Objective: To explore the risk factors of prolonged postoperative ileus (PPOI) after segmental jejunectomy by propensity score matching (PSM). Methods: This study was designed as a case-control study. The inclusion criteria were as follows: (1) age >18 years; (2) receipt of segmental jejunal resection; (3) postoperative pathological diagnosis of benign jejunal lesions, including small intestinal polyps, small intestinal diverticulitis, small intestinal diverticula, benign small intestinal tumors, small intestinal ulcers, small intestinal hemangioma, small intestinal vascular malformation, and ectopic pancreas of the jejunum, as well as gastrointestinal stromal tumors, lymphoma, or adenocarcinoma; and (4) complete clinical and pathological data.The exclusion criteria were as follows: (1) concomitant other malignancies; (2) combined resection of other organs; (3) emergency surgery due to intestinal obstruction, perforation, or other conditions, including intestinal bleeding, jejunal injury, jejunal rupture, acute enteritis, acute hemorrhagic necrotizing enteritis, acute intestinal obstruction, and mesenteric arterial thrombosis; (4) preoperative constipation; and (5) postoperative complications other than PPOI of Clavien-Dindo grade II or higher, or inflammatory reactions involving intra-abdominal organs, such as peritonitis, cholecystitis, or pancreatitis. According to the above criteria, clinicopathological data of patients who underwent elective segmental jejunal resection at the General Surgery Center of Beijing Friendship Hospital, Capital Medical University, between July 2013 and June 2025 were retrospectively collected. After screening, 262 patients were included and divided into the PPOI group (n = 42) and the non-PPOI group (n = 220) according to the occurrence of PPOI. Propensity score matching was performed using the nearest-neighbor matching method with a caliper value of 0.1 at a 1∶1 ratio. Logistic regression analysis was used to identify risk factors for PPOI after segmental jejunal resection. Results: Among the 262 patients who underwent elective segmental jejunal resection, PPOI occurred in 42 patients, with an incidence rate of 16.1%. After propensity score matching (PSM), 42 matched pairs of patients were successfully generated. After matching, there were no statistically significant differences between the PPOI and non-PPOI groups in terms of disease type, surgical approach, maximum lesion diameter, or anastomotic method (P>0.05). The PPOI group had significantly higher age, postoperative length of hospital stay, and postoperative C-reactive protein levels than the non-PPOI group, whereas the distance from the lesion center to the ligament of Treitz, postoperative serum potassium levels, and albumin levels were significantly lower in the PPOI group (P<0.05). Univariate analysis showed that a distance from the lesion center to the ligament of Treitz of <30 cm, postoperative serum potassium level of <3.5 mmol/L, postoperative C-reactive protein level of >85 mg/L, and postoperative albumin level of <33 g/L were associated with the occurrence of PPOI after segmental jejunal resection (P<0.05). Multivariate analysis showed that a distance from the lesion center to the ligament of Treitz of <30 cm (OR=8.481, 95%CI: 2.102-34.223, P=0.003), postoperative serum potassium level of <3.5 mmol/L (OR = 16.600, 95%CI: 3.869-71.230, P=0.011), and postoperative C-reactive protein level of >85 mg/L (OR=6.168, 95%CI: 1.514-25.128, P=0.007) were independent risk factors for PPOI after segmental jejunal resection. Conclusions: Patients undergoing proximal jejunal resection, defined as a distance from the lesion center to the ligament of Treitz of <30 cm, as well as those with postoperative hypokalemia and elevated C-reactive protein levels, are at a higher risk of developing PPOI.

Gastric-type endocervical adenocarcinoma (G-EAC) is a mucinous adenocarcinoma with gastric differentiation, and its preoperative diagnosis is challenging due to nonspecific symptoms. Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by mucocutaneous pigmentation and multiple gastrointestinal hamartomatous polyps, associated with an increased risk of G-EAC and other gynecological malignancies. We report a 44-year-old woman presenting with a 10-year cervical mass and 3-year vaginal discharge. She did not seek further medical attention because the cervical mass was asymptomatic and grew slowly. At age 35, she underwent partial jejunectomy for multiple small bowel polyps and intussusception, and postoperative pathology confirmed PJS. Her ultrasound revealed a 4.9 × 3.5 × 3.3 cm cervical mass, while cervical cytology examination was normal. G-EAC was unexpectedly diagnosed on postoperative pathology following total hysterectomy. Postoperative PET-CT imaging demonstrated pelvic lymph node metastasis. She subsequently underwent radical parametrectomy, bilateral oophorectomy, pelvic lymph node dissection, followed by chemotherapy. We also reviewed previously G-EAC cases with PJS, summarizing the pathogenesis and key points for diagnosis and treatment. We provide an in-depth analysis of the reasons for missed diagnosis of G-EAC and highlight the diagnostic challenges. The aim is to enhance gynecologists' understanding of G-EAC in patients with PJS.

Acute superior mesenteric artery (SMA) occlusion is a lethal but often misdiagnosed disease. A 66-year-old man presented with marked epigastric pain after eating raw fish. Emergency gastroscopy performed due to suspected anisakiasis revealed intestinal ischemia, leading to the diagnosis of SMA embolism based on the finding of newly detected atrial flutter without anticoagulation. His symptom improved after reperfusion by endovascular therapy using a self-expandable stent, and he was discharged with the ability to eat a normal diet after additional laparoscopic partial jejunectomy. In this instructive case with a clinical scenario mimicking anisakiasis, acute SMA embolism was successfully diagnosed.

Small-bowel adenocarcinoma (SBA) is rare and often diagnosed at an advanced stage. We report the case of a 61-year-old man with locally advanced unresectable upper jejunal SBA secondary to metastatic lymph nodes involving the superior mesenteric artery. Initial chemotherapy with FOLFOX (oxaliplatin, fluorouracil, and folinic acid) was initiated; however, a microsatellite instability-high (MSI-H) status was identified, and the treatment was promptly switched to pembrolizumab. After four cycles, marked regression of the metastatic lymph nodes was observed, and conversion surgery was performed. Partial jejunectomy with lymphadenectomy was performed to achieve an R0 resection. Pathological examination revealed a moderately differentiated adenocarcinoma with extensive fibrosis in the metastatic lymph nodes, indicating a substantial response to immunotherapy. The patient remained disease-free for 9 months postoperatively. Additionally, a brief meta-analysis of 10 studies comprising 72 patients with MSI-H/mismatch repair-deficient SBA revealed an objective response rate to immune checkpoint inhibitors of 65.3%. This case highlights the potential of pembrolizumab for the curative resection of an initially unresectable MSI-H SBA.

Gastrointestinal bleeding (GIB) is a known complication in patients with left ventricular assist devices (LVADs), and can be difficult to manage when bleeding is recurrent or unresponsive to standard therapies. We describe the case of a 63-year-old woman with a HeartMate 3 LVAD who presented with repeated episodes of GIB. Extensive evaluation revealed jejunal angiodysplasia as the source. Despite multiple endoscopic treatments and temporary discontinuation of anticoagulation, the bleeding persisted. Ultimately, the patient underwent exploratory laparotomy with resection of approximately 100 cm of proximal jejunum, which successfully resolved the bleeding. This case demonstrates that surgical intervention can be an effective option for refractory GIB due to angiodysplasia in LVAD patients, and underscores the importance of a multidisciplinary approach when balancing bleeding and thrombotic risks.

A 38-year-old woman was admitted to our hospital due to severe anemia. CT showed a 13×12 cm tumor with moderately enhanced wall thickening in the right upper abdomen. The huge tumor located adjacent to the jejunum and compressed the right transverse colon. Hemorrhagic necrosis and air were observed within the tumor, suspecting tumor penetration into the jejunum. The patient was diagnosed with abdominal GIST with jejunal infiltration. Laparotomy revealed a 13× 11 cm solid mass with intra-tumoral hemorrhage and invasion into the jejunum, located in the transverse mesocolon. Tumor resection combined with partial jejunectomy and transverse colectomy were performed. Immunohistochemical findings of the resected specimen was positive for c-kit and DOG-1, and the MIB-1 positive rate was 10%. Three weeks after the operation, re-anastomosis was performed due to transverse colon anastomotic stricture. She was discharged 45 days after first operation. Currently, 9 months after the operation, patient has been prescribed imatinib and is alive without recurrence.

The patient was a 30s male visited our hospital with the complaints of abdominal pain and melena. The internal medicine physician could not detect the cause of the melena by upper and lower gastrointestinal endoscopy. Although the patient resolved with a fast as conservative management so he left our hospital once, he relapsed nausea and abdominal pain. He visited our department. We performed surgery under a preoperative diagnosis of intestinal obstruction. The histopathological diagnosis was moderate differentiated jejunal adenocarcinoma(Stage ⅡA). At present, 1 year 7 months since surgery, the patient survives although with lymphnode recurrence.

The patient was a 79-year-old man who underwent robot-assisted gastrectomy for esophagogastric junction cancer. pT4aN1M0, pStage ⅢA. Nine months after surgery, he had emergency visit to the hospital due to abdominal pain and vomiting, and contrast CT scan showed a small intestine with poor contrast effect above the left diaphragm. He was diagnosed as a diaphragmatic hernia with small intestinal strangulation and underwent emergency surgery. Under laparotomy, 2 fb hernia orifice were observed on the ventral side of the esophageal hiatus, and a 50 cm jejunum was incarcerated and became necrotic. A partial jejunectomy was performed, and the esophageal hiatus was closed by suturing the stomach with 3-0 absorbable suture. He was discharged from the hospital with good postoperative course. But one month after the operation, the patient was seen in the hospital again with abdominal pain. Under laparotomy, it was found that one suture was dropped off the esophageal hiatus at the previous surgery, and a 100 cm jejunum was incarcerated, which was not necrotic. The hiatal hernia was closed by suturing the stomach and the hiatal hernia with 3-0 non-absorbable suture. Diaphragmatic hernia is a rare late complication of esophagogastric junction cancer.