Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.
Ampulla of Vater ; Biliary Tract ; Choledochal Cyst ; Duodenum ; Endoscopy, Digestive System ; Endosonography ; Enteritis ; Epithelium ; Female ; Humans ; Ileum ; Intestinal Diseases ; Intestine, Small ; Jejunum ; Rare Diseases ; SNARE Proteins

Inflammatory myofibroblastic tumors (IMTs) are solid neoplastic mesenchymal proliferations composed of myofibroblastic spindle cells admixed with inflammatory infiltrates. The documented sites in the gastrointestinal tract include the esophagus, small intestine, colon, appendix, rectum, pancreas, spleen, liver, and Meckel's diverticulum. Biliary IMTs are rare, and IMTs arising from the ampulla of Vater have not been reported previously. Herein we report the case of a 65-year-old woman with an extrahepatic biliary obstruction due to IMT of the ampulla of Vater, and a successful therapeutic approach using endoscopic ultrasonography and endoscopic papillectomy.
Aged ; Ampulla of Vater ; Appendix ; Colon ; Endosonography ; Esophagus ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Liver ; Meckel Diverticulum ; Myofibroblasts ; Pancreas ; Rectum ; Spleen

A giant mesenteric hemangioma with small intestinal involvement was rarely found as the cause of recurrent gastrointestinal bleeding. Enteric hemangiomas account for 7~10% of all benign tumors of the small intestine and the jejunum is the most common location. A 52-year-old man was admitted with recurrent melena for 4 years. Submucosal tumor like elevated lesion was found at just distal Ampulla of Vater. This lesion was seen woozing type bleeding. For evaluation of bleeding focus, mesenteric angiogram was done. A mesenteric angiogram revealed normal gastro-duodenal, superior and inferior mesenteric arteries. Whole abdominal computed tomography revealed low- density lesion at distal to duodenal 2nd portion. To prevent further recurrent bleeding, Whipple's operation was done. The histologic diagnosis of the lesion was a giant mesenteric hemangioma of mesentery with involvement of the mucosa of duodenum and pancreatic parenchyme.
Ampulla of Vater ; Diagnosis ; Duodenum* ; Gastrointestinal Hemorrhage ; Hemangioma* ; Hemorrhage ; Humans ; Intestine, Small ; Jejunum ; Melena ; Mesenteric Artery, Inferior ; Mesentery ; Middle Aged ; Mucous Membrane*

PURPOSE: Meckel's diverticulum, an omphalomesenteric remnant, is the most common congenital anomaly of the human gastrointestinal tract. The incidence of Meckel's diverticulum varies from 1% to 3% in the general population. However the incidence has not been previously reported in Korea. Therefore, we performed a prospective study to determine the incidence of Meckel's diverticulum in Korea. METHODS: During the 9 years from March 1992 to February 2000, cases of Meckel's diverticula were examined prospectively in 806 (530 males and 276 females) patients who underwent laparotomy due to various intra-abdomimal diseases at Gospel Hospital, Kosin University. We looked for the presence of Meckel's diverticulum by inspecting the small intestine throughout its entire length from the ileocecal junction to the Treitz ligament. We recorded the distance from the terminal ileum and the length of the Meckel's diverticulum. In principle, we did not excise the Meckel's diverticulum. RESULTS: Meckel's diverticula were detected in 17 patients (2.1%). 12 patients were male (2.3%) and 5 were female (1.8%). The male to female ratio was 1.3:1. Meckel's diverticula were located 40~110 (81.3+/-19.9) cm proximal to the ileocecal junction. The mean length of the Meckel's diverticulum was 3.5+/-1.8 cm (range, 1.5~7 cm). CONCLUSION: The incidence of Meckel's diverticulum in Korea was 2.1%, similar to western countries. Meckel's diverticulum was seen as frequently in males as in females.
Diverticulum ; Female ; Gastrointestinal Tract ; Humans ; Ileum ; Incidence* ; Intestine, Small ; Korea ; Laparotomy ; Ligaments ; Male ; Meckel Diverticulum* ; Prospective Studies

With the exception of Meckel's diverticulum, a small bowel diverticulum is an acquired disease due to high pressure in the small bowel lumen. The causes of the increase in the pressure of the lumen are usually a motility disorder of the small bowel, a luminal obstruction due to a tumor mass, or adhesion of the bowel loop. The prevalence of small bowel diverticulum increases with age, but the clinical manifestations are asymptomatic or nonspecific, such as vague abdominal pain, nausea, vomiting, indigestion, constipation, and diarrhea. Therefore, the disease is relatively difficult to diagnose until complications, such as perforation, obstruction, intussusception, or hemorrhage, develop. Because of its rarity, Physicians usually neglect to rule out small bowel diverticulitis. As the proportion of the elderly increases, the rate of small bowel diverticulitis will increase. If complications from small bowel diverticulitis develop in the elderly, mortality and morbidity may increase. To detect small bowel diverticulitis before complications develop, emergency physicians need to be aware of small bowel diverticulitis in elderly patients with abdominal pain of uncertain cause and need to evaluate it with multiple diagnostic tools. We report a case of perforation of a small bowel diverticulum due to intestinal obstruction caused by primary Non-Hodgkin's lymphoma of the terminal ileum.
Abdominal Pain ; Aged ; Constipation ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Emergencies ; Hemorrhage ; Humans ; Ileum* ; Intestinal Obstruction ; Intestine, Small ; Intussusception ; Lymphoma, Non-Hodgkin* ; Meckel Diverticulum ; Mortality ; Nausea ; Phenobarbital ; Prevalence ; Vomiting

BACKGROUND/AIMS: Gastrointestinal stromal tumors (GIST) in the small intestine are rare and can cause bleeding. The study investigated the clinical characteristics of GIST in the small intestine and to determine the factors related to gastrointestinal bleeding. METHODS: We retrospectively evaluated the clinical outcomes of 22 patients with small bowel GIST who were pathologically diagnosed at Gangneung Asan Hospital between March 1997 and August 2012. RESULTS: The median age was 63.5 (38-82) years. Nine patients (40.9%) had gastrointestinal bleeding, five patients (22.7%) had abdominal pain, two patients (9%) had palpable mass. The site of tumor was the duodenum in nine cases (40.9%), jejunum in 7 cases (31.8%), and ileum in six cases (27.3%). Most patients underwent small bowel resection or wedge resection but three patients underwent pancreaticoduodenectomy. Tumor size ranged from 1.6 to 19 cm (median 6.5 cm). The median mitotic rate was 2 (0-50)/50 high power fields (HPF). The median mitotic rate was 2 (0-50)/50 HPF. Five patients (25%) showed recurrence. Gender, aspirin or warfarin use, size and mitotic index of tumor, hospital stay, recurrence and survival were not significantly different between bleeding and non-bleeding group. Bleeding group showed older age, proximal location in small intestine and mucosal ulceration significantly. CONCLUSIONS: Small bowel GISTs with bleeding were marked by older age, mucosal ulceration and location of proximal small bowel (duodenum and jejunum) rather than distal small bowel (ileum).
Abdominal Pain ; Aspirin ; Duodenum ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Ileum ; Intestine, Small ; Jejunum ; Length of Stay ; Mitotic Index ; Pancreaticoduodenectomy ; Recurrence ; Retrospective Studies ; Ulcer ; Warfarin

This study was designed to investigate the effect of GABA and related substances on the spontaneous contraction of rat small intestine. The rats (Sprague-Dawley), weighing 200-250g, were sacrificed by cervical dislocation, and the small intestine was isolated. Longitudinal muscle strips from duodenum, jejunum and ileum were suspended in Biancani's isolated muscle chambers and myographied isometrically. GABA and muscimol, a GABA A receptor agonist relaxed the duodenum and jejunum significantly, but baclofen-induced relaxation in those muscle strips negligible. The effectiveness of GABA and muscimol in various regions were the greatest on duodenum, and greater on jejunum than on ileum The effect of GABA and muscimol was antagonized by bicuculline, a competitive GABA A receptor antagonist and picrotoxin, a noncompetitive GABA A receptor antagonist. Duodenal relaxation induced by GABA and muscimol was unaffected by hexamethonium, but was prevented by tetrodotoxin. These results suggest that GABA inhibit the contractility of smooth muscle with distinct regional difference of efficacy, and the site of inhibitory action is the GABA A receptor existing at the presynaptic membrane of postganglionic excitatory nerves.
Animals ; Bicuculline ; Dislocations ; Duodenum ; GABA-A Receptor Agonists ; GABA-A Receptor Antagonists ; gamma-Aminobutyric Acid* ; Hexamethonium ; Ileum ; Intestine, Small* ; Jejunum ; Membranes ; Muscimol ; Muscle, Smooth ; Picrotoxin ; Rats* ; Receptors, GABA-A ; Relaxation ; Tetrodotoxin

To study the metabolism of trans-resveratrol-3-O-glucoside (TRG) in vitro in rat tissues, the incubation with cell-free extracts from rat stomach, duodenum, jejunum, ileum and liver was performed, separately. After TRG was incubated with the tissue extracts at 37 degrees C for up to 90 min, the deglycosylation of TRG was (3.50 +/- 0.24) % for stomach, (65.7 +/- 5.94)% for duodenum, (83.5 +/- 6.43)% for jejunum, (77.6 +/- 6.26)% for ileum and (9.62 +/- 1.21)% for liver, separately. It was observed that the small intestine extracts were more active in deglycosylation of TRG than the liver extract, which suggested that the small intestine mucosa played an important role in deglycosylation of TRG. It was assumed that the deglycosylation of TRG was catalyzed by beta-glucosidase in small intestine mucosa.
Animals ; Duodenum ; metabolism ; Female ; Glucosides ; metabolism ; Ileum ; metabolism ; Intestinal Mucosa ; metabolism ; Intestine, Small ; metabolism ; Jejunum ; metabolism ; Liver ; metabolism ; Male ; Rats ; Rats, Wistar ; Stilbenes ; metabolism ; Stomach ; metabolism

AIMTo investigate the stereoselectivity in absorption of trans tramadol (trans T) in rat intestine.

METHODSThe duodenum, jejunum and ileum were separately perfusated in situ with trans T dissolved in Krebs-Ringer buffer. Trans T enantiomers in the perfusate were analyzed with a high performance capillary electrophoresis (HPCE) method.

RESULTSThe absorbed fractions of trans T enantiomers were similar among the different segments of the rat intestine. The absorbed fraction of (+)-trans T was lower than that of (-)-trans T when the concentration of trans T was not higher than 40 mumol.L-1. As the concentration of trans T increased, the absorbed fractions of trans T enantiomers were reduced and the difference in absorbed fractions between trans T enantiomers became not significant.

CONCLUSIONTrans T enantiomers can be absorbed in different parts of the rat intestine. The intestinal absorption of trans T was stereoselective, (-)-trans T being preferentially absorbed.

Analgesics, Opioid ; pharmacokinetics ; Animals ; Duodenum ; metabolism ; Female ; Ileum ; metabolism ; Intestinal Absorption ; Intestine, Small ; metabolism ; Jejunum ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Stereoisomerism ; Tramadol ; pharmacokinetics

Activity of the enteric nervous system (ENS) is controlled by the autonomic nerves under the normal physiological condition, even though ENS has been regarded to be independent from the central nervous system. However, the relation between myenteric neurons and vagus nerves has not been fully clarified. For the defining of topographical and functional relationship between these two nervous systems, we analyzed how many myenteric neurons are activated after electrical vagal stimulation in the rat. Bilateral cervical vagi were electrically stimulated (10 V, 5 msec, 40 Hz) for a duration of 30 minutes, and then each part of the small intestine was obtained. Fos, as a functional marker for neuronal activation, immunohistochemistry was used for the detection of vagally activated myenteric neurons. Total number of myenteric neurons was obtained using cuprolinic blue stained samples, and was calculated as 12,819+/-1,514, 14,261+/-1,452, 15,411+/-2,380 per unit area (1 cm2) in duodenum, jejunum and ileum, respectively. Fos-positive myenteric neurons were scarcely observed in the normal control group. After the electrical vagal stimulation, Fos-immunoreactive (IR) neurons were detected as 31+/-17%, 17+/-9%, 16+/-10% of total number of myenteric neurons in duodenum, jejunum and ileum, respectively. These data demonstrate that only some (16~31%) of myenteric neurons are regulated by vagal efferent input, and the duodenum receives much more vagal input functionally than other distal regions. Furthermore, these findings can be applied to trials defining the functional circuit of the myenteric nervous system linked to the vagus nerves, since Fos-positive nuclei can be easily double-labeled with various neurotransmitters existing in the myenteric neurons.
Animals ; Autonomic Pathways ; Central Nervous System ; Duodenum ; Enteric Nervous System ; Ileum ; Immunohistochemistry ; Intestine, Small* ; Jejunum ; Myenteric Plexus* ; Nervous System ; Neurons* ; Neurotransmitter Agents ; Rats* ; Vagus Nerve