Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoilei...Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoileitis can complicate established celiac disease or develop in patients de novo.Increased levels of tumor necrosis factor-alpha(TNF-α) in the small intestine of patients with untreated celiac disease are associated with a role in the immune pathogenesis of this disorder.No specific therapy has been shown to change the course of ulcerative jejunoileitis.We report a case of severe ulcerative jejunoileitis previously unresponsive to traditional therapies,including high dose corticosteroids and cyclosporine.The patient had a dramatic resolution of symptoms and a complete normalization of endoscopic findings after anti-TNF-α monoclonal antibody,infliximab(Remicade).展开更多
We present the case of an elderly woman who developed a bowel perforation related to pneumatosis intestinalis, 33 years after a jejuno-ileal bypass for severe obesity. Final histological examination revealed the prese...We present the case of an elderly woman who developed a bowel perforation related to pneumatosis intestinalis, 33 years after a jejuno-ileal bypass for severe obesity. Final histological examination revealed the presence of dysplasia in the resected specimen. On the basis of our case and a review of the literature, we discuss the etiopathogenesis, the clinical aspects and the treatment of this rare condition.展开更多
AIM:To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS:Three data sources were used:the Medline and Google search engines...AIM:To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS:Three data sources were used:the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel's diverticulitis excluded) that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software.RESULTS:GroupⅠ:106 patients (48 men) were found. Mean age was 72.2 ± 13.1 years (mean ± SD). Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively). Preoperative assessment was plain radiography in 53.3% or computed tomography (CT) in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001). Duration of symptoms before hospitalization was 3.6 d (range:1-35 d), but longer duration was not associated with poor outcome (P = 0.748). Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local peritonitis in 47.5%, and diffuse peritonitis in 22.8%. Peritonitis grade correlated with the reoperation rate (r = 0.43). Conservatively treated patients had similar hospital length of stay as operated patients (10.6 ± 8.3 d vs 10.7 ± 7.9 d, respectively). Age correlated with hospital stay (r = 0.46). No difference in outcomes for operated or nonoperated patients was found (P = 0.814). Group Ⅱ:113 patients (57 men). Mean age 67.6 ± 16.4 years (range: 21-96 years). Mean age for men was 61.3 ± 16.2 years, and 74.7 ± 12.5 years for women (P = 0.001). Number of procedures per year was 11.2 ± 0.9, and bowel resection was performed in 82.3% of patients. Group Ⅲ: 47 patients (21 men). Patient age was 65.4 ± 14.4 years. Mean age for men was 61.5 ± 17.3 years and 65.3 ± 14.4 years for women. Duration of symptoms before hospitalization was 6.9 d (range: 1-180 d). No patients had a preoperative diagnosis, 97.9% of patients underwent surgery, and 78.3% had multiple diverticula. Bowel resection was performed in 67.4% of patients, and suture closure in 32.6%. Mortality was 23.4%. There was no difference in length of history or its impact on survival between Groups Ⅰ and Ⅲ (P = 0.241 and P = 0.198, respectively). Resection was more often performed in Group Ⅰ (P = 0.01). Mortality was higher in Group Ⅲ (P = 0.002). CONCLUSION: In cases with contained perforation, conservative treatment gives satisfactory results, laparosco-py with lavage and drainage can be attempted and continued with a conservative course.展开更多
Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study a...Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.展开更多
文摘Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoileitis can complicate established celiac disease or develop in patients de novo.Increased levels of tumor necrosis factor-alpha(TNF-α) in the small intestine of patients with untreated celiac disease are associated with a role in the immune pathogenesis of this disorder.No specific therapy has been shown to change the course of ulcerative jejunoileitis.We report a case of severe ulcerative jejunoileitis previously unresponsive to traditional therapies,including high dose corticosteroids and cyclosporine.The patient had a dramatic resolution of symptoms and a complete normalization of endoscopic findings after anti-TNF-α monoclonal antibody,infliximab(Remicade).
文摘We present the case of an elderly woman who developed a bowel perforation related to pneumatosis intestinalis, 33 years after a jejuno-ileal bypass for severe obesity. Final histological examination revealed the presence of dysplasia in the resected specimen. On the basis of our case and a review of the literature, we discuss the etiopathogenesis, the clinical aspects and the treatment of this rare condition.
文摘AIM:To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis. METHODS:Three data sources were used:the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel's diverticulitis excluded) that were published after 1995. The inclusion criterion was sufficient individual patient data in the article. Both indexed and non-indexed journals were used. Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group. Data on symptoms, laboratory and radiology results, treatment modalities, surgical access, procedures, complications and outcomes were collected. The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007. The data collected were age, sex, mode of access, surgical procedure performed and number of patients per year. Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data. Statistical analysis was done with SPSS software.RESULTS:GroupⅠ:106 patients (48 men) were found. Mean age was 72.2 ± 13.1 years (mean ± SD). Age or sex had no impact on outcomes (P = 0.057 and P = 0.771, respectively). Preoperative assessment was plain radiography in 53.3% or computed tomography (CT) in 76.1%. Correct diagnosis was made in 77.1% with CT, 5.6% without (P = 0.001). Duration of symptoms before hospitalization was 3.6 d (range:1-35 d), but longer duration was not associated with poor outcome (P = 0.748). Eighty-six point eight percent of patients underwent surgery, 92.4% of these through open access where 90.1% had bowel resection. Complications occurred in 19.2% of patients and 16.3% underwent reoperation. Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm. At surgery, no peritonitis was found in 29.7% of patients, local peritonitis in 47.5%, and diffuse peritonitis in 22.8%. Peritonitis grade correlated with the reoperation rate (r = 0.43). Conservatively treated patients had similar hospital length of stay as operated patients (10.6 ± 8.3 d vs 10.7 ± 7.9 d, respectively). Age correlated with hospital stay (r = 0.46). No difference in outcomes for operated or nonoperated patients was found (P = 0.814). Group Ⅱ:113 patients (57 men). Mean age 67.6 ± 16.4 years (range: 21-96 years). Mean age for men was 61.3 ± 16.2 years, and 74.7 ± 12.5 years for women (P = 0.001). Number of procedures per year was 11.2 ± 0.9, and bowel resection was performed in 82.3% of patients. Group Ⅲ: 47 patients (21 men). Patient age was 65.4 ± 14.4 years. Mean age for men was 61.5 ± 17.3 years and 65.3 ± 14.4 years for women. Duration of symptoms before hospitalization was 6.9 d (range: 1-180 d). No patients had a preoperative diagnosis, 97.9% of patients underwent surgery, and 78.3% had multiple diverticula. Bowel resection was performed in 67.4% of patients, and suture closure in 32.6%. Mortality was 23.4%. There was no difference in length of history or its impact on survival between Groups Ⅰ and Ⅲ (P = 0.241 and P = 0.198, respectively). Resection was more often performed in Group Ⅰ (P = 0.01). Mortality was higher in Group Ⅲ (P = 0.002). CONCLUSION: In cases with contained perforation, conservative treatment gives satisfactory results, laparosco-py with lavage and drainage can be attempted and continued with a conservative course.
基金supported by the Science and Technology Planning Project of Guangdong Province(2014A020212022).
文摘Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.
