.To asses the micromorphology of intestinal mucosa by light microscopy (LM), biopsy specimens of the donor small bowel were taken in situ before perfusion and after transplant at 7,14,21 and 36 days. In those series with orthotopic transplantation bowel samples were studied, in addition, by Transmision Electron Microscopy (TEM).The absortive function of the transplanted bowel was observed by Glucose absorption test performed at same time points of the biopsies. Histomorphometric determinations of size of villus height and width, and total epithelial surface was performed by LM H/E and Image Processing and Analysis System.RESULTSMorphometrical study shows a progressive shortening of villus in both groups of transplanted animals, being more pronounced in the group C at the end of study. A tendency to increase was observed in the villus width. The absorptive epithelial surface showed an initial reduction followed of return to normal state after orthotopical interposition.A significative progressive reduction of glucose absorption was observed in both groups of transplanted animals than in the control group.Study by TEM showed cytoplasmic vacuoles in the absorptive cells. There was also a slight alteration on morphology of microvilli, mitochondries and endoplasmic reticulum.DISCUSSION/CONCLUSIONSAn alteration of cellular physiology underlies the failure of intestinal absorptive function after SBT and this failure does not depend on the size of epithelial surface. The findings of TEM suggest a severe ultrastructural damage could be the cause of cellular absorptive failure, but the cause of this cellular damage remains unkown.

No description available.

Lange Zeit galt der Dünndarm als „Blackbox“ des Gastrointestinaltraktes. Seit Einführung der Videokapselendoskopie im Jahr 2001 eröffnete sich eine Methode, den Dünndarm zu visualisieren. An einem Kollektiv von 203 Patienten habe ich Indikationen, Ergebnisse und klinischen Nutzen von Dünndarmkapselendoskopien in einem Zeitraum von 4 Jahren untersucht. Der Dünndarm ist in der Gastroduodeno- und Koloskopie nicht komplett zugänglich, so dass bei entsprechender Indikation die nicht-invasive Videokapselendoskopie vorgenommen werden kann. Sie ist in der Lage 2-4 Bilder pro Sekunde in einem Zeitraum von 8-9 Stunden aufzunehmen, die als Film von ca. 50.000 Bildern zusammengestellt und interpretiert werden kann. Die Daten zur diagnostischen Ausbeute dieser Untersuchung variieren und sind abhängig von der entsprechenden Indikation. Zur Überprüfung des klinischen Nutzens habe ich daher in meiner Arbeit speziell die Passagezeiten und die erhobenen Befunde, wie Erosionen, Ulzerationen, Angiodysplasien, Petechien, Venektasien, Lymphangiektasien, Erytheme, Ödeme, Zottenreliefveränderungen, extrinsische Engen und Erhabenheiten im Hinblick für ihre diagnostische Bedeutung ausgewertet. Berücksichtigt wurden die Auswertbarkeit, Komplikationsrate sowie Vor- und Nachuntersuchungen. Das Aufklärungsgespräch erfolgte mindestens einen Tag vor der Videokapselendoskopie. Die Abführmaßnahmen entsprachen einer Koloskopievorbereitung. Das Studienkollektiv (203 Patienten) bestand aus 58% männlichen und 42% weiblichen Patienten. Der Altersdurchschnitt betrug 58 Jahre, die Altersspanne reichte von 8-90 Jahren. Über 93% nahmen die Videokapsel selbstständig ein, eine Applikation erfolgte bei 7% der Patienten in den Bulbus duodeni. Folgende Indikationen führten bei unserer Patientenklientel zu der Videokapselendoskopie: unklare gastrointestinale Blutung (45,3%), unklare abdominelle Schmerzen (24,1%), unklare Anämie (11,3%), Verdacht auf/ oder Komplikation bei Morbus Crohn (6,5%), unklare Diarrhoe (6,4%), Polyp- und Tumorsuche (5,4%), rezidivierendes unklares Erbrechen und Eiweißverlustsyndrom (jeweils 0,5%). Eine komplette Dünndarmpassage konnte innerhalb der Aufzeichnungszeit von 8-9 Stunden bei 84% der Patienten erreicht werden. Der Mittelwert der Magenpassagezeit lag bei 21 Minuten und der Dünndarmpassagezeit bei 6 Stunden. Die Komplikation Kapselretention trat bei 2% auf. Pathologische Befunde im Dünndarm wurden bei 85% detektiert. Die höchste diagnostische Ausbeute ergab sich bei der Abklärung der unklaren gastrointestinalen Blutung (80%) und bei der unklaren Anämie (78%), als häufigste Ursache wurden Schleimhautläsionen (43%) gefunden. Unklare abdominelle Schmerzen wiesen eine niedrigere diagnostische Ausbeute (41%) auf. Therapeutische Maßnahmen resultierten bei 73% der untersuchten Patienten aus den Kapselergebnissen. Eine medikamentöse Therapie wurde bei 66% eingeleitet oder verändert, Endoskopien wurden bei 4% und eine operative Therapie bei 4,4% durchgeführt. Damit ist die Dünndarmkapselendoskopie bei klarer Fragestellung und guter Darmvorbereitung eine sichere und sinnvolle Untersuchungsmethode, insbesondere zur Klärung unklarer gastrointestinaler Blutungen. Spezifische Dünndarmerkrankungen, wie der M. Crohn oder Tumore können relativ sicher ausgeschlossen werden.

The detailed visualization of the small bowel at the radiographic series is restricted by factors as loops overlap and content absence that doesn't allow the contrast with the other structures, disabling many times, an accurate radiographic diagnosis. Despite the usefulness of the conventional contrast series in several diagnoses, significant alterations are needed to instigate modification in the positive contrast medium coat to make it evident. The objective of this study was to adjust an exam technique with intestinal double-contrast, based on techniques used in the human medicine, which resulted satisfactorily in the demonstration of the mucosal surface in the 30 dogs submitted to the exam. The double-contrast in the lumen was achieved by a combination of a positive contrast medium, recovering the mucosal surface, and a negative filling the lumen. Ambiental air and carboximethylcelullose were the negative contrast medium tested and both were radiographicly similar / A visualização detalhada do intestino delgado no exame radiográfico é limitada por fatores como a sobreposição das alças e a ausência de conteúdo, o que não permite o devido contraste com as demais estruturas, impossibilitando muitas vezes, um diagnóstico radiológico preciso. Apesar da utilidade da técnica convencional de exame contrastado em diversos diagnósticos, este necessita de alterações significativas para promover modificação no preenchimento feito pelo meio de contraste radiopaco e evidenciá-las radiograficamente. O objetivo deste trabalho foi adaptar uma técnica de exame com duplo-contraste intestinal, baseada em técnicas radiográficas usadas na medicina humana, a qual resultou satisfatoriamente na demonstração da superfície mucosa nos 30 cães submetidos ao exame. O duplo-contraste no interior das alças intestinais foi obtido pela combinação de um meio de contraste positivo, recobrindo a superfície mucosa, e um meio de contraste negativo, preenchendo o lúmen. Dois meios de contraste negativos foram testados: o ar ambiente e a carboximetilcelulose, os quais, radiologicamente, mostraram-se semelhantes

Case Report: Krukenberg tumor is a metastatic adenocarcinoma of the ovary that classically arises from the gastrointestinal tract, most often as a metastasis from the stomach as the primary origin, followed by colon. Krukenberg tumors are very rare malignant tumors of the ovary, only accounting for 1-2% of all ovarian malignancies. They tend to present with bilateral involvement. The most common presenting symptoms are abdominal pain, distention, and ascites, secondary to the large ovarian masses. Postmenopausal vaginal bleeding is a rare presenting symptom of a Krukenberg tumor. The diagnosis is commonly delayed until late in the disease progression. We present a case of a 77-year-old woman with stage IV metastatic adenocarcinoma of lower GI with mesenteric involvement and pulmonary nodules. Her disease was confirmed by mesenteric mass biopsy and was histologically CK20 positive, CDX positive, and CK7 negative. She underwent eighteen rounds of palliative chemotherapy with oral capecitabine (Xeloda) over the course of fifteen months. Sixteen months after the initial diagnosis, imaging uncovered a new cystic pelvic mass measuring 15x13x12 cm, decreased mesenteric mass, increasing liver lesion, metastasis to the left adrenal gland, and minimal ascites. She has had vaginal bleeding. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and small bowel resection by gynecological oncologist. The left ovary was involved by metastatic adenocarcinoma, 15 cm, consistent with small bowel origin. The small bowel resection showed adenocarcinoma, 3.3 cm in size with serosal invasion arising in an adenoma. Patient is planned for chemotherapy with irinotecan in palliation. Our case demonstrates a rare case of small bowel adenocarcinoma later presenting as a Krukenburg tumor.