Experience of serious intestinal hemorrhage and perforation in small bowel lymphoma: a case report

There have been several reports of complications of small bowel lymphoma, such as bleeding, obstruction, and perforation, often require emergency surgery. It is hardly showed complications of bleeding and wound dehiscence for diffuse large B cell lymphoma with distal ileum involvement, which needed urgent surgery and medical management. A 65-year-old man with diffuse large B-cell lymphoma with distal ileum involvement experienced both intestinal bleeding and perforation during the course of treatment. As the patient was diagnosed with stage III disease, resection before chemotherapy was not considered due to the resulting delay in chemotherapy, which necessitated sufficient tissue healing. Chemotherapy is important when treating small bowel lymphoma, complications such as bleeding and perforation should always be considered for the treatment of small bowel lymphoma, and surgery is necessary in this situation. After surgery of the small bowel, subsequent chemotherapy could cause wound dehiscence and perforation; therefore, adequate recovery time should be given before chemotherapy.

An unusual case of small bowel obstruction secondary to internal herniation of distal ileum through a rent between adhered inflamed vermiform appendix and appendices epiploicae

Intestinal obstruction secondary to an internal hernia is rare and that occurring through a rent between the adhered inflamed vermiform appendix and appendices epiploicae of the proximal caecum is so rare that this case was the first of its kind ever to be reported. Such a cause for obstruction should be suspected in a patient with a virgin abdomen with no history/clinical features of an obstructing external hernia or abdominal tumor. A 28 year old man presented to the ER with features of intestinal obstruction, in whom CECT abdomen revealed multiple dilated small bowel loops with breaking-of seen in the region of the terminal ileum. Surgical exploration revealed internal herniation of the distal ileum through a rent between the adhered inflamed vermiform appendix and the appendices epiploicae of the proximal caecum; reduction of which was sufficient to relieve the obstruction and demonstrate healthy reperfusion. Adhesiolysis, epiploicae appendectomy and appendectomy was done with no other points of obstruction along the small bowel. Due to its rarity, non-specific presentation pattern and limited usefulness of imaging for diagnosis, a high index of suspicion with prompt early surgical exploration is a must for a successful outcome in such cases intestinal obstruction; especially in a virgin abdomen.

Experience of Serious Intestinal Hemorrhage and Perforation in Small Bowel Lymphoma: A Case Report

Background: There have been several reports of complications of small bowel lymphoma, such as bleeding, obstruction, and perforation, which require emergency surgery. It is hardly showed complication of bleeding and wound dehiscence for diffuse large B cell lymphoma with distal ileum involvement, which needed urgent surgery and medical management. Chemotherapy is also important when treating small bowel lymphoma, but complications such as bleeding and perforation should always be kept in mind.Case presentation: A 65 year-old man with stage III diffuse large B-cell lymphoma of the activated-B cell (ABC) type with distal ileum involvement experienced both intestinal bleeding and perforation during the course of treatment. As the patient was diagnosed with stage III disease, resection before chemotherapy was not considered due to the resulting delay in chemotherapy, which necessitated sufficient tissue healing. Conclusion: As shown in this case, complications such as bleeding and perforation should always be considered for the treatment of small bowel lymphoma, and surgery is necessary in this situation. After surgery of the small bowel, subsequent chemotherapy could cause the wound dehiscence and perforation; therefore, adequate recovery time should be given before chemotherapy.

249 Laparoscopic Assisted Enterolithotomy: A Viable Option in The Management of Gallstone Ileus

Introduction Gallstone ileus (GSI) is a rare cause of small bowel obstruction in patients over the age of 65 years. We report a case of GSI treated successfully with a laparoscopic assisted enterolithotomy. Case report A 75-year-old female presented with two days of abdominal distension and vomiting with a non-peritonitic abdomen on examination. A computerised tomography scan demonstrated small bowel obstruction due to an obstructing stone in the distal ileum. Three port laparoscopy and small bowel assessment confirmed a solitary enterolith (4cms) in the distal ileum with upstream dilated loops. An infra-umbilical 6 cm midline incision was made and the localised bowel loop was delivered. An enterotomy was made proximal to the point of obstruction, stone retrieved, and a single layer interrupted closure was performed. Ten weeks post-operatively, patient had a virtual follow-up consultation and is doing well. Conclusions GSI often presents in elderly patients with multiple co-morbidities. A laparotomy with enterolithotomy is the initial treatment of choice with biliary intervention as a second operation, if needed, at a later date. Clearly, a conventional exploratory laparotomy in this cohort of patients carries a high risk and therefore the use of less morbid and less invasive procedure like laparoscopy should be considered. Although a total laparoscopic approach would require advanced laparoscopic skills particularly due to dilated bowel loops limiting the intra-abdominal space for suturing, a laparoscopic assisted approach as described above should be considered as a reasonable option within the remits of an emergency general surgeon.

A rare case of spindle cell tumour of mesentery

We herein reported a rare case of a patient who developed a spindle cell tumor of the mesentery. A 45 years old female with a previous history of hysterectomy presented with pain in the abdomen for two weeks. CT scan was suggestive of a well-defined solid, enhancing lesion in the right pelvic region and iliac fossa measuring 10.9×13.9×15.1 cm, abutting right ovary, ileocaecal junction, caecum, appendix and rectosigmoid junction (possible differentials) are right ovarian neoplastic lesion or desmoid tumor. The patient was planned for surgery underwent laparotomy, where the mass appeared to originate from the mesentery (15×12) in dimensions and was adherent to distal ileum and caecum. The mass was inseparable, hence, the right quadra colectomy was taken and the whole mass with distal ileum and caecum and right colon was excised and ileocolic anastomosis was done. The tumor was histologically diagnosed as a spindle cell tumor. Follow up of the patient had been uneventful.

Impact of combined xylanase and β-glucanase enzymes on digesta transit time, short-chain fatty acids and caecal thermal profile of broilers fed corn-soy-based diets

A study was conducted to evaluate the effects of including a xylanase + β-glucanase enzyme product in corn-soy-based diets on performance, caecal short-chain fatty acids and thermal profile, ileal digestibility and intestinal kinetics of broiler chickens. A total of 744 d-old male chicks were randomly allotted to 24 floor pens and distributed in a 2 × 2 factorial arrangement with low or high energy level × without or with 100 grams of the enzyme per ton of feed. Enzyme supplementation improved bodyweight gain from 1 to 21 d. An increased caecal concentration of acetic acid was observed when the enzyme was added to the low-energy diet. The pH of the caecal content was reduced and the caecal temperature was increased by low-energy diets. The apparent ileal digestibility of energy was improved by the enzyme. The addition of the enzyme increased the mean retention time in the distal ileum. In summary, the addition of a xylanase + β-glucanase enzyme product in corn-based diets increases the retention time of digesta in the distal ileum and the caecal acetic acid concentration, improves ileal digestibility of energy and performance from 1 to 21 d in broiler chickens fed corn-soy-based diets.

Diagnosis of Fibrotic Distal Ileum Stenosis after Ischemic Enteritis Using Transabdominal Ultrasonography

Ischemic enteritis (IE) is a rare disorder which is caused by inadequate blood flow to small intestine. The diagnostic procedure of this disease has not sufficiently established because of its rarity. Here, we report a case of IE in a hemodialysis-dependent 70-year-old man and summarize the diagnostic options for IE. The patient was admitted to our hospital because of acute abdominal distention and vomiting. He presented with mild tenderness in the lower abdomen and slightly elevated C-reactive protein level as revealed by blood tests. Radiographic imaging showed small bowel obstruction due to a stricture in the distal ileum. Contrast-enhanced abdominal ultrasonography revealed a 7-cm stenotic site with increased intestinal wall thickening, which preserved mucosal blood perfusion. Elastography revealed a highly elastic alteration of the stenotic lesion, indicating benign fibrotic changes resulting from chronic insufficient blood flow. Based on a clinical diagnosis of IE with fibrous stenosis, a partial ileostomy was performed. After surgical treatment, oral intake was initiated without recurrence of intestinal obstruction. Pathological findings revealed deep ulceration with inflammatory cell infiltration at the stenotic site. Occlusion and hyalinization of the venules in the submucosal layer indicated IE. In addition to current case, we reviewed past case reports of IE. Through this case presentation and literature review, we summarize the usefulness and safety of transabdominal ultrasonography for diagnosing IE.