SYMPTOMATIC MECKELS DIVERTICULUM IN THE NEWBORN: REVIEW OF THE LITERATURE

Meckels diverticulum accounts for 2 to 3% of gastrointestinal tract malformations in children. It is a distal remnant of the incompletely obliterated omphalo mesenteric duct that occurs at 4 weeks gestation, and is located approximately 40 to 60 cm from the last ileal loop. In the majority of cases, its presentation is asymptomatic and discovery is incidental. The symptomatic form represents 4% and is rare in children, including bleeding, occlusion, inflammation and intermittent umbilical oozing. The symptomatic form is exceptional in newborns. This work is a descriptive study of the literature regarding reported cases of newborns diagnosed with symptomatic Meckels diverticulum either as a picture of intestinal obstruction or by spontaneous perforation of the DM The objective of our study is to describe the cases of newborns operated in emergency for symptomatic Meckels diverticulum and to evaluate the surgical management.

Left Amyand’s hernia with inflamed appendix and sealed of perforated caecum an unusual case

Amyand’s hernia is defined as the hernia with appendix normal, inflamed or perforated as content. 1% of inguinal hernias are Amyand’s and amongst them 0.1% contains inflamed appendix. Commonly encountered on right size due to anatomical position of appendix. Left Amyand’s is rare and associated with intestinal malrotation, situs invertus and mobile caecum. Here, we presented an interesting case of left irreducible hernia in 70 years old gentleman with no signs of acute obstruction or strangulation, patient underwent emergency laparotomy in which hernial sac contents were inflamed ileal loop, inflamed appendix and perforated caecum in 70 years old man is rare presentation and not reported in any literature as per our knowledge. Resection of inflamed bowel loop with ceacum done along with ileo ascending anastomosis with primary tissue repair done. Post-operative period was uneventful. Hernia sac contents are most of the time surprising and their management sometimes differ according to the content. Appendix in hernia sac is found in 1% of all hernia but lack of facility for the pre-operative diagnosis and varied presentation it is challenging to diagnose and operate accordingly.

Endoscopic tissue sampling – Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Recommendations 1 ESGE suggests performing segmental biopsies (at least two from each segment), which should be placed in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum) in patients with clinical and endoscopic signs of colitis.Weak recommendation, low quality of evidence. 2 ESGE recommends taking two biopsies from the right hemicolon (ascending and transverse colon) and, in a separate container, two biopsies from the left hemicolon (descending and sigmoid colon) when microscopic colitis is suspected.Strong recommendation, low quality of evidence. 3 ESGE recommends pancolonic dye-based chromoendoscopy or virtual chromoendoscopy with targeted biopsies of any visible lesions during surveillance endoscopy in patients with inflammatory bowel disease. Strong recommendation, moderate quality of evidence. 4 ESGE suggests that, in high risk patients with a history of colonic neoplasia, tubular-appearing colon, strictures, ongoing therapy-refractory inflammation, or primary sclerosing cholangitis, chromoendoscopy with targeted biopsies can be combined with four-quadrant non-targeted biopsies every 10 cm along the colon. Weak recommendation, low quality of evidence. 5 ESGE recommends that, if pouch surveillance for dysplasia is performed, visible abnormalities should be biopsied, with at least two biopsies systematically taken from each of the afferent ileal loop, the efferent blind loop, the pouch, and the anorectal cuff.Strong recommendation, low quality of evidence. 6 ESGE recommends that, in patients with known ulcerative colitis and endoscopic signs of inflammation, at least two biopsies be obtained from the worst affected areas for the assessment of activity or the presence of cytomegalovirus; for those with no evident endoscopic signs of inflammation, advanced imaging technologies may be useful in identifying areas for targeted biopsies to assess histologic remission if this would have therapeutic consequences. Strong recommendation, low quality of evidence. 7 ESGE suggests not biopsying endoscopically visible inflammation or normal-appearing mucosa to assess disease activity in known Crohn’s disease.Weak recommendation, low quality of evidence. 8 ESGE recommends that adequately assessed colorectal polyps that are judged to be premalignant should be fully excised rather than biopsied.Strong recommendation, low quality of evidence. 9 ESGE recommends that, where endoscopically feasible, potentially malignant colorectal polyps should be excised en bloc rather than being biopsied. If the endoscopist cannot confidently perform en bloc excision at that time, careful representative images (rather than biopsies) should be taken of the potential focus of cancer, and the patient should be rescheduled or referred to an expert center.Strong recommendation, low quality of evidence. 10 ESGE recommends that, in malignant lesions not amenable to endoscopic excision owing to deep invasion, six carefully targeted biopsies should be taken from the potential focus of cancer.Strong recommendation, low quality of evidence.

A RARE CASE OF PERFORATED ILEAL GIST PRESENTING AS ACUTE ABDOMEN

A case of perforated gastrointestinal stromal tumor (GIST) of ileum causing acute abdomen is described, with a brief review of the literature. A male patient presented with symptoms of acute abdomen. After evaluation, a laparotomy was performed, where perforation of a tumor in the ileum was found. The tumor was attached to the ileal loop and also to the peritoneal attachment of the dome of urinary bladder. The tumor was resected with adjacent ileal loop and ileoileal anastomosis was done . On examining later revealed a perforation of small bowel at the site of tumor and histopathological examination showed that the tumor was GIST. Postoperative period was uneventful and the patient received treatment, using imatinib. Gastrointestinal stromal tumors are relatively rare and often present with vague symptoms. Their rst clinical manifestation as acute abdomen due to their perforation is extremely rare. In emergency laparotomy, a R0 resection is required and adjuvant therapy with imatinib must be considered.

Comparative study between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of Morbid Obesity

Background Single anastomosis sleeve ileal bypass (SASI) procedure appears as anew metabolic and bariatric surgery based on santoro's operation, in which sleeve gastrectomy is followed by side to side gastro-ileal loop anastomosis. Aim of the Work to compare between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of morbid obesity. Patients and Methods Our study was a prospective randomized comparative study in Ain Shams University hospitals involving 50 patients suffering from morbid obesity and in whom surgical management was indicated. Our patients were randomly divided using closed envelopment method into two groups: Group (1): (25 patients) were treated by laparoscopic SASI. Group (2): (25 patients) were treated by laparoscopic MGB. Results One year after the surgery, there was significant diabetic remission rate and there was improvement of most of obesity-associated metabolic parameters Conclusion Our study suggests that both SASI and MGB are highly effective in controlling diabetes mellitus, hypertension and hyperlipidemia.

What is the onset mechanism of internal hernia after vertebral body fracture? A case of internal hernia secondary to traumatic vertebral fracture

A 67-year-old man who had been pinned between a basket crane and a tree complained of severe pain in his lower back and a decreased appetite. Laparotomy after decompressing the gastrointestinal tract revealed incarceration of an ileal loop within a fractured third lumbar vertebra. The damaged bowel was resected, and an end-to-end anastomosis was performed. Once the patient’s condition had stabilised, posterior lumbar fixation was performed. There were no abdominal complications or lower limb neurological deficits during the follow-up period. Enhanced CT and MRI had been helpful in making the diagnoses. Histopathological examination revealed the aetiology of the traumatic incarceration: the intestine had been pinched as the disc space closed, and the body attempted to return to its original state by exerting countertraction.

Ileal duplication cyst with giant polypoidal gastric heterotropia:

Enteric duplication cysts (EDCs) are congenital malformations of the gastrointestinal tract. EDCs can present as tubular or spherical cystic lesions of the abdomen. The tubular variant of EDC arises as an outpouching from the bowel wall, whereas the spherical variant rarely shows bowel communication. EDCs are known to harbour heterotopic pancreatic parenchyma or gastric mucosa. We present a case of EDC of the ileum (tubular type) with heterotopic gastric mucosa in a 7-year-old child who came with malena and abdominal discomfort. CT revealed focal abnormal dilatation of the ileal loop with polypoidal mucosal thickening. Differential diagnosis of lymphoma, bowel polyps and Meckel’s diverticula with gastric heterotopia (GH) were considered. Subsequent surgery followed by histopathology revealed it to be EDC with GH. We discuss this case to familiarise radiologists with the atypical imaging features of EDC, to prevent misdiagnosis and initiate prompt treatment in appropriate clinical settings.

TOURNIQUET APPENDIX: RARE ETIOLOGY OF ORGANIC ACUTE INTESTINAL OBSTRUCTION

Acute appendicitis is the most common surgical emergency. A bowel obstruction due to the appendicitis is in most cases functional with a paralytic ileus mechanical bowel obstructions are rare or exceptional. We describe a rare case of a mechanical bowel obstruction due to a strangulation of the last ileal loop by the appendix.

Fifty Shadows of Mesenteric Ischemia

A 66-year-old female presented to the emergency department with sudden onset of central abdominal pain irradiated to the back. Blood tests were unremarkable. Computed tomography scan showed acute focal ischaemia of small bowel loops sustained by an encircling omental band around a mid ileal loop, which was released on urgent mini-laparotomy. The ischaemic loops were covered with hot moist gauzes for several minutes until the normal luster and peristaltic wave returned. Indocyanine green fluorescence angiography confirmed sufficient bowel perfusion and viability. The patient was discharged 5 days after surgery and did not experience any symptom recurrence up to 6 months later. Mesenteric or colonic ischaemia may respectively affect the small or large intestine. The small intestine is able to compensate for a 75% reduction in mesenteric perfusion for up to 12 hours. If promptly treated, resection may be successfully avoided.