- [Heterotopic tissue in the gastrointestinal tract]. [Review]
- PPathologe 2018 Aug 13
- Heterotopia of the gastrointestinal tract is a common finding. This is due to the complex embryogenesis and the relative ease to detect heterotopic tissue during endoscopy. The reason for biopsy is m...
Heterotopia of the gastrointestinal tract is a common finding. This is due to the complex embryogenesis and the relative ease to detect heterotopic tissue during endoscopy. The reason for biopsy is mostly to rule out neoplasms or to define specific causes of inflammation. Heterotopic tissue can occur in any location of the gastrointestinal tract. The most frequent are gastric heterotopia, pancreatic heterotopia, and heterotopia of Brunner's gland. On rare occasions, heterotopic tissue of salivary gland type as well as heterotopias of apocrine glands, thyroid, and prostatic tissue have been described. The most frequently involved organs are the small intestine, in particular the duodenum, the esophagus, and the stomach. Heterotopia of the large bowel occurs exclusively in the rectum. Most heterotopias do not cause symptoms and are easily diagnosed by biopsy and histology. However, depending on location, size, and the kind of underlying heterotopic tissue, they may cause significant complications, such as inflammation, ulceration and perforation, obstruction, intussusception, and severe life-threatening bleeding. Another rare but significant complication is neoplasia. Gastric heterotopias may give rise to pyloric gland adenomas within the bowel or rarely adenocarcinomas of the esophagus. Pancreatic heterotopia can be complicated by ductal type pancreatic adenocarcinomas, by acinus cell carcinomas, by intraductal papillary mucinous neoplasias, and also by endocrine tumors. The present paper summarizes our current knowledge about heterotopias in a topographic clinico-pathological manner.
- Intraductal papillary mucinous neoplasm originating from a heterotopic pancreas within the jejunum: a case report. [Journal Article]
- JSJ Surg Case Rep 2018; 2018(8):rjy181
- We report a case of intraductal papillary mucinous neoplasm arising within the heterotopic pancreatic tissue which was found incidentally in the jejunum during surgery for bowel obstruction. A 54-yea...
We report a case of intraductal papillary mucinous neoplasm arising within the heterotopic pancreatic tissue which was found incidentally in the jejunum during surgery for bowel obstruction. A 54-year-old female patient was admitted to our hospital due to sudden abdominal pain. In preoperative findings, we diagnosed bowel obstruction and performed surgery. Intra-operative findings showed adhesive intestinal obstruction, we performed synechiotomy for adhesion release. During surgery, when searching the small intestine, we coincidentally found a tumor in the jejunum and partial resected the jejunum. Pathological examination revealed a 1.2 cm × 1.0 cm × 1.0 cm white yellow nodule with cystic spaces. Histological examination demonstrated heterotopic pancreatic tissue consisting of well-formed lobules of pancreatic acini and cystically dilated ducts containing intraductal papillary neoplasm. Moreover, in immunohistochemical staining, MUC5AC was diffusely expressed, but not MUC1, MUC2 and MUC6.
- Intestinal obstruction as a cause of death in the mentally disabled. [Journal Article]
- FSForensic Sci Med Pathol 2018 Aug 04
- Two cases of intestinal obstruction in the mentally disabled are reported. The first case concerns 61-year-old oligophrenic woman who resided in a nursing home, where she was found hypotensive and un...
Two cases of intestinal obstruction in the mentally disabled are reported. The first case concerns 61-year-old oligophrenic woman who resided in a nursing home, where she was found hypotensive and unresponsive. Upon opening the peritoneal cavity at autopsy, extremely dilated (measuring on average 12 cm in diameter) loops of the colon emerged- they compressed the small intestine and other intraperitoneal organs, lifting both hemidiaphragms deep into the pleural cavity. Lodged firmly into the rectum, a partly disintegrated sanitary pad was found. In the second case, young man with Down syndrome was found dead in his room in a nursing facility. At autopsy, a massively dilated stomach and intestinal loops emerged, interposing one of the loops between the liver and right hemidiaphragm (pushing it to the 3rd intercostal space). This was caused by a volvulus - the cecum, the entire ascending colon and hepatic flexure were gangrenous, dilated (the maximum diameter was 15 cm) and twisted in a full circle around the mesenteric attachment. There were no signs of colon perforation. In both cases, intellectual disability was at the core of poor communication and delayed medical treatment, which led to a fatal outcome. Caregivers must be trained to recognize distress in the mentally disabled, especially since the symptoms and signs of gastrointestinal diseases may be subtle, or at least less recognizable. By performing careful physical examination medical staff should search more cautiously for these signs. Any suspicion of mistreatment or neglect of the mentally impaired requires a medico-legal investigation and autopsy.
- Expression of RAD21 immunoreactivity in myenteric neurons of the human and mouse small intestine. [Journal Article]
- NMNeurogastroenterol Motil 2018 Aug 01; :e13429
- CONCLUSIONS: Our data showing cytoplasmic RAD21 expression in enteric neurons provide a basis toward understanding how mutations of this gene may contribute to altered neuronal function/survival thus leading to gut-motor abnormalities.
- Lethal small intestinal herniation through a congenital mesenteric defect. [Journal Article]
- FSForensic Sci Med Pathol 2018 Aug 01
- A three-year-old boy with mild symptoms of an upper respiratory tract infection and recent onset vomiting collapsed at home. Resuscitative attempts in hospital were eventually unsuccessful. At autops...
A three-year-old boy with mild symptoms of an upper respiratory tract infection and recent onset vomiting collapsed at home. Resuscitative attempts in hospital were eventually unsuccessful. At autopsy an obstruction of the small intestine, with ischemia, was identified. It had been caused by strangulation of the small intestine through a congenital mesenteric defect. Moderate mesenteric lymphadenopathy, with enlarged lymph nodes in the region of the herniated small intestine, were associated with positive testing for human metapneumovirus and enterovirus. Transmesenteric hernias are a very rare form of internal herniation that have the highest risk of strangulation. Unfortunately in children the presentation may be relatively nonspecific with a precipitate decline towards the end. In the reported case it is possible that mesenteric lymphadenopathy may have contributed to intestinal entrapment by preventing spontaneous reduction.
- Genetic analysis is helpful for the diagnosis of small bowel ulceration. [Comment]
- WJWorld J Gastroenterol 2018 Jul 28; 24(28):3198-3200
- The widespread use of capsule endoscopy and balloon-assisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel dise...
The widespread use of capsule endoscopy and balloon-assisted endoscopy has provided easy access for detailed mucosal assessment of the small intestine. However, the diagnosis of rare small bowel diseases, such as cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), remains difficult because clinical and morphological features of these diseases are obscure even for gastroenterologists. In an issue of this journal in 2017, Hwang et al reviewed and summarized clinical and radiographic features of 20 patients with an established diagnosis of CMUSE. Recently, recessive mutations in the PLA2G4A and SLCO2A1 genes have been shown to cause small intestinal diseases. The small bowel ulcers in each disease mimic those in the other and furthermore those found in nonsteroidal anti-inflammatory drug-induced enteropathy. These recent and novel findings suggest that a clinical diagnosis exclusively based on the characteristics of small bowel lesions is possibly imprecise. Genetic analyses seem to be inevitable for the diagnosis of rare small bowel disorders such as CMUSE.
- Comparison of Feeding Jejunostomy via Gastric Tube Versus Jejunum After Esophageal Cancer Surgery. [Journal Article]
- ARAnticancer Res 2018; 38(8):4941-4945
- CONCLUSIONS: Feeding jejunostomy reconstruction via gastric tube appears to be a safe and useful procedure.
- Diagnosis and surgical management of congenital intestinal malrotation presenting with midgut volvulus in an adult: high index of suspicion (case report). [Case Reports]
- PAPan Afr Med J 2018; 29:154
- Congenital intestinal malrotation is a gastrointestinal anomaly whose most serious complication is midgut volvulus. More commonly, it presents as an incidental finding at laparotomy, or as a finding ...
Congenital intestinal malrotation is a gastrointestinal anomaly whose most serious complication is midgut volvulus. More commonly, it presents as an incidental finding at laparotomy, or as a finding on diagnostic imaging (Ultrasound, CT, Upper GI contrast study). Most patients are diagnosed in childhood. Laparoscopic Ladd's procedure is an accepted alternative to Laparotomy in children but has not been well-studied in adult. We present the case of this unexpected finding in a patient 38 years old, during emergency laparotomy for mechanical intestinal obstruction. Intra-operative findings included intestinal malrotation with small bowel volvulus. The terminal ilea and cecum were gangrenous on the basis of ischemic necrosis. A limited right hemycolectomy and primary end-to- end anastomosis was performed.
- Pneumatosis intestinalis in an adult patient with antral stenosis and midgut malrotation. [Journal Article]
- BCBMJ Case Rep 2018 Jul 19; 2018
- Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that un...
Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that underwent diagnostic surgery and finally diagnosed by midgut malrotation and antral stenosis. A 40-year-old man with 1-year history of dyspepsia and vomiting which was aggravated by 20 kg underweight since 3 months ago, despite medications was presented. His imaging examinations showed partial antral obstruction besides pneumoperitoneum and gas collection in the small intestine wall, which were in favour of PI. Samplings of the small intestine during laparotomy reported simple serosal cysts. Persistence of his symptoms forced him to recourse to another hospital and their new imaging revealed Ladds' band in addition to mentioned findings in previous studies; he underwent subtotal gastrectomy plus Ladds' band division by Braun gastrojejunostomy. PI could be a presentation of antral stenosis and midgut malrotation. PI with pneumoperitoneum needs surgical interventions. Considering that most of the midgut malrotation cases are diagnosed in the first year of life and it is very rare in adults, it may bethat these new findings are due to adhesion band formation after the first surgery in this case.
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- Clinical characteristics of lupus enteritis in Japanese patients: the large intestine-dominant type has features of intestinal pseudo-obstruction. [Journal Article]
- LLupus 2018; 27(10):1661-1669
- This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our ...
This study was performed to investigate the clinical characteristics of lupus enteritis in Japanese patients with systemic lupus erythematosus (SLE). A total of 481 patients with SLE admitted to our hospital between 2001 and 2015 were retrospectively reviewed. Diagnosis of lupus enteritis was based on the following three criteria: (1) abdominal symptoms, (2) diffuse long-segment bowel thickening and (3) a requirement for glucocorticoid therapy. Lupus enteritis was identified in 17 patients (3.5%) and there were two distinct types: small intestine-dominant and large intestine-dominant. Significant differences between the two types were noted with respect to the age, frequency of biopsy-proven lupus nephritis, frequency of rectal involvement, maximum bowel wall thickness, and requirement for steroid pulse therapy. Among patients with large intestine-dominant lupus enteritis, 60% had extra-intestinal symptoms (hydroureter, bladder wall thickening, and bile duct dilatation) that are known complications of intestinal pseudo-obstruction. Two patients with large intestine-dominant lupus enteritis developed intestinal pseudo-obstruction either before or after diagnosis of lupus enteritis. Five patients (29%) developed recurrence during a median observation period of 7.2 years (1.4-14.4 years). In conclusion, large intestine-dominant lupus enteritis resembles intestinal pseudo-obstruction and these two diseases may have a common pathogenesis.