scholarly journals Analysis of therapeutic results and complications after colic surgery in 434 horses

2008 ◽  
Vol 53 (No. 1) ◽  
pp. 12-28 ◽  
Author(s):  
J. Mezerova ◽  
Z. Zert ◽  
R. Kabes ◽  
L. Ottova
Keyword(s):  
Small Intestine ◽  
Postoperative Period ◽  
Paralytic Ileus ◽  
Abdominal Cavity ◽  
Adhesion Formation ◽  
Intestinal Resection ◽  
Colon Surgery ◽  
Common Finding ◽  
Intestinal Surgery ◽  
Small Intestinal

Out of the total number of 434 horses that underwent colic surgery, small intestine was operated in 195 (44.9%) patients, caecum in 10 (2.3%) horses, large colon surgery was performed in 196 (45.2%) cases and small colon surgery in 14 (3.2%) horses. In 12 patients (2.8%) two different parts of the gastrointestinal tract were affected simultaneously, one horse suffered from peritonitis, torsion of the uterus developed in two mares and three animals had negative surgical findings. Of 434 horses, 371 (85.5%) survived. After small intestinal surgery, 159 patients (81.5%) recovered from anaesthesia and were discharged home as well as seven horses (70%) after caecal surgery, 175 horses (89.3%) after large colon surgery and 14 horses (100%) following small colon surgery. 75 out of 103 horses (72.8%) were discharged home after the small intestinal resection and 89 of 98 horses (90.8%) with small intestinal problems where no resection was needed. In total, 43 of the patients that underwent one surgery did not survive the immediate postoperative period. The most frequent lethal complications in horses following the small intestinal surgery included peritonitis (five horses) and paralytic ileus (four horses) and in horses with large colon problems it was typhlocolitis (six cases). Relaparotomy was indicated in 41 of 434 horses (9.4%) that recovered from colic surgery. 21 out of the 41 (51.2%) relaparotomised colic patients were released from the clinic. All successfully repeated surgeries were carried out to overcome primary small intestine ileus problems, and in 14 of these cases (66.7%) resection and anastomosis were performed. The most common finding, diagnosed in 9 of 21 reoperated horses, was paralytic ileus. Of 20 relaparotomised horses that did not survive, three animals were lost after the introduction of anaesthesia, nine horses were euthanised after the abdominal cavity revision, one horse did not recover after the surgical procedure and seven horses did not survive the postoperative period. In 15 of 20 dead horses, the cause of the first surgical intervention was small intestinal ileus, in other four horses there was a large colon problem and in the last patient, it was a stomach disease. In 13 of 15 (86.7%) horses with small intestinal problems and in three of four (75%) patients with large colon disease, either resection or bypass was performed. In the remaining four non-surviving horses of 20 relaparotomised ones, peritonitis and/or adhesion formation was diagnosed at the second surgery, in three horses anastomosis complications were the main problem. Peritonitis or paralytic ileus led to death or euthanasia in four of seven horses that recovered after relaparotomy.

CHOICE OF SURGERY TACTICS IN PATIENTS WITH HIGH RISK OF ANASTOMOTIC LEAK DEVELOPMENT

2020 ◽  
pp. 25-28
Author(s):  
M. Ye. Tymchenko
Keyword(s):  
Small Intestine ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Intestinal Resection ◽  
Surgery Complications ◽  
Intestinal Anastomoses ◽  
Post Surgery ◽  
Intestinal Stoma ◽  
Small Intestinal ◽  
Surgical Tactics

Intestinal resection is one of the most common surgeries performed on urgent indications, the most difficult is the decision in favor of the formation of primary anastomosis in the case of primary infection of abdominal cavity, multiple defects of the intestinal wall, as well as the general serious condition of a patient. In order to improve the methods of diagnosis and prevention of post−surgery complications, as well as personification of surgical tactics of treatment in the patients undergoing anastomotic surgeries in intestine, the results of treatment of 96 patients were analyzed. The level of serum cryoglobulins was determined by the method of A. E. Kalovidoris with modifications. The results of surgical treatment were evaluated according to the classification of D. Dindo et al. (2004). The use of cryoglobulin levels before surgery can significantly affect surgical tactics: at a low degree it is possible to perform resection of a segment of small intestine with the formation of primary small intestinal anastomoses; at average − it is possible to perform small−intestinal anastomoses with unloading intestinal stoma or with the location of the anastomosis extraperitoneally (if possible) and decompression of the anastomosis with an incubation probe; at high − it is expedient to supplement performance of an anastomosis with a variant of an enterostomy or "delayed" anastomoses, at a severe general condition of patients it is expedient to form final small intestinal stoma. Determining the level of cryoglobulinemia as a marker of the prognosis of failure of the sutures of intestinal anastomoses and the use of differentiated surgical tactics depending on the level of this index contributes to a significant improvement in direct results of surgical treatment of the patients undergoing resection of small intestine segments. The proposed tactics virtually eliminate the implementation of multi−stage surgical interventions and helps to reduce the duration of treatment of patients, reduce the level of post−surgery complications and mortality. Key words: cryoglobulinemia, surgical treatment, small intestine, anastomoses.

scholarly journals Small Intestine Ultrasound Findings on Horses Following Exploratory Laparotomy, Can We Predict Postoperative Reflux?

Animals ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. 1106
Author(s):  
Gabriel Cuevas-Ramos ◽  
Lara Domenech ◽  
Marta Prades
Keyword(s):  
Small Intestine ◽  
Postoperative Period ◽  
Intestinal Resection ◽  
Exploratory Laparotomy ◽  
Abdominal Ultrasound ◽  
Control Group ◽  
Postoperative Reflux ◽  
Intestinal Pathology ◽  
Ultrasound Findings ◽  
Small Intestinal

Postoperative reflux (POR) is a well-recognized complication after colic surgery in horses, particularly when presenting small intestinal pathology. Even though much has been written about the pathophysiology and management of POR, additional clinical studies are needed to better understand and anticipate this complication. The aim of the study was to provide clinical evidence of ultrasound findings in the postoperative period (three days). The study is based on transcutaneous abdominal ultrasounds of the caudoventral abdomen during the postoperative period (three days), in 58 horses, presented for an exploratory laparotomy, and compared to 20 horses that underwent general anesthesia for an elective surgical procedure. Small intestine (SI) images and videos were analyzed for loop number, loop diameter, wall thickness, motility, and echogenic type of loop contents. Ultrasound findings of horses that had a large colon pathology were similar to those of the control group. Interestingly, horses that presented an SI pathology had significantly thicker SI walls, increased loop diameter, slower motility, and hypoechoic contents, particularly in horses that had undergone small intestinal resection and anastomosis. Although the number of horses that developed POR in our study was too small for statistical analysis, they all had the aforementioned ultrasonographic changes. Abdominal ultrasound, during the postoperative period (three days), was a useful method to identify horses with abnormal small intestinal parameters. Further investigation as to whether these parameters can be used to predict POR in a larger population is warranted.

scholarly journals MORPHOLOGICAL CHANGES OF THE SMALL INTESTINE IN ACUTE STRANGULATIVE INTESTINAL OBSTRUCTION IN THE STAGE OF DECOMPOSITION IN CHILDREN

2018 ◽  
Vol 8 (3) ◽  
pp. 28-33 ◽  
Author(s):  
A. E. Solovev ◽  
I. V. Vasin ◽  
O. А. Kul’chitskij
Keyword(s):  
Small Intestine ◽  
Intestinal Obstruction ◽  
Morphological Changes ◽  
Intestinal Resection ◽  
Intestinal Wall ◽  
Intestinal Necrosis ◽  
Morphological Studies ◽  
Intestinal Strangulation ◽  
Small Intestinal ◽  
Adhesive Obstruction

Purpose. The purpose was to determine the depth and prevalence of pathomorphological changes in the small intestine of children at the distance from the visible border of necrosis with decompensated acute strangulated intestinal obstruction (ASIO) to determine the minimum possible length of intestinal resection.Material and methods. Morphological studies of a resected fragment of the small intestine were performed in 24 children aged 3 days to 18 years who had undergone a surgery for ASIO with intestinal necrosis. Strangulated adhesive obstruction was found in 17 children, five children had congenital intestine torsion and two children faced small intestinal strangulation in the congenital mesenteric defect. The postsurgical material was studied morphologically using histological stains with the distance of 3 cm between the section.Results. The depth, prevalence of the morphological changes in the small intestinal wall, intensity and length of morphological changes in children with decompensated ASIO were determined.Conclusion. A differentiated approach to the selection of resection scope in the proximal and distal directions from the visible border of ASIO-related necrosis is necessary. The distances are twice shorter in children as compared to adults. Refusal from extensive resections will enable to reduce the rate of short bowel syndrome in children.

scholarly journals Laparoscopic-assisted disinvagination and polypectomy for multiple intussusceptions induced by small intestinal polyps in patients with Peutz-Jeghers syndrome: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Masaaki Yamamoto ◽  
Kazuya Iwamoto ◽  
Rei Suzuki ◽  
Yosuke Mukai ◽  
Tomohira Takeoka ◽  
...  
Keyword(s):  
Small Intestine ◽  
Genetic Disorder ◽  
Vena Cava ◽  
Intestinal Resection ◽  
Hamartomatous Polyps ◽  
Intestinal Polyps ◽  
Small Intestinal ◽  
Peutz Jeghers Syndrome ◽  
Hands And Feet ◽  
Laparoscopic Assisted

Abstract Background Peutz–Jeghers syndrome (PJS) is a very rare autosomal dominant genetic disorder characterized by hamartomatous polyps in the gastrointestinal tract and hyperpigmentation of the lips, hands, and feet. The hamartomatous polyps in the small intestine often cause intussusception and bleeding. Case presentation A 62-year-old male was hospitalized for treatment of deep vein thrombosis and pulmonary embolism. In the small intestine, computed tomography showed three small polyps with intussusceptions. Since the patient had gastrointestinal polyposis and pigmentation of his lips, fingers, and toes, he was diagnosed with PJS. After an inferior vena cava filter was placed, he underwent laparoscopic-assisted surgery. The polyps causing intussusception were resected as far as possible without intestinal resection, since they had caused progressive anemia and might cause intestinal obstruction in the future. The patient was discharged from the hospital on postoperative day 9 without complications. Conclusions Laparoscopic-assisted disinvagination and polypectomy is a useful, minimally invasive treatment for multiple intussusceptions caused by small intestinal polyps in patients with PJS.

Comparison of biomarkers among 34,855 GI cancer samples show heterogeneity of tumor types.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14287-e14287
Author(s):  
Shaheenah S. Dawood
Keyword(s):  
Small Intestine ◽  
Intestinal Cancer ◽  
Common Finding ◽  
Gastric Gist ◽  
Ras Mutation ◽  
Gi Cancer ◽  
Small Intestinal Cancer ◽  
Cancer Types ◽  
Small Intestinal ◽  
Tumor Types

e14287 Background: Recent data indicate that biomarker driven use of targeted therapy and I/O-therapy among patients with GI cancer is associated with improved outcome. The presence of biomarkers varies broadly between different GI tumor types, highlighting the importance of comprehensive molecular profiling.To analyze the presence of various alterations in GI cancer samples of a large database, comparing congruency between various tumor types. Methods: A retrospective data analysis of 34855 GI cancer patients profiled at CARIS Life Sciences obtained from Jan 1st2010 till Sep 14th2018 was performed. GI tumors were classified as : CRC, esophageal/gastric/GIST, small intestine, pancreatic/hepatobiliary/liver. Technologies used to analyze the biomarkers: IHC for PD-L1, MMR and Her2, and DNA-NGS for EGFR, BRAF, KRAS, NRAS, MET-CNV, TMB, MSI, POLE and BRCA1/2. Results: Median age was 61 (range 18-89 years). 51.5% was CRC (n = 18047), 15.5 % was esophageal /Gastric/GIST (n = 5470), 3% was small intestinal cancer (n = 886) and 30% was pancreatic/hepatobiliary/liver cancer (n = 10452). Information on biomarkers was available from 2931 cases for MET amplification to 28536 for RAS information. Overall, the most common finding was a pathogenic RAS-mutation (either KRAS or NRAS) in 7650 cases (26.81%), the rarest one was a mutation in EGFR in 12 cases (0.06%). Higher rate of HER2 amplification was observed among pts with esophageal/gastric/GIST tumors (6.5%) in comparison to tumors at other GI sites ( ~1.5%). High TMB was seen among patient with CRC and small intestine tumors (~7%) while it was lowest among pancreatic cancer (1.8%). Compared to other GI sites lower MSI /MMR deficiency rates were observed in pancreatic /hepatobiliary tumors, significantly higher PD-L1 positivity was observed in gastrooesophageal cancer types, increased MET-amplifications in gastrooesophageal and small intestinal cancer types and lower RAS-mutation rate in gastrooesophageal cancer. Conclusions: Molecular profiling analyzing druggable biomarkers can help identify patients with increased likelihood for benefit from immune-checkpoint-inhibitors and targeted therapies. Further investigations are needed to evaluate the different findings in various GI cancer types.

Magnitude of functional adaptation after intestinal resection

1999 ◽  
Vol 276 (5) ◽  
pp. R1265-R1275 ◽  
Author(s):  
Timothy P. O’Connor ◽  
Mandy M. Lam ◽  
Jared Diamond
Keyword(s):  
Small Intestine ◽  
Glucose Uptake ◽  
Safety Factor ◽  
Time Course ◽  
Intestinal Adaptation ◽  
Intestinal Resection ◽  
Functional Adaptation ◽  
Glucose Load ◽  
Uptake Capacity ◽  
Small Intestinal

Intestinal adaptation after resection has been much studied, but rarely examined in an integrative context. Hence we assessed the effects of resection and subsequent adaptation on the quantitative relationship between dietary glucose load and gut capacity to transport glucose. The ratio of capacity to load is termed the “safety factor.” Our objectives were to determine 1) the time course of intestinal adaptation after resection, 2) whether adaptation is quantitatively complete, 3) whether survival requires maintaining a safety factor of at least 1.0 for glucose transport, 4) the effect of altered energy demands on adaptation, and 5) the relationship between the amount of tissue removed and the magnitude of functional adaptation. We performed 80% resection of the small intestine on Sprague-Dawley rats and measured small intestinal glucose uptake capacity, dietary glucose load, and gut gross morphology at 1, 5, and 10 wk postsurgery. Nearly all aspects of adaptation were complete by 1 wk postsurgery. After resection, remnant small intestine mass increased by over fivefold within 1 wk, to reach 50–70% of its preresection value. However, mass-specific glucose uptake activity was reduced, so that intestinal regeneration restored uptake capacity to only 33% of control values. Increased energetic demands had only modest effects on intestinal adaptation. Although the safety factor for small intestinal glucose uptake remained <1.0 (i.e., capacity < load) after adaptation to resection, nearly all rats survived. Hindgut fermentation of nonabsorbed nutrients appeared to contribute to that survival, despite inadequate small intestinal capacity. After less massive resection surgeries (25, 50, and 75% resections), the percent increase in glucose uptake capacity increased with the amount of tissue removed.

scholarly journals Presumed Solitary Dissemination of Colon Cancer Mimicking Primary Cancer of the Small Intestine

2021 ◽  
pp. 1422-1428
Author(s):  
Daisuke Inoue ◽  
Shoji Oura ◽  
Tomoya Takami ◽  
Shinichiro Makimoto
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Small Intestine ◽  
Intestinal Epithelium ◽  
Abdominal Cavity ◽  
Intestinal Lumen ◽  
Small Intestinal Epithelium ◽  
Borrmann Type ◽  
Small Intestinal

A 69-year-old man with abdominal distention was referred to our hospital. The patient had undergone laparoscopic surgery for his Borrmann type 2 rectal cancer 2 years before. In addition to the re-elevation of serum CEA and CA19-9 levels, computed tomography (CT) showed intestinal dilatation, and positron emission CT showed a presumed tumor with abnormal fluorodeoxyglucose accumulation in the small intestine. We judged the small intestinal dilatation was highly due to the solitary recurrent peritoneal dissemination of rectal cancer and performed laparoscopic evaluation of the abdominal cavity followed by laparoscopic resection of the affected small intestine. The small intestinal tumor resembled the rectal cancer both on macroscopical and microscopical findings, that is, Borrmann type 2 phenotype and adenocarcinoma that was well differentiated in the part that protruded into the small intestinal lumen and whose degree of differentiation gradually decreased toward the serosa. In addition, abrupt disruption of the normal small intestinal epithelium and the lymphocytic aggregation, presumed tumor-infiltrating lymphocytes, just between the tumor and the small intestinal epithelium highly suggested the tumor originating from the colon cancer. The patient recovered uneventfully with marked decrease in tumor marker levels 1 month after the operation but did not receive colon cancer-oriented chemotherapy as adjuvant therapy for his financial reasons. Oncologists should note this type of recurrence to properly treat the patients with recurrent colorectal cancer.

scholarly journals Cessation of methotrexate and a small intestinal resection provide a good clinical course for a patient with a jejunum perforation induced by a methotrexate-associated lymphoproliferative disorder: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Masahiro Nomura ◽  
Ryusuke Sumiya ◽  
Hayato Ono ◽  
Takeshi Nagai ◽  
Keigo Kumazawa ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Digestive Tract ◽  
Abdominal Cavity ◽  
Interleukin 2 ◽  
Intestinal Resection ◽  
Lymphoproliferative Disorders ◽  
Barr Virus ◽  
Tract Perforation ◽  
Small Intestinal ◽  
Epstein Barr

Abstract Background Methotrexate (MTX) is a frequently used drug in the treatment of rheumatoid arthritis (RA), but occurrences of lymphoproliferative disorders (LPD) have been reported in patients undergoing an MTX regimen. Almost half of the patients with methotrexate-associated lymphoproliferative disorders (MTX-LPD) have extranodal lesions; moreover, although extremely rare, digestive tract perforations resulting from the extranodal lesions of MTX-LPD have also been reported. Case presentation We describe the case of an 81-year-old woman with RA who had been prescribed MTX at 6 mg per week for the past 11 years. She was admitted to our hospital with occasional abdominal pain and was first diagnosed with enteritis. Her abdominal pain did not improve, and a computed tomography scan showed abdominal effusion and free air in the abdominal cavity. She was diagnosed with a digestive tract perforation and underwent emergency surgery. The perforation site was identified in the jejunum, and she underwent small intestinal resection around the perforated region. The pathological findings showed an ulcer in the jejunum and infiltration of large atypical lymphocytes around the perforated region. An immunohistochemical examination revealed the expression of a cluster of differentiation 20 and latent membrane protein 1. Considering the patient’s history of RA treated with MTX, she was diagnosed as having Epstein–Barr virus (EBV)-related MTX-LPD with a histological diagnosis of EBVMCU. MTX was discontinued after the surgery, and her soluble interleukin-2 receptor (sIL-2R) levels had returned to normal 1 year later. She has had a good course for the 2 years since surgery and remains asymptomatic with no recurrence of MTX-LPD, as confirmed by the sIL-2R levels. Conclusion We experienced a rare case of the jejunum perforation induced by MTX-LPD. Since only a few cases have been reported of a patient with small intestinal perforation induced by MTX-LPD, further research is necessary to evaluate the clinicopathological features of MTX-LPD. The patient had disease remission after surgery and by discontinuing MTX treatment; our case did not require chemotherapy. EBV-positive patients, especially those with a pathological presentation of EBVMCU, could have a higher likelihood of remission, which could have been a factor in the present case.

Synchronous celiac axis and superior mesenteric artery embolism

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 495-498 ◽  
Author(s):  
Rajkovic ◽  
Zelic ◽  
Papes ◽  
Cizmek ◽  
Arslani
Keyword(s):  
Atrial Fibrillation ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Ct Scan ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Abdominal Cavity ◽  
Celiac Axis ◽  
Contrast Administration ◽  
Artery Embolism

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patient’s condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

scholarly journals Biodistribution of the radiophamarceutical sodium pertechnetate (Na99mTcO4) after massive small bowel resection in rats

2007 ◽  
Vol 22 (6) ◽  
pp. 430-435 ◽  
Author(s):  
Dâmaso de Araújo Chacon ◽  
Irami Araújo-Filho ◽  
Arthur Villarim-Neto ◽  
Amália Cínthia Meneses Rêgo ◽  
Ítalo Medeiros Azevedo ◽  
...  
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Intestinal Mucosa ◽  
Intestinal Resection ◽  
Small Bowel Resection ◽  
Control Group ◽  
Short Bowel ◽  
Massive Resection ◽  
Mucosal Thickness ◽  
Misleading Interpretation

PURPOSE: To evaluate the biodistribution of sodium pertecnetate (Na99mTcO4) in organs and tissues, the morphometry of remnant intestinal mucosa and ponderal evolution in rats subjected to massive resection of the small intestine. METHODS: Twenty-one Wistar rats were randomly divided into three groups of 7 animals each. The short bowel (SB) group was subjected to massive resection of the small intestine; the control group (C) rats were not operated on, and soft intestinal handling was performed in sham rats. The animals were weighed weekly. On the 30th postoperative day, 0.l mL of Na99mTcO4, with mean activity of 0.66 MBq was injected intravenously into the orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The biopsies were washed with 0.9% NaCl.,The radioactivity was counted using Gama Counter WizardTM 1470, PerkinElmer. The percentage of radioactivity per gram of tissue (%ATI/g) was calculated. Biopsies of the remaining jejunum were analysed by HE staining to obtain mucosal thickness. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. RESULTS: There were no significant differences in %ATI/g of the Na99mTcO4 in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05). CONCLUSION: In rats with experimentally-produced short bowel syndrome, an adaptive response by the intestinal mucosa reduced weight loss. The biodistribution of Na99mTcO4 was not affected by massive intestinal resection, suggesting that short bowel syndrome is not the cause of misleading interpretation, if an examination using this radiopharmaceutical is indicated.

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