scholarly journals Small bowel hemorrhage from check point inhibitor enteritis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kellie Young ◽  
Emery Lin ◽  
Emerson Chen ◽  
Brian Brinkerhoff ◽  
Gregory Scott ◽  
...  
Keyword(s):  
Small Bowel ◽  
Checkpoint Inhibitors ◽  
Colon Adenocarcinoma ◽  
Small Bowel Resection ◽  
Push Enteroscopy ◽  
Duodenal Ulcers ◽  
Clostridioides Difficile ◽  
Active Extravasation ◽  
Gastrointestinal Side Effects ◽  
Clinically Significant

Abstract Background There is rising utilization of immune checkpoint inhibitors (ICI) for a growing number of metastatic malignancies. While gastrointestinal side effects of ICI are common, isolated ICI-induced enteritis leading to small bowel hemorrhage is rare. Case presentation A 71-year-old man with a previously resected right colon adenocarcinoma on atezolizumab and recently treated Clostridioides difficile presented with acute on chronic abdominal pain and non-bloody diarrhea. A CT scan revealed enteritis of the duodenum and jejunum without colitis. Initial endoscopic work-up revealed many clean-based non-bleeding duodenal ulcers to the third portion of the duodenum and normal rectosigmoid mucosa. The patient initially improved on steroids but was readmitted on day after discharge with hematochezia and hemorrhagic shock. Repeat CT showed improvement in enteritis; however, repeat push enteroscopy revealed multiple duodenal and jejunal ulcers, two with visible vessels requiring endoscopic intervention. He continued to have significant hemorrhage requiring transfusions despite IV methylprednisolone. Conventional angiogram revealed multiple sites of active extravasation, and he underwent small bowel resection and subsequent IR embolization due to persistent bleeding. He was then started on infliximab 10 mg/kg with resolution of his small bowel hemorrhage and diarrhea. Conclusions Severe isolated ICI-enteritis is rare and can lead to clinically significant gastrointestinal hemorrhage. Patients with severe ICI-enteritis on endoscopy should be carefully monitored for steroid refractory disease for consideration of step-up therapy such as infliximab.

scholarly journals Clostridioides difficile Enteritis Induced Anastomotic Rupture: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
David R. Velez ◽  
Mentor Ahmeti
Keyword(s):  
Small Bowel ◽  
Primary Anastomosis ◽  
Skilled Nursing Facility ◽  
Anastomotic Dehiscence ◽  
Hemodynamic Instability ◽  
Small Bowel Resection ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Clostridioides Difficile ◽  
Prolonged Hospital

Background. A 76-year-old male patient who suffered small bowel anastomotic dehiscence believed to be a complication provoked by Clostridioides difficile enteritis. Case Presentation. The patient was a 76-year-old male who underwent small bowel resection with primary anastomosis for a small bowel obstruction. On postoperative day #7, he rapidly decompensated and upon return to the operating room was found to have complete anastomotic dehiscence with copious enteric spillage. The presentation appeared as if the staple line had burst open. Enteric contents confirmed the diagnosis of Clostridioides difficile enteritis. Subsequent hospital course was complicated by ventilatory-dependent respiratory failure, hemodynamic instability, and persistent anemia secondary to gastric ulcer requiring endoscopic cauterization. After a prolonged hospital course, he eventually progressed and was transferred to a skilled nursing facility on hospital day #42. Discussion. Clostridioides difficile causes inflammation and copious large volume secretions that would theoretically increase intraluminal pressures creating an internal tension. This tension along with other factors from the infection itself would likely be inhibitory of anastomotic healing. Although it is rare, Clostridioides difficile enteritis is being reported with increasing frequency, and in the setting of recent small bowel anastomosis, it should be considered a possible risk factor for anastomotic leak.

Relation of Small Bowel Resection to Nutrition in Man

1960 ◽  
Vol 38 (4) ◽  
pp. 605-615 ◽  
Author(s):  
M.H. Kalser ◽  
J.L.A. Roth ◽  
H. Tumen ◽  
T.A. Johnson
Keyword(s):  
Small Bowel ◽  
Bowel Resection ◽  
Small Bowel Resection

scholarly journals The effect of pre-resection obesity on post-resection body composition after 75% small bowel resection in rats

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Neesha S. Patel ◽  
Ujwal R. Yanala ◽  
Shruthishree Aravind ◽  
Roger D. Reidelberger ◽  
Jon S. Thompson ◽  
...  
Keyword(s):  
Body Weight ◽  
Small Bowel ◽  
Lean Mass ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
High Fat ◽  
Low Fat ◽  
Low Fat Diet ◽  
Massive Resection ◽  
Obese Rats

AbstractIn patients with short bowel syndrome, an elevated pre-resection Body Mass Index may be protective of post-resection body composition. We hypothesized that rats with diet-induced obesity would lose less lean body mass after undergoing massive small bowel resection compared to non-obese rats. Rats (CD IGS; age = 2 mo; N = 80) were randomly assigned to either a high-fat (obese rats) or a low-fat diet (non-obese rats), and fed ad lib for six months. Each diet group then was randomized to either underwent a 75% distal small bowel resection (massive resection) or small bowel transection with re-anastomosis (sham resection). All rats then were fed ad lib with an intermediate-fat diet (25% of total calories) for two months. Body weight and quantitative magnetic resonance-determined body composition were monitored. Preoperative body weight was 884 ± 95 versus 741 ± 75 g, and preoperative percent body fat was 35.8 ± 3.9 versus 24.9 ± 4.6%; high-fat vs. low fat diet, respectively (p < 0.0001); preoperative diet type had no effect on lean mass. Regarding total body weight, massive resection produced an 18% versus 5% decrease in high-fat versus low-fat rats respectively, while sham resection produced a 2% decrease vs. a 7% increase, respectively (p < 0.0001, preoperative vs. necropsy data). Sham resection had no effect on lean mass; after massive resection, both high-fat and low-fat rats lost lean mass, but these changes were not different between the latter two rat groups. The high-fat diet and low-fat diet induced obesity and marginal obesity, respectively. The massive resection produced greater weight loss in high-fat rats compared to low-fat rats. The type of dietary preconditioning had no effect on lean mass loss after massive resection. A protective effect of pre-existing obesity on lean mass after massive intestinal resection was not demonstrated.

scholarly journals Intestinal intussusception and progressive anemia due to pyogenic granuloma of the ileum: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kodai Nagakari ◽  
Akikazu Yago ◽  
Yu Ohkura ◽  
Daisuke Tomita ◽  
Shusuke Haruta ◽  
...  
Keyword(s):  
Small Bowel ◽  
English Literature ◽  
Laboratory Data ◽  
Pyogenic Granuloma ◽  
Vascular Tumor ◽  
Small Bowel Resection ◽  
Intestinal Intussusception ◽  
Enhanced Computed Tomography ◽  
Laparoscopic Assisted ◽  
Progressive Anemia

Abstract Background Pyogenic granuloma is a benign vascular tumor, usually occurring on the skin or in the oral cavity. Small intestinal pyogenic granuloma is extremely rare, but intestinal intussusception due to the tumor is even rarer. Only 3 cases have been reported in the English literature at this writing. Case presentation An 86-year-old woman presented with abdominal pain and vomiting. Laboratory data discovered anemia. Contrast-enhanced computed tomography revealed small bowel obstruction due to intestinal intussusception. After decompression by long tube for 1 week, the obstruction did not improve and the anemia got worse. Therefore, laparoscopic assisted small bowel resection was performed as a diagnostic therapy. Pathology confirmed the diagnosis of pyogenic granuloma. The postoperative course was uneventful and the patient was discharged 10 days after surgery. Conclusions We experienced a case of intestinal intussusception and progressive anemia due to pyogenic granuloma of the ileum. Although the condition is extremely rare, surgeons must take into consideration the tumor in similar cases, and complete surgical resection is required.

scholarly journals Subacute Enteritis Two Months After COVID-19 Pneumonia With Mucosal Bleeding, Perforation, and Internal Fistulas

2021 ◽  
pp. 000313482110234
Author(s):  
Babak Abbassi ◽  
Anasua Deb ◽  
Vanessa Costilla ◽  
Brittany Bankhead-Kendall
Keyword(s):  
Histopathological Examination ◽  
Failure To Thrive ◽  
Small Bowel Resection ◽  
Resected Specimen ◽  
Push Enteroscopy ◽  
Midline Laparotomy ◽  
Internal Fistulas ◽  
Mucosal Bleeding ◽  
Gi Bleed ◽  
Prolonged Hospital

Chronic sequelae of COVID-19 remain undetermined. We report a case of postinfection sequelae in a patient presenting with subacute obstruction 2 months after COVID-19 infection. A 34-year-old man with a prior prolonged hospital stay due to COVID-19 complicated by upper gastrointestinal (GI) bleed presented with subacute obstruction and failure to thrive. Upper GI push enteroscopy revealed residual ulcers and multiple proximal jejuno-jejunal fistulae. Midline laparotomy revealed strictures with dense intra-abdominal adhesions, a large jejuno-jejunal fistula, and evidence of prior jejunal perforation following severe COVID-19 infection. The patient recovered after small bowel resection with anastomoses and was discharged home. Histopathological examination of resected specimen confirmed transmural infarction with evidence of prior hemorrhage, diffuse ulcers, and multifocal inflammation. This is the first report of a chronic GI sequelae resulting from COVID-19. As the pandemic evolves, medical professionals must be vigilant to consider alternative GI diagnoses in the COVID-19 survivors.

scholarly journals A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

2019 ◽  
Vol 12 (5) ◽  
pp. e228050
Author(s):  
Andrew James Brown ◽  
Thomas Whitehead-Clarke ◽  
Vera Tudyka
Keyword(s):  
Small Bowel ◽  
Bowel Perforation ◽  
Linear Structure ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Small Bowel Perforation ◽  
Chicken Bone ◽  
Abdomen Ct ◽  
Distal Migration ◽  
The Right

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!

239 CLOSTRIDIOIDES DIFFICILE INFECTIONS IN CANCER PATIENTS ON IMMUNE-CHECKPOINT INHIBITORS

2021 ◽  
Vol 160 (6) ◽  
pp. S-50-S-51
Author(s):  
Shaleen Vasavada ◽  
Rajan Amin ◽  
Pablo C. Okhuysen ◽  
Anusha Shirwaikar Thomas ◽  
Yinghong Wang
Keyword(s):  
Cancer Patients ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Clostridioides Difficile

Pathophysiological correlates of two unique renal tubule lesions in rats with intestinal resection

2006 ◽  
Vol 291 (5) ◽  
pp. F1061-F1069 ◽  
Author(s):  
Elaine Worcester ◽  
Andrew Evan ◽  
Sharon Bledsoe ◽  
Mark Lyon ◽  
Mark Chuang ◽  
...  
Keyword(s):  
Calcium Phosphate ◽  
Small Bowel ◽  
Bowel Resection ◽  
Cell Damage ◽  
Intestinal Resection ◽  
Small Bowel Resection ◽  
Renal Tissue ◽  
Apical Surface ◽  
Crystal Deposition ◽  
Oxalate Excretion

Rats with small bowel resection fed a high-oxalate diet develop extensive deposition of calcium oxalate (CaOx) and calcium phosphate crystals in the kidney after 4 mo. To explore the earliest sites of renal crystal deposition, rats received either small bowel resection or transection and were then fed either standard chow or a high-oxalate diet; perfusion-fixed renal tissue from five rats in each group was examined by light microscopy at 2, 4, 8, and 12 wk. Rats fed the high-oxalate diet developed birefringent microcrystals at the brush border of proximal tubule cells, with or without cell damage; the lesion was most common in rats with both resection and a high-oxalate diet (10/19 with the lesion) and was significantly correlated with urine oxalate excretion ( P < 0.001). Rats with bowel resection fed normal chow had mild hyperoxaluria but high urine CaOx supersaturation; four of these rats developed birefringent crystal deposition with tubule plugging in inner medullary collecting ducts (IMCD). Two rats fed a high-oxalate diet also developed this lesion, which was correlated with CaOx supersaturation, but not oxalate excretion. Tissue was examined under oil immersion, and tiny birefringent crystals were noted on the apical surface of IMCD cells only in animals with IMCD crystal plugging. In one animal, IMCD crystals were both birefringent and nonbirefringent, suggesting a mix of CaOx and calcium phosphate. Overall, these animals demonstrate two distinct sites and mechanisms of renal crystal deposition and may help elucidate renal lesions seen in humans with enteric hyperoxaluria and stones.

scholarly journals Helicobacter pylori infection has a detrimental impact on the efficacy of cancer immunotherapies

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323392
Author(s):  
Paul Oster ◽  
Laurie Vaillant ◽  
Erika Riva ◽  
Brynn McMillan ◽  
Christina Begka ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Checkpoint Inhibitors ◽  
Nsclc Patient ◽  
Colon Adenocarcinoma ◽  
Progression Free Survival ◽  
Microbiome Composition ◽  
Apparent Decrease ◽  
H Pylori ◽  
Cancer Immunotherapies

ObjectiveIn this study, we determined whether Helicobacter pylori (H. pylori) infection dampens the efficacy of cancer immunotherapies.DesignUsing mouse models, we evaluated whether immune checkpoint inhibitors or vaccine-based immunotherapies are effective in reducing tumour volumes of H. pylori-infected mice. In humans, we evaluated the correlation between H. pylori seropositivity and the efficacy of the programmed cell death protein 1 (PD-1) blockade therapy in patients with non-small-cell lung cancer (NSCLC).ResultsIn mice engrafted with MC38 colon adenocarcinoma or B16-OVA melanoma cells, the tumour volumes of non-infected mice undergoing anticytotoxic T-lymphocyte-associated protein 4 and/or programmed death ligand 1 or anti-cancer vaccine treatments were significantly smaller than those of infected mice. We observed a decreased number and activation status of tumour-specific CD8+ T cells in the tumours of infected mice treated with cancer immunotherapies independent of the gut microbiome composition. Additionally, by performing an in vitro co-culture assay, we observed that dendritic cells of infected mice promote lower tumour-specific CD8+ T cell proliferation. We performed retrospective human clinical studies in two independent cohorts. In the Dijon cohort, H. pylori seropositivity was found to be associated with a decreased NSCLC patient survival on anti-PD-1 therapy. The survival median for H. pylori seropositive patients was 6.7 months compared with 15.4 months for seronegative patients (p=0.001). Additionally, in the Montreal cohort, H. pylori seropositivity was found to be associated with an apparent decrease of NSCLC patient progression-free survival on anti-PD-1 therapy.ConclusionOur study unveils for the first time that the stomach microbiota affects the response to cancer immunotherapies and that H. pylori serology would be a powerful tool to personalize cancer immunotherapy treatment.

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