AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHO...AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.展开更多
AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epi...AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.展开更多
We reported a case with an obstructive acute abdomen,and emergency exploratory laparotomy was performed.Ap-pendiceal neoplasm was observed adhered to the ileum,and an ileohemicolectomy was performed.From the histopath...We reported a case with an obstructive acute abdomen,and emergency exploratory laparotomy was performed.Ap-pendiceal neoplasm was observed adhered to the ileum,and an ileohemicolectomy was performed.From the histopathological point of view the neoplasm was an infiltrating colonic type adenocarcinoma of the appendix,with extension to the periapendicular adipose tissue and fixation of an adjacent ileal loop secondary to infiltration of the intestinal wall.The tumor produced a moderate luminal stenosis of the intestine,this explained the clinical manifestations of the patient.Post-operative evolution was satisfac-tory and there had been no signs of recurrence in the 5 years since the operation.Based upon the comparison of clinical char-acteristics,pathological behavior(in relation to the growth and dissemination),and therapeutic considerations,possibly colonic type adenocarcinoma of the appendix is a neoplasm similar to the carcinomas of ascending colon.展开更多
Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was...Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.展开更多
基金Supported by The Fondazione Umberto Di Mario,Largo Marchiafava,1,Roma,Italya Grant Research from PRIN 2008,No. 2008X8NRH4,Italy
文摘AIM:To compare computed tomography enteroclysis(CTE) vs small intestine contrast ultrasonography(SICUS) for assessing small bowel lesions in Crohn's disease(CD),when using surgical pathology as gold standard.METHODS:From January 2007 to July 2008,15 eligible patients undergoing elective resection of the distal ileum and coecum(or right colon) were prospectively enrolled.All patients were under follow-up.The study population included 6 males and 9 females,with a median age of 44 years(range:18-80 years).Inclusion criteria:(1) certain diagnosis of small bowel requiring elective ileo-colonic resection;(2) age between 18-80 years;(3) elective surgery in our Surgical Unit;and(4) written informed consent.SICUS and CTE were performed ≤ 3 mo before surgery,followed by surgical pathology.The following small bowel lesions were blindly reported by one sonologist,radiologist,surgeon and histolopathologist:disease site,extent,strictures,abscesses,fistulae,small bowel dilation.Comparison between findings at SICUS,CTE,surgical specimens and histological examination was made by assessing the specificity,sensitivity and accuracy of each technique,when using surgical findings as gold standard.RESULTS:Among the 15 patients enrolled,CTE was not feasible in 2 patients,due to urgent surgery in one patients and to low compliance in the second patient,refusing to perform CTE due to the discomfort related to the naso-jejunal tube.The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled.Differently from CTE,SICUS was feasible in all the 15 patients enrolled.No complications were observed when using SICUS or CTE.Surgical pathology findings in the tested population included:small bowel stricture in 13 patients,small bowel dilation above ileal stricture in 10 patients,abdominal abscesses in 2 patients,enteric fistulae in 5 patients,lymphnodes enlargement(> 1 cm) in 7 patients and mesenteric enlargement in 9 patients.In order to compare findings by using SICUS,CTE,histology and surgery,characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologistsonologist,radiologist,surgeon and anatomopathologist.At surgery,lesions related to CD were detected in the distal ileum in all 13 patients,also visualized by both SICUS and CTE in all 13 patients.Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients,confirmed by SICUS and CTE in the same 12 out of the 13 patients.When using surgical findings as a gold standard,SICUS and CTE showed the exactly same sensitivity,specificity and accuracy for detecting the presence of small bowel fistulae(accuracy 77% for both) and abscesses(accuracy 85% for both).In the tested CD population,SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures(92% vs 100%),small bowel fistulae(77% for both) and small bowel dilation(85% vs 82%).CONCLUSION:In our study population,CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.
基金The Fondazione Umberto Di Mario,Largo Marchiafava n.1, ZIP code 00161,Roma,Italy
文摘AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.
文摘We reported a case with an obstructive acute abdomen,and emergency exploratory laparotomy was performed.Ap-pendiceal neoplasm was observed adhered to the ileum,and an ileohemicolectomy was performed.From the histopathological point of view the neoplasm was an infiltrating colonic type adenocarcinoma of the appendix,with extension to the periapendicular adipose tissue and fixation of an adjacent ileal loop secondary to infiltration of the intestinal wall.The tumor produced a moderate luminal stenosis of the intestine,this explained the clinical manifestations of the patient.Post-operative evolution was satisfac-tory and there had been no signs of recurrence in the 5 years since the operation.Based upon the comparison of clinical char-acteristics,pathological behavior(in relation to the growth and dissemination),and therapeutic considerations,possibly colonic type adenocarcinoma of the appendix is a neoplasm similar to the carcinomas of ascending colon.
文摘Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.