scholarly journals Per-rectal bleeding due to jejunal Crohn’s: a rare case report from Bangladesh

2019 ◽  
Vol 10 (1) ◽  
pp. 68-72
Author(s):  
Shireen Ahmed ◽  
Md Nazmul Hoque ◽  
Md Anisur Rahman
Keyword(s):  
Weight Loss ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Capsule Endoscopy ◽  
Oral Steroid ◽  
Intestinal Bleeding ◽  
Clinical Relapse ◽  
Proximal Small Bowel

Crohn’s disease (CD) is a disorder of uncertain etiology that is characterized by transmural inflammation of the gastrointestinal tract. CD may involve the entire gastrointestinal tract from mouth to the perianal area. Isolated jejunal involvement of CD is a rare entity. We describe a case of CD involving only jejunum with successful treatment in a 74-years-man who presented with melaena, abdominal pain and significant weight loss. Endoscopy of upper gastro-intestinal tract revealed gastritis and colonoscopy showed small sessile polyp at rectum and sigmoid colon, polypectomy was done accordingly. After few days of polypectomy, he again noticed melaena along with abdominal discomfort and weakness with loss of 4 kg weight within this periods. Diagnosis was confirmed by capsule endoscopy and serology. Treatment was thereafter started with oral steroid and mesalamine sachet. The patient is now on remission and is on regular follow up. CD has propensity to involve the distal small intestine and proximal large bowel. Affected persons usually experience diarrhea and abdominal pain, frequently accompanied by weight loss. Proximal small bowel involvement is less common than distal small bowel or colonic involvement in CD. CD involving proximal small intestine should be suspected in Asian patients with middle gastro-intestinal bleeding. It is associated with a high risk of clinical relapse and morbidity, including the need for abdominal surgery. Different modalities of baseline evaluation and more sophisticated diagnostic modalities may be required for patients with CD involving proximal small bowel. Capsule endoscopy (CE) currently plays an important role in CD. Birdem Med J 2020; 10(1): 68-72

scholarly journals 1610 Haemangiomas of the Small Intestine: Poorly Known Cause of Abdominal Pain

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B Mohamed ◽  
I Soric
Keyword(s):  
Small Intestine ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Resection ◽  
Vascular Lesions ◽  
Intestinal Bleeding ◽  
Cavernous Haemangioma ◽  
Quadrant Pain ◽  
Therapeutic Measures ◽  
Resection And Anastomosis

Abstract Background Haemangioma of the small intestine is a rare disease in adult patients and is usually located in the jejunum. The usual clinical features include abdominal pain, bleeding, and obstruction. Acute intestinal bleeding leading to anaemia is the most common presentation in most patients. Intussusception and even perforation caused by cavernous haemangioma are extremely rare Case Summary we report a 31-year-old male with a right upper quadrant pain, nausea, elevated CRP. ultrasound abdomen suggestive of hepatic haemgioma whereas the CT abdomen showed left upper quadrant mass. He had laparoscopy converted the laparotomy showed5*5cm small intestine mass. small bowel resection and anastomosis was done. Histology has confirmed haemangioma. Discussion Small bowel haemangioma accounts for 5 to 10 % of all benign neoplasms of the small intestine. It is thought to be one of the congenital benign vascular lesions. Haemangiomas are classified as cavernous, capillary, or mixed type, and the cavernous type is the most common Malignant change is quite unusual. Multiple lesions are often associated with similar neoplasms in other organs, such as the liver and skin. Conclusions Small intestine haemangioma are often very difficult to diagnose. Early diagnosis and appropriate intervention could provide good outcomes. Diagnostic and therapeutic measures should be taken to avoid further complications.

scholarly journals P168 Isolated terminal ileitis: when capsule endoscopy is key for Crohn’s disease diagnosis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S222-S222
Author(s):  
M FREITAS ◽  
T Cúrdia Gonçalves ◽  
P Boal Carvalho ◽  
F Dias de Castro ◽  
B Rosa ◽  
...  
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Disease Diagnosis ◽  
Inflammatory Activity ◽  
Extraintestinal Manifestations ◽  
Terminal Ileitis ◽  
Proximal Small Bowel

Abstract Background Terminal ileitis (TI) is a common condition in clinical practice and may be associated with a wide variety of diseases, mostly Crohn’s disease (CD). Data regarding predictors of CD diagnosis in isolated TI are lacking, particularly concerning small bowel capsule endoscopy (SBCE) findings. Aim To evaluate predictive factors for CD diagnosis in patients with isolated TI detected during ileocolonoscopy, submitted to SBCE. Methods Retrospective study including consecutive patients undergoing SBCE after diagnosis of TI without colonic mucosal abnormalities on ileocolonoscopy between January 2016 and September 2019. Demographic, clinical, biochemical, endoscopic and imaging data were collected. The diagnosis of CD was based on clinical evaluation, endoscopic, histological, radiological, and/or biochemical investigations. Results One hundred and two patients with isolated ileitis on ileocolonoscopy were included. After performing SBCE, 34.3% of the patients had a diagnosis of CD. All CD diagnosed patients had positive SBCE findings. Extraintestinal manifestations (p = 0.003), weight loss (p = 0.01), abnormal imaging (p = 0.04) and positive SBCE findings (p = 0.005) were independently associated with CD diagnosis. Regarding SBCE, presence of proximal small-bowel disease (p = 0.02), diffuse findings (p = 0.002) and presence of moderate to severe inflammatory activity (Lewis Score≥790) (p < 0.001) were independently associated with CD diagnosis. Conclusion SBCE is a valuable tool that should be systematically used in patients presenting with isolated TI, since it enabled CD diagnosis in approximately one-third of patients. A diagnosis of CD should be considered when a patient with TI shows extraintestinal manifestations, weight loss, abnormal imaging and positive SBCE findings, especially proximal involvement, diffuse findings and the presence of moderate to severe inflammatory activity.

scholarly journals Multiple Small Intestine Ulcers with Desquamation of the Fingers

2017 ◽  
Vol 11 (2) ◽  
pp. 452-461
Author(s):  
Azusa Kawasaki ◽  
Kunihiro Tsuji ◽  
Hisashi Doyama
Keyword(s):  
Computed Tomography ◽  
Small Intestine ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Yersinia Pseudotuberculosis ◽  
Oral Ulcers ◽  
Palmar Erythema ◽  
Antibody Titers ◽  
Endoscopic Characteristics ◽  
Multiple Ulcers

A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.

Enhancing Video Capsule Endoscopy: Location and Bleeding Detection

2010 ◽  
Author(s):  
Douglas Yeung ◽  
Amir Sabet Sarvestani ◽  
Jonathan Yap ◽  
Yuri Inoue
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Capsule Endoscopy ◽  
Cost Reduction ◽  
Video Capsule Endoscopy ◽  
Non Invasive ◽  
Elapsed Time ◽  
Bleeding Detection ◽  
Invasive Method ◽  
Intuitive User Interface

Video capsule endoscopy (VCE) is a non-invasive method of visually examining the internal lumen of small intestine for inflammation and bleeding through a wireless camera contained in a small capsule. Currently, VCE technology is limited because it cannot map images to their specific locations in the small bowel. Furthermore, approximately 40% of identified problem areas are false positives, making bleeding difficult to find. Therefore, physicians can only estimate the location of inflammation and bleeding areas based on the elapsed time before performing a wired endoscopy. Our pill camera offers an innovative wireless imaging GPS-like location system, in an easy to swallow pill that accurately identifies and displays bleeding areas within the small intestine through an intuitive user interface, which results in a 50% reduction in clinical times, as well as improved diagnosis for potential investors and providers, thus resulting in a $500 cost reduction in physician fees per patient.

Capsule endoscopy in small bowel Crohn’s disease and Tuberculosis

2017 ◽  
Vol 47 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Surinder Singh Rana ◽  
Vishal Sharma ◽  
Ravi Sharma ◽  
Ritambhra Nada ◽  
Rajesh Gupta ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Ileocecal Valve ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Large N ◽  
Aphthous Ulcers

Differentiation of small bowel tuberculosis (SBTB) from Crohn’s disease (CD) is a diagnostic challenge. We studied 52 patients with suspected SBTB or CD with terminal ileal involvement, who were prospectively enrolled. After confirming patency of the gastrointestinal tract, 26 patients underwent capsule endoscopy (CE). A final diagnosis of CD was found in 18 patients and SBTB in eight patients. All SBTB patients had involvment of the ileocecal valve (ICV) with large (n = 6) and aphthous (n = 2) ulcers in the ileal segment. In CD, ICV involvement was seen in five (33%) patients. Large and aphthous ulcers were observed in seven (47%) and 15 (100%) patients, respectively. On comparison with CD, patients with SBTB had increased frequency of ICV involvement ( P = 0.002) and lesser frequency of aphthous ulcers ( P = 0.007). CE can help in differentiating CD from SBTB by the position of its involvement and the type of ulcers present.

Video Capsule Endoscopy and Deep Enteroscopy

2017 ◽  
Author(s):  
Neil Marya ◽  
Veronica Baptista ◽  
Anupam Singh ◽  
Joseph Charpentier ◽  
David Cave
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Carcinoid Tumor ◽  
Capsule Endoscopy ◽  
Crohn Disease ◽  
Malignant Tumors ◽  
Video Capsule Endoscopy ◽  
X Rays ◽  
Small Bowel Tumors ◽  
Peutz Jeghers Syndrome

Until 2001, the nonsurgical evaluation of the small intestine was largely limited to the use of radiologic imaging (e.g., small bowel follow-through or enteroclysis). With the now widespread availability of video capsule endoscopy and deep enteroscopy since 2001, we are now able to visualize the length and most of the mucosa of the small intestine and manage small bowel lesions that were previously inaccessible except by surgical intervention. This review serves as an overview for these two procedures, detailing the indications and contraindications, proper timing of the procedure, technical aspects of the devices themselves, possible complications, and outcomes. Figures show endoscopic images that demonstrate multiple angioectasias, bleeding during capsule endoscopy, active Crohn disease of the small bowel, severe mucosal scalloping, small bowel carcinoid tumor, small bowel polyp associated with Peutz-Jeghers syndrome, and nonsteroidal antiinflammatory drug enteropathy; serial x-rays of a patient with a patency capsule retained inside the small intestine; a computer image showing the distribution of small bowel tumors; and a pie chart displaying the breakdown of the distribution of benign and malignant tumors that can be found in the small intestine. Videos show multiple angioectasias, bleeding during capsule endoscopy, active Crohn disease of the small bowel, small bowel carcinoid tumor, and small bowel polyp associated with Peutz-Jeghers syndrome. This review contains 10 highly rendered figures, 5 videos, and 50 references.

Maximal lymphatic triglyceride transport rate from the rat small intestine

1982 ◽  
Vol 242 (4) ◽  
pp. G408-G415 ◽  
Author(s):  
P. Tso ◽  
K. L. Buch ◽  
J. A. Balint ◽  
J. B. Rodgers
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Transport Rate ◽  
Lymphatic Transport ◽  
Onset Of Action ◽  
Triglyceride Fatty Acid ◽  
Proximal Half ◽  
Proximal Small Bowel

In previous studies, we demonstrated that the hydrophobic surfactant Pluronic L-81 blocks lymphatic triglyceride transport from the small intestine and leads to accumulation of triglyceride in the mucosa. The onset of action of Pluronic L-81 is rapid and quickly reversed once its administration is discontinued. We have taken advantage of these effects of Pluronic L-81 on intestinal lipid transport in order to determine the apparent maximal triglyceride transport capacity of the proximal half of the rat small bowel using lymph fistula rats infused intraduodenally with a phosphate-buffered, taurocholate-stabilized emulsion containing 40 mumol [3H]triolein and 0.5 mg Pluronic L-81 at 3 ml/h for 8 h to load the proximal small bowel with lipid. Studies were done in one group of rats in order to be certain that only the proximal half of the small bowel contained 3H-lipid after this period of infusion. In other rats treated similarly, the 8 h of lipid-Pluronic L-81 infusion were followed by infusion of 3 ml/h of 0.15 M salt solution for 5 h. Lymphatic transport of lipid was determined throughout the entire period of infusion. During lipid-Pluronic L-81 infusion, transport of 3H-triglyceride fatty acid into lymph was only 22-27 mumol/h but rose steadily after substitution of saline and reached a maximal transport rate of 109 +/- 6.2 mumol/h (means +/- SE) after 3.5 h. During this 3.5-h period, the amount of 3H-lipid in the proximal mucosa declined from 530 to 263 mumol. While Pluronic L-81 was infused, only very low-density-lipoprotein-sized particles were seen in lymph by electron microscopy, whereas, at the peak of triglyceride transport during saline infusion, chylomicrons of up to 6,000 A were observed in lymph.

scholarly journals Panenteric capsule endoscopy versus ileocolonoscopy plus magnetic resonance enterography in Crohn’s disease: a multicentre, prospective study

2020 ◽  
Vol 7 (1) ◽  
pp. e000365 ◽  
Author(s):  
David Henry Bruining ◽  
Salvatore Oliva ◽  
Mark R Fleisher ◽  
Monika Fischer ◽  
Joel G Fletcher
Keyword(s):  
Crohn’S Disease ◽  
Magnetic Resonance ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Terminal Ileum ◽  
Imaging Modality ◽  
Disease Diagnosis ◽  
Magnetic Resonance Enterography ◽  
Proximal Small Bowel

IntroductionCrohn’s disease diagnosis and monitoring remains a great clinical challenge and often requires multiple testing modalities. Assessing Crohn’s disease activity in the entire gastrointestinal (GI) tract using a panenteric capsule endoscopy (CE) system could be used as an alternative to colonoscopy and cross-sectional imaging. This study assessed the accuracy and safety of panenteric CE in Crohn’s disease as compared with ileocolonoscopy (IC) and/or magnetic resonance enterography (MRE).MethodsA prospective, multicentre study was performed in subjects with established Crohn’s disease. Individuals with proven small bowel patency underwent a standardised bowel preparation, followed by CE ingestion and IC either the same or following day. MRE, IC, and CE interpretations were performed by blinded central readers using validated scoring systems. The primary endpoint was the overall sensitivity of CE vs MRE and/or IC in Crohn’s disease subjects.ResultsStudy enrolment included 158 subjects from 21 sites in the USA, Austria, and Israel. Of those, 99 were included in the analysis. Imaging modality scores indicated none to mild inflammation in the proximal small bowel and colon, but discrepant levels of inflammation in the terminal ileum. Overall sensitivity for active enteric inflammation (CE vs MRE and/or IC) was 94% vs 100% (p=0.125) and specificity was 74% vs 22% (p=0.001). Sensitivity of CE was superior to MRE for enteric inflammation in the proximal small bowel (97% vs 71%, p=0.021), and similar to MRE and/or IC in the terminal ileum and colon (p=0.500–0.625). There were seven serious adverse advents of which three were related to the CE device.ConclusionPanenteric CE is a reliable tool for assessing Crohn’s disease mucosal activity and extent compared with more invasive methods. This study demonstrates high performance of the panenteric CE as compared to MRE and/or IC without the need for multiple tests in non-stricturing Crohn’s disease.Trial registration numberClinicalTrials.gov NCT03241368

Small Bowel Adenocarcinoma Complicating Crohn's Disease

1992 ◽  
Vol 37 (2) ◽  
pp. 54-55 ◽  
Author(s):  
H.E. Ellamushi ◽  
I.S. Smith
Keyword(s):  
Small Intestine ◽  
Crohn’S Disease ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Small Bowel Obstruction ◽  
Medical Therapy ◽  
Acute Abdominal Pain ◽  
Fistula Formation ◽  
Small Bowel Adenocarcinoma

Crohn's disease of the small intestine is usually managed by medical therapy with surgery being reserved for obstruction or fistula formation. A patient is described who developed small bowel obstruction due to an adenocarcinoma of the ileum after over twenty years of medical therapy for Crohn's disease, originally diagnosed at a laparotomy for acute abdominal pain. The possibility of malignancy in such long-standing disease should be considered.

Effects of bile and pancreatic secretions on intestinal mucosa after proximal small bowel resection in rats

1980 ◽  
Vol 58 (9) ◽  
pp. 1117-1123 ◽  
Author(s):  
Monique D. Gélinas ◽  
Claude L. Morin
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Pancreatic Juice ◽  
Bowel Resection ◽  
Intestinal Resection ◽  
Small Bowel Resection ◽  
Sprague Dawley ◽  
Ileal Mucosa ◽  
Distal Small Intestine ◽  
Proximal Small Bowel

After proximal small bowel resection the remaining small intestine undergoes adaptive hyperplasia. In the present study, the relative contributions of bile and (or) pancreatic juice to adaptive intestinal hyperplasia following proximal resection was studied. Using male Sprague–Dawley rats a 50% proximal intestinal resection was done starting 10 cm distal to the beginning of the jejunum. The animals were also subjected to diversion of bile and (or) pancreatic secretions to the distal ileum at 18 cm proximal to the ileocecal junction. After 8 days gut and mucosal weights, mucosal proteins, and DNA were measured in the duodenojejunum (gut segment proximal to the resection anastomosis) and in the ileum (first half of the small bowel segment distal to the diversion site). The results indicate that (1) in rats fed either chow (Purina rat chow) or a chemically defined diet diversion of pancreaticobiliary secretions to the ileum significantly stimulated ileal mucosa growth whereas no changes were observed in the duodenojejunum, (2) in rats fed a chemically defined diet neither bile nor pancreatic juice affected ileal mucosa when separately diverted to the ileum, and (3) pancreatic juice draining into the duodenum while bile was diverted to the ileum induced hypoplastic changes in the duodenojejunum. The present study suggests that following jejunectomy the regulation of mucosal growth by pancreatic and bile secretions is different in the proximal and distal small intestine. Pancreaticobiliary secretions are trophic for the ileum. However, in the proximal gut bile offers protection against a direct or indirect catabolic action of pancreatic juice.

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