No abstract available
Adult ; Crohn Disease/*diagnosis/radiography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Intestine, Small/pathology/radiography ; Tomography, X-Ray Computed

A jejunal ectopic pancreas, where pancreatic tissue is found outside of the usual anatomical location, is a rare submucosal tumor that may cause obscure gastrointestinal (GI) bleeding. After initial negative endoscopic evaluation of the obscure GI bleeding, including colonoscopy and/or upper endoscopy, it is reasonable to proceed with further evaluation of the small bowel. Diagnostic options for the evaluation of the small bowel may include capsule endoscopy, push enteroscopy, or barium contrast small bowel studies. Here, we report a case of obscure GI bleeding caused by a jejunal ectopic pancreas, diagnosed through capsule endoscopy and barium contrast small bowel studies, which was treated successfully with single incision access laparoscopy.
Aged ; Capsule Endoscopy ; Diagnosis, Differential ; Female ; Gastrointestinal Hemorrhage/*diagnosis/surgery ; Humans ; Intestine, Small/radiography ; Jejunum/pathology ; Pancreas/pathology

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.
Child ; Diagnosis, Differential ; Female ; Gangrene ; Hernia/complications/*diagnosis/radiography ; Humans ; Ileal Diseases/*diagnosis/radiography/surgery ; Intestinal Obstruction/etiology/radiography ; Intestine, Small/*pathology/surgery ; Mesentery ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The role of double balloon enteroscopy (DBE) is still evolving. The aim of this study was to compare the diagnostic yield of DBE with that of small bowel series (SBS). METHODS: We enrolled patients with suspected small bowel disease consecutively, and performed both DBE and SBS in all patients. RESULTS: Eighteen patients (M:F=12:6, 14-82 years) were included. Indications for small bowel evaluation were obscure gastrointestinal bleeding (10), abdominal pain (5), diarrhea (2) and abnormal CT finding (1). Of 10 obscure gastrointestinal bleeding patients, 6 showed the same findings in both studies. However, 4 showed negative findings in SBS while DBE detected erosions or ulcerations. Of 5 abdominal pain patients, 3 showed the same results in both studies. However, 2 demonstrated different results. One was suspected of early Crohn's disease in SBS, but proved to be normal in DBE, and the other was suspected of malignancy in SBS but was suspected of benign ulcers in DBE. Of 2 chronic diarrhea patients, one was diagnosed as Crohn's disease in both studies. The other was suspected of tuberculosis in SBS but diagnosed as lymphangiectasia by DBE with biopsy. One patient with jejunal wall thickening in CT proved to be normal in both DBE and SBS. There were no serious complications associated with DBE and SBS. CONCLUSIONS: DBE is better than SBS in terms of diagnostic accuracy. DBE may become an important method for the evaluation of small bowel diseases.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Endoscopes, Gastrointestinal ; *Endoscopy, Gastrointestinal ; Female ; Humans ; Intestinal Diseases/*diagnosis/radiography ; *Intestine, Small/pathology/radiography ; Male ; Middle Aged

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin B and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin B therapy.
Case Report ; Female ; Human ; Intestinal Diseases/therapy ; Intestinal Diseases/radiography ; Intestinal Diseases/pathology* ; Intestinal Diseases/microbiology ; Intestine, Small/radiography ; Intestine, Small/pathology ; Liver Diseases/therapy ; Liver Diseases/radiography ; Liver Diseases/pathology* ; Liver Diseases/microbiology ; Middle Age ; Mucormycosis/therapy ; Mucormycosis/radiography ; Mucormycosis/pathology* ; Mucormycosis/microbiology ; Tomography Scanners, X-Ray Computed

Anisakiasis usually occurs in the stomach and can easily be diagnosed by digestive tract endoscopy as opposed to enteric anisakiasis which is very rare and difficult to be diagnosed definitively. The most important and useful tool in diagnosing enteric anisakiasis is obtaining an accurate patient history of having eaten raw fish before the onset of symptoms. We report a case of small bowel obstruction caused by acute invasive enteric anisakiasis. A 60-year-old woman visited the emergency room suffering from sudden abdominal pain. She had eaten raw fish 1 day before the onset of symptom. Radiologic studies showed small bowel obstruction. However, no definitive cause could be found. An emergency laparotomy revealed edematous and dilated proximal jejunum and a focal stenosis of the distal jejunum. Segmental resection of the jejunum was performed, and histopathological examination revealed enteric anisakiasis. The patient was discharged on the 7th day after surgery following an uneventful course of recovery.
Acute Disease ; Animals ; Anisakiasis/complications/*diagnosis/surgery ; Anisakis/isolation & purification ; Diagnosis, Differential ; Female ; Humans ; Intestinal Obstruction/*diagnosis/etiology/radiography ; Intestine, Small/pathology ; Middle Aged ; Tomography, X-Ray Computed

Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.
Angiography ; Capsule Endoscopy ; Enteritis/complications/*diagnosis/radiography ; Gastrointestinal Hemorrhage/etiology ; Humans ; Intestine, Small/pathology ; Male ; Tomography, X-Ray Computed ; Young Adult

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.
Adult ; Antibodies, Anti-Idiotypic/immunology ; Autoimmune Diseases/*diagnosis/immunology ; Humans ; Immunoglobulin G/*immunology ; Intestine, Small/*pathology/radiography ; Male ; Multidetector Computed Tomography/*methods ; Sclerosis/diagnosis/immunology

Intestinal malrotation is a developmental anomaly resulting from embryologic failure of fixation and rotation of the gut and predisposed to midgut vovulus and small bowel obstruction. Although various forms of malrotation anomalies in the gut can occur, nonrotation of prearterial segment with the initial symptomatic presentation at advanced age has been rarely reported. Here, we report a case of nonrotation of the prearterial segment of the midgut presenting with duodenal obstruction in a 60-year-old man. To our best knowledge, this is the first case reported about nonrotation of prearterial segment of the midgut in Korea.
Diagnosis, Differential ; Duodenal Obstruction/*diagnosis/surgery ; Humans ; Intestinal Volvulus/*diagnosis/radiography ; Intestine, Small/*abnormalities/embryology/pathology ; Male ; Middle Aged ; Rotation ; Tomography, X-Ray Computed

Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstuction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstuction who developed a pneumoperitoneum.
Adult ; Chronic Disease ; Humans ; Intestinal Pseudo-Obstruction/complications/*diagnosis/surgery ; Intestine, Small/pathology ; Male ; Pneumoperitoneum/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed