Effects of maternal methyl donor intake during pregnancy on ileum methylation and function in an intrauterine growth restriction pig model

Background Intrauterine growth retardation(IUGR)affects intestinal growth,morphology,and function,which leads to poor growth performance and high mortality.The present study explored whether maternal dietary methyl donor(MET)supplementation alleviates IUGR and enhances offspring’s growth performance by improving intestinal growth,function,and DNA methylation of the ileum in a porcine IUGR model.Methods Forty multiparous sows were allocated to the control or MET diet groups from mating until delivery.After farrowing,8 pairs of IUGR and normal birth weight piglets from 8 litters were selected for sampling before suckling colostrum.Results The results showed that maternal MET supplementation tended to decrease the IUGR incidence and increased the average weaning weight of piglets.Moreover,maternal MET supplementation significantly reduced the plasma concentrations of isoleucine,cysteine,urea,and total amino acids in sows and newborn pig-lets.It also increased lactase and sucrase activity in the jejunum of newborn piglets.MET addition resulted in lower ileal methionine synthase activity and increased betaine homocysteine S-methyltransferase activity in the ileum of newborn piglets.DNA methylation analysis of the ileum showed that MET supplementation increased the methyla-tion level of DNA CpG sites in the ileum of newborn piglets.Down-regulated differentially methylated genes were enriched in folic acid binding,insulin receptor signaling pathway,and endothelial cell proliferation.In contrast,up-regulated methylated genes were enriched in growth hormone receptor signaling pathway and nitric oxide biosyn-thetic process.Conclusions Maternal MET supplementation can reduce the incidence of IUGR and increase the weaning litter weight of piglets,which may be associated with better intestinal function and methylation status.

Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

Background: Perforations of the terminal ileum are a frequent clinical situation and a therapeutic challenge. Surgical treatment is controversial. Several surgical modalities have been proposed and postoperative morbidity and mortality remain high. The aim of this study was to review our experience in the surgical management of perforations of the terminal ileum. Patients and methods: This is a descriptive cross-sectional study with retrospective data collection from January 1, 2017 to December 31, 2021, in five hospitals in Cameroon. Patients’ demographic, clinical presentation, surgical findings and 30-days postoperative outcomes data were collected. Results: We collected 34 files. The sex ratio was 1.4 and the average age was 20.28 years. The average consultation time was 9.1 days. Abdominal pain was present in all our patients. Peritoneal irritation was present in 46 cases (88.5%). The mean time to treatment after admission was 17.5 hours. The perforation was unique in 40 cases (76.9%) and located between 6 and 10 cm from the ileocecal valve in 29 cases (55.8%). Typhoid was the most suspected etiology intraoperatively in 38 cases (73.1%). A simple suture was performed in 18 patients (34.6%), resection with anastomosis in 11 patients (21.2%) and an ileostomy in 5 patients (9.6%). The average length of hospitalization was 21.74 days. Postoperative morbidity and mortality were 32.7% and 17.3% respectively. Conclusion: Perforations of the terminal ileum are common and affect young people. Surgical procedures are varied. Reducing consultation and care times and respecting treatment principles could improve postoperative morbidity and mortality, which remain high.

Crohn’s disease: Why the ileum?

Crohn’s disease(CD)is an inflammatory bowel disease characterized by immunemediated flares affecting any region of the intestine alternating with remission periods.In CD,the ileum is frequently affected and about one third of patients presents with a pure ileal type.Moreover,the ileal type of CD presents epidemiological specificities like a younger age at onset and often a strong link with smoking and genetic susceptibility genes.Most of these genes are associated with Paneth cell dysfunction,a cell type found in the intestinal crypts of the ileum.Besides,a Western-type diet is associated in epidemiological studies with CD onset and increasing evidence shows that diet can modulate the composition of bile acids and gut microbiota,which in turn modulates the susceptibility of the ileum to inflammation.Thus,the interplay between environmental factors and the histological and anatomical features of the ileum is thought to explain the specific transcriptome profile observed in CD ileitis.Indeed,both immune response and cellular healing processes harbour differences between ileal and non-ileal CD.Taken together,these findings advocate for a dedicated therapeutic approach to managing ileal CD.Currently,interventional pharmacological studies have failed to clearly demonstrate distinct response profiles according to disease site.However,the high rate of stricturing disease in ileal CD requires the identification of new therapeutic targets to significantly change the natural history of this debilitating disease.

Repair of a giant inguinoscrotal hernia with herniation of the ileum and sigmoid colon:A case report

BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture.Giant inguinoscrotal hernias are rare in developed countries because of their better medical resources and early treatment.However,they can develop in patients who refuse surgery or ignore their condition.Intervention is inevitable because strangulation and organ perforation can occur,leading to peritonitis and sepsis.Common surgical approaches include open abdominal and inguinal approaches or a combination of both.CASE SUMMARY We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic complications.Abdominal computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the colon.Emergency surgical intervention was performed immediately because intestinal strangulation was highly suspected.The operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal approach.The incarcerated organs,which included the ileum and sigmoid colon,had relatively good intestinal perfusion without perforation or ischemic changes.They were successfully reduced into the abdomen,and bowel resection was not necessary.A tension-free prosthetic mesh was used for the hernia repair.Two weeks after the initial surgery,and with adequate antimicrobial therapy,the patient recovered and was discharged from our hospital.No evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after surgery.CONCLUSION Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.

Effects of N-(3',4',5'-Trimethoxycinnamoyl) ortho-Aminobenzoic Acid on Antigen-induced Contraction of Guinea-pig Ileum and the Degranulation of and Histamine Release from Mast Cells

N-(3′,4′,5′-Trimethoxycinnamoyl)ortho-aminobenzoic acid(TOA),at the concentration of 80μg/ml,significantly inhibited the antigen-induced contraction of ileum isolated from the actively sensitized guinea-pig.At the concentrations of 25 and 50μg/ml, TOA inhibited homocytotropic antibody-mediated degranulation of mast cells in the rat mesentery,and also inhibited anaphylactic histamine release from rat peritoneal mast cells.

Effects of Bifidobacterium infantis on cytokine-induced neutrophil chemoattractant and insulin-like growth factor-1 in the ileum of rats with endotoxin injury

BACKGROUND The digestive tract is the maximal immunizing tissue in the body, and mucosal integrity and functional status of the gut is very important to maintain a healthy organism. Severe infection is one of the most common causes of gastrointestinal dysfunction, and the pathogenesis is closely related to endotoxemia and intestinal barrier injury. Bifidobacterium is one of the main probiotics in the human body that is involved in digestion, absorption, metabolism, nutrition, and immunity.Bifidobacterium plays an important role in maintaining the intestinal mucosal barrier integrity. This study investigated the protective mechanism of Bifidobacterium during ileal injury in rats.AIM To investigate the effects of Bifidobacterium on cytokine-induced neutrophil chemoattractant(CINC) and insulin-like growth factor 1(IGF-1) in the ileum of rats with endotoxin injury.METHODS Preweaning rats were randomly divided into three groups: Control(group C),model(group E) and treatment(group T). Group E was intraperitoneally injected with lipopolysaccharide(LPS) to create an animal model of intestinal injury.Group T was intragastrically administered Bifidobacterium suspension 7 d before LPS. Group C was intraperitoneally injected with normal saline. The rats were killed at 2, 6 or 12 h after LPS or physiological saline injection to collect ilealtissue samples. The expression of ileal CINC mRNA was evaluated by reverse transcription-polymerase chain reaction(RT-PCR), and expression of ileal IGF-1 protein and mRNA was detected by immunohistochemistry and RT-PCR,respectively.RESULTS The ileum of rats in Group C did not express CINC mRNA, ileums from Group E expressed high levels, which was then significantly decreased in Group T(F =23.947, P < 0.05). There was no significant difference in CINC mRNA expression at different times(F = 0.665, P > 0.05). There was a high level of IGF-1 brown granules in ileal crypts and epithelial cells in Group C, sparse staining in Group E, and dark, dense brown staining in Group T. There was a significant difference between Groups C and E and Groups E and T(P < 0.05). There was no significant difference in IGF-1 protein expression at different times(F = 1.269, P > 0.05). IGF-1 mRNA expression was significantly different among the three groups(P < 0.05),though not at different times(F = 0.086, P > 0.05).CONCLUSION Expression of CINC mRNA increased in the ileum of preweaning rats with endotoxin injury, and exogenous administration of Bifidobacterium reduced CINC m RNA expression. IGF-1 protein and mRNA expression decreased in the ileum of preweaning rats with endotoxin injury, and exogenous administration of Bifidobacterium prevented the decrease in IGF-1 expression. Bifidobacterium may increase IGF-1 expression and enhance intestinal immune barrier function in rats with endotoxin injury.

Altered spontaneous contractions of the ileum by anesthetic agents in rats exposed to peritonitis

AIM： To investigate in vitro effects of propofol, midazolam and dexmedetomidine, which are commonly used anaesthesic or sedatives, on spontaneous contractions of the ileum both in normal rats and those exposed to hyperdynamic peritonitis.METHODS： Spontaneous contractions of isolated ileum muscle segments from sham operated rats and those exposed to peritonitis, were studied in vitro. The amplitude and the frequency of spontaneous contractions of ileum muscle segments were studied after adding dexmetetomidine, propofoi, and midazolam to the organ bath in a cumulative manner.RESULTS： Both amplitude （85.2 ± 6.6 vs 47.4 ± 7.1） and frequency （32.8 ± 4.6 vs 20.2 ± 3.9） of spontaneous contractions in ileum smooth muscle segments were decreased significantly in the peritonitis group compared to the control group （P 〈 0.05）. Dexmedetomidine significantly increased the amplitude of spontaneous contractions （85.2 ± 6.6 vs 152.0 ± 5.4, P 〈 0.05） whereas, propofol （85.2 ± 6.6 vs 49.6 ± 4.8, P 〈 0.05） and midazolam （85.2 ± 6.6 vs 39.2 ± 4.5, P 〈 0.05） decreased it in both control and peritonitis groups. The frequency of spontaneous contractions were significantly decreased by propofol in both control （32.8 ± 4.6 vs 18.2 ± 3.4, P 〈 0.05） and peritonitis groups 20.2 ± 3.9 vs 11.6 ± 3.2, P 〈 0.05）. Dexmedetomidine and midazolam did not cause significant changes in the number of spontaneous contractions in both control and the peritonitis groups （P 〉 0.05）.CONCLUSION： Propofol, midazolam and dexmede- tomidine have various in vitro effects on spontaneous contractions of the rat ileum. While dexmedetomidine augments the spontaneous contraction of the rat ileum, propofol attenuates it. However, the effects of these compounds were parallel in both control and peritonitis groups.

Endocrine cells in the ileum of patients with irritable bowel syndrome

AIM: To study the ileal endocrine cell types in irritable bowel syndrome (IBS) patients.

Dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the activity staging of terminal ileum Crohn's disease

BACKGROUND The activity staging of Crohn’s disease(CD)in the terminal ileum is critical in developing an accurate clinical treatment plan.The activity of terminal ileum CD is associated with the microcirculation of involved bowel walls.Dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusionweighted imaging(DWI)can reflect perfusion and permeability of bowel walls by providing microcirculation information.As such,we hypothesize that DCE-MRI and DWI parameters can assess terminal ileum CD,thereby providing an opportunity to stage CD activity.AIM To evaluate the value of DCE-MRI and DWI in assessing activity of terminal ileum CD.METHODS Forty-eight patients with CD who underwent DCE-MRI and DWI were enrolled.The patients’activity was graded as remission,mild and moderate-severe.The transfer constant(Ktrans),wash-out constant(Kep),and extravascular extracellular volume fraction(Ve)were calculated from DCE-MRI and the apparent diffusion coefficient(ADC)was obtained from DWI.Magnetic Resonance Index of Activity(MaRIA)was calculated from magnetic resonance enterography.Differences in these quantitative parameters were compared between normal ileal loop(NIL)and inflamed terminal ileum(ITI)and among different activity grades.The correlations between these parameters,MaRIA,the Crohn’s Disease Activity Index(CDAI),and Crohn’s Disease Endoscopic Index of Severity(CDEIS)were examined.Receiver operating characteristic curve analyses were used to determine the diagnostic performance of these parameters in differentiating between CD activity levels.RESULTS Higher Ktrans(0.07±0.04 vs 0.01±0.01),Kep(0.24±0.11 vs 0.15±0.05)and Ve(0.27±0.07 vs 0.08±0.03),but lower ADC(1.41±0.26 vs 2.41±0.30)values were found in ITI than in NIL(all P<0.001).The Ktrans,Kep,Ve and MaRIA increased with disease activity,whereas the ADC decreased(all P<0.001).The Ktrans,Kep,Ve and MaRIA showed positive correlations with the CDAI(r=0.866 for Ktrans,0.870 for Kep,0.858 for Ve,0.890 for MaRIA,all P<0.001)and CDEIS(r=0.563 for Ktrans,0.567 for Kep,0.571 for Ve,0.842 for MaRIA,all P<0.001),while the ADC showed negative correlations with the CDAI(r=-0.857,P<0.001)and CDEIS(r=-0.536,P<0.001).The areas under the curve(AUC)for the Ktrans,Kep,Ve,ADC and MaRIA values ranged from 0.68 to 0.91 for differentiating inactive CD(CD remission)from active CD(mild to severe CD).The AUC when combining the Ktrans,Kep and Ve was 0.80,while combining DCE-MRI parameters and ADC values yielded the highest AUC of 0.95.CONCLUSION DCE-MRI and DWI parameters all serve as measures to stage CD activity.When they are combined,the assessment performance is improved and better than MaRIA.

Effect of thienorphine on intestinal transit and isolated guinea-pig ileum contraction

AIM: To evaluate the effect of thienorphine on small intestinal transit in vivo and on guinea-pig ileum (GPI) contraction in vitro . METHODS: The effects of thienorphine on intestinal transit were examined in mice and in isolated GPI. Buprenorphine and morphine served as controls. The distance traveled by the head of the charchol and the total length of the intestine were measured in vivo . Gastrointestinal transit was expressed as a percentage of the distance traveled by the head of the marker relative to the total length of the small intestine. The isolated GPI preparations were connected to an isotonic force transducer and equilibrated for at least 1 h before exposure to drugs. Acetylcholine was used for muscle stimulation. RESULTS: Thienorphine (0.005-1.0 mg/kg, ig ) or bu-prenorphine (0.005-1.0 mg/kg, sc ) dose-dependently significantly inhibited gut transit compared with saline. Thienorphine inhibited gut transit less than buprenorphine. The maximum inhibition by thienorphine on the intestinal transit was 50%-60%, whereas the maximum inhibition by morphine on gut transit was about 100%. Thienorphine also exhibited less inhibition on acetylcholine-induced contraction of GPI, with a maximum inhibition of 65%, compared with 93% inhibition by buprenorphine and 100% inhibition by morphine. Thienorphine induced a concentration-dependent decrease in the basal tonus of spontaneous movement of the GPI, the effect of which was weaker than that with buprenorphine. The duration of the effect of thienorphine on the GPI was longer than that with buprenorphine. CONCLUSION: Thienorphine had less influence, but a longer duration of action on GPI contraction and moderately inhibited intestinal transit.

The role of α- and β-adrenergic receptors in the spasmolytic effects on rat ileum of Petroselinum crispum Latifolum(parsley)

Objective:To investigate Petroselinum crispum Latifolum(parsley) for treating stomach and intestinal disorders in Iran.Methods:An 80%ethanol extract was prepared from parsley seeds, and its antispasmodic activity assessed by measuring contractions of isolated ilea induced by 60 mM potassium chloride(KG).A piece of ileum from an adult male Wistar rat was dissected and mounted in an organ bath containing Tyrode’s solution,and ileum contractions were recorded by an isotonic transducer under one gram resting tension.The effect of parsley extract was measured in the presence of two antagonists’ of a - and(5-adrenoceptors.Results:These experiments showed that parsley extract inhibited the response to 60 mM KC1 in a concentration-dependent manner(P【0.01,n=7).The spasmolytic effect of parsley extract was unaffected by 1μM phentolamine or 1μM propranolol.Conclusions:This study shows that parsley seed extract is a relaxant of isolated rat ileum and the relaxation effect of extract does not involved adrenergic receptors.

Terminal ileum gangrene secondary to a type Ⅳ paraesophageal hernia

Type Ⅳ paraesophageal hernia(PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type Ⅳ PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in Pub Med. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type Ⅳ PEH with incarceration of only the terminal ileum.

Expression of matrix metalloproteinases and tissue inhibitor metalloproteinases increases in X-irradiated rat ileum despite the disappearance of CD8a T cells

AIM： To investigate their expression and activity in the rat ileum after exposure to ionizing radiation along with that of the cellular effectors and molecular mediators involved in the regulation of MMPs. METHODS： Rats were exposed to a single 10-Gy dose of X-rays delivered to the abdomen. A combination of methods, such as zymography, immunohistochemistry and real time reverse transcriptase-polymerase chain reaction, were used to localize and quantify MMPs and the molecules involved in MMP activating and inhibitory pathways （plasmin/ plasminogen, TIMPs）, CD^8＋, as well as inflammatory （interleukin （IL）-1β, IL-8, tumor necrosis factor-s, TNF-α） and fibrogenic mediators （transforming growth factor- β1-3） within ileal tissue at 1, 3, and 7 d after irradiation. RESULTS： A marked increase in MMP-2 and -14 mRNA and protein levels associated with an increased activity of MMP-2 was observed in irradiated ileal tissue. MMP-2 and -14 expression was mainly observed in inflammatory, epithelial, and mesenchymal cells, whereas a slight increase in MMP-3 expression was detected in the few infiltrating macrophages at d i after irradiation. Conversely, MMP-1, -7, and -9 mRNA levels were not found to be affected by abdominal irradiation. Irradiation was found to induce disappearance of CD^8＋ cells. Furthermore, we have observed that TNF-α and IL-1β protein levels increased 6 h after irradiation, whereas those of IL-8 only increased after 3 d and was concomitant with neutrophil infiltration. In addition, the expressions of molecules involved in MMP activating and inhibitory pathways （urokinase-type plasminogen activator andtissue-type plasminogen activator; TIMP-1, TIMP-2, and plasminogen activator-inhibitor-i） were found to be increased after abdominal irradiation. CONCLUSION： This study showed that abdominal irradiation induces an acute remodeling of the ileum associated with an increased expression of MMPs and TIMPs that do not involve CD^8＋ T cells but involve mesenchymal and epithelial cells, although to a lesser extent, and probably even soluble inflammatory and fibrogenic mediators.

Endoscopic identification of Peyer's patches of the terminal ileum in a patient with Crohn's disease

We presented a 20-year-old patient with Crohn's disease (CD).Colonoscopy revealed longitudinal ulceration in the terminal ileum and rectal aphtoid ulcers.After treatment with mesalamine and total parenteral nutrition,repeat colonoscopy revealed a granular elevated area in the terminal ileum,which appeared as an irregular dome-like elevation with irregularly arranged villi on magnifying endoscopy.Biopsy specimens taken from the region showed microgranulomas and lymphoid hyperplasia,Scanning electron microscopy revealed the presence of M cells,confirming that the area corresponded to Peyer's patches.Peyer's patches by magnifying endoscopy and electron microscopy may provide insights into the pathogenesis of CD.

P2X7 receptor antagonist recovers ileum myenteric neurons after experimental ulcerative colitis

BACKGROUND The P2X7 receptor is expressed by enteric neurons and enteric glial cells.Studies have demonstrated that administration of a P2X7 receptor antagonist,brilliant blue G(BBG),prevents neuronal loss.AIM To report the effects of BBG in ileum enteric neurons immunoreactive(ir)following experimental ulcerative colitis in Rattus norvegicus albinus.METHODS 2,4,6-trinitrobenzene sulfonic acid(TNBS group,n=5)was injected into the distal colon.BBG(50 mg/kg,BBG group,n=5)or vehicle(sham group,n=5)was given subcutaneously 1 h after TNBS.The animals were euthanized after 24 h,and the ileum was removed.Immunohistochemistry was performed on the myenteric plexus to evaluate immunoreactivity for P2X7 receptor,neuronal nitric oxide synthase(nNOS),choline acetyltransferase(ChAT),HuC/D and glial fibrillary acidic protein.RESULTS The numbers of nNOS-,ChAT-,HuC/D-ir neurons and glial fibrillary acidic protein-ir glial cells were decreased in the TNBS group and recovered in the BBG group.The neuronal profile area(μm^2)demonstrated that nNOS-ir neurons decreased in the TNBS group and recovered in the BBG group.There were no differences in the profile areas of ChAT-and HuC/D-ir neurons.CONCLUSION Our data conclude that ileum myenteric neurons and glial cells were affected by ulcerative colitis and that treatment with BBG had a neuroprotective effect.Thus,these results demonstrate that the P2X7 receptor may be an important target in therapeutic strategies.

Cavernous hemangioma of the ileum in a young man:A case report and review of literature

BACKGROUND Small intestinal cavernous hemangioma is a rare disease,especially in the ileum.It is difficult to accurately diagnose due to its hidden location and nonspecific clinical symptoms.Here,we reported a case of ileal cavernous hemangioma with chronic hemorrhage in a 20-year-old man and review the literature to gain a better understanding of this disease.CASE SUMMARY The patient complained of intermittent melena and hematochezia for > 3 mo.The lowest hemoglobin level revealed by laboratory testing was 3.4 g/d L(normal range:12-16 g/dL).However,the gastroscopy,colonoscopy and peroral doubleballoon enteroscopy(DBE) showed no signs of bleeding.The transanal DBE detected a lesion at about 340 cm proximal to the ileocecal valve.Thus,we performed an exploratory laparoscopy and the lesion was resected.After the operation,the patient had no melena.Finally,the pathological examination identified the neoplasm as an ileal cavernous hemangioma,thereby resulting in gastrointestinal hemorrhage.CONCLUSION This report might improve the diagnosis and treatment of ileal cavernous hemangioma.

Rare case of omentum-wrapped abscess caused by a fish bone penetrating the terminal ileum

Accidentally ingested foreign bodies, for the most part, pass through the gastrointestinal tract, but can cause several complications. Perforation is rare, but can occur in any segment of the gastrointestinal tract. Intestinal perforations due to foreign bodies are rarely diagnosed preoperatively as clinical symptoms are non-specific and they can mimic other abdominal conditions. We describe a case of a 48-year-old patient who was admitted to the emergency room because of severe abdominal pain of 5 d duration. A computed tomography scan showed an undefined liquid collection involving a linear image 35 mm in size, suggestive of a foreign body. On laparotomy, an abscess containing a fish bone was resected. As fish bone ingestion is usually not remembered by the patient, the diagnosis can be delayed. The preoperative diagnosis is frequently acute abdomen of unknown cause. A low threshold of suspicion along with a good clinical history and radiologicalstudies are extremely important in order to make a correct diagnosis.

Ileo-ileal intussusception caused by diffuse large B-cell lymphoma of the ileum

The occurrence of adult intussusception from small intestinal lymphoma is quite rare.We present an82-year-old man with a two-month history of intermittent abdominal pain,nausea and fatigue.Clinical symptoms included moderate abdominal tenderness in the right lower abdomen.Computed tomography scan of the abdomen revealed a mass in the terminal ileum with the sign of"bowel within bowel"which was suspicious of ileo-ileum intussusception.The patient underwent laparoscopic segmental ileal resection.Pathologic evaluation revealed a diffuse large B cell non-Hodgkin’s lymphoma of the ileum.The postoperative course was uneventful.

Adult intussusception secondary to an ileum hamartoma

Intussusception is a rare condition in the adult population.However,in contrast to its presentation in children,an identifiable etiology is found in the majority of cases.Clinical manifestations of adult intussusception are non-specific and patients may present with acute,intermittent or chronic symptoms,predominantly those of intestinal obstruction.A 27-year-old male patient with recurrent abdominal pain secondary to intussusception is herein reported.The clinical presentation and ultrasonographic findings led to the diagnosis.At laparotomy,an ileal hamartoma was found as the lead point of the intussusception.Surgical management and histopathologic studies are described.A recurrent intestinal obstruction and classic ultrasound findings may lead to the diagnosis of intussusception but surgical exploration remains essential.The principle of resection without reduction is well established.

Mucosal Atrophy of Distal Ileum

Endoscopic biopsies from the distal ileal mucosa in 366 subjects with suspectedlower gastrointestinal disease and 81 normal volunteers were examined comparatively withlight microscope,scanning electron microscope(SEM)and ilcoscopy.Mucosal atrophyof distal ileum were found in 21 cases.Endoscopically the atrophied ileal mucosa pre-sented a pale red colour and the twiggy vessels were distinct.The lumen of the distalileum was usually dilated.Histopathological and SEM study of the above 21 patientsand 81 normal volunteers was carried out.Heal biopsy samples were marked with Indianink on the mucosal surface,and serially sectioned after their orientation was defined.The range of villou height was 0-320 μm,averaging 185±164 μm in the ilcal mucosalatrophy group(IMAG),whereas it was 370-500 μn,averaging 416±22 μm in thenormal volunteers.The difference between the normal group and the IMAG was signifi-cant ,P【0.001 ,The atrophied ilcal mucosa could bc divided into four grades accordingto its villous height,our definition is as follows :Grade 0-from lower limit of normalvalue to 300 μm is a height which suggests that mucosal atrophy might bc present:Grade 1-300-200 μm is difincd as slight mucosal atrophy;Grade 2 200-100μm,moderate mucosal atrophy;Grade 3 from 100 μm to disappcarance of villi,severemucosal atrophy.Villous atrophy was found not in proportion to the cxtent of mucosalinflammation.Atrophied villi under microscope showed a shortened ,battlement-like ap-pearance.Sometimes the villi had disappeared.Under SEM,the villi appeared shor-tened,papilla-like or gyrus-like.