Child ; Humans ; Infant ; Intestines ; abnormalities ; surgery ; Male

Female ; Gastrointestinal Tract ; surgery ; Humans ; Intestines ; surgery ; Male

Bariatric surgery is the most effective treatment for obesity and its comorbidities, but mechanisms of bariatric surgery remain unknown. In addition to volume restriction and malabsorption, gut hormones, bile acids, adipokines, intestinal microbiome and central nervous system may be the potential mechanisms.
Bariatric Surgery ; Gastrointestinal Hormones ; Humans ; Intestines ; microbiology ; Microbiota ; Obesity

Child, Preschool ; Foreign Bodies ; surgery ; Humans ; Intestines ; Laparoscopy ; methods

OBJECTIVETo investigate the influence of different pressures of CO2 pneumoperitioneum on pathomorphism and function of intestines following laparoscopic gastrectomy (LG).

METHODSForty-eight gastric cancer patients were prospectively enrolled in the study. Among them, 36 patients scheduled for elective LG were randomly assigned to low pressure group (LP), middle pressure (MP), and high pressure group (HP) with 12 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 8-10 mmhg in LP, 11-13 mmhg in MP, and 14-16 mmhg in HP. The control group was open gastrectomy group (OG) in 12 cases. The intestinal pathomorphism and level of plasma D-lactic acid before, during and after operation, and postoperative intestinal function of four groups were examined and compared.

RESULTSThere were no statistical differences in preoperative data among the four groups(all P>0.05). LG group was associated with a lower rate of surgical complications than OG (8.3% vs. 41.7%, P<0.05). No obvious damage of intestinal mucosa was found in OG group. Damage degree of intestinal mucosa after operation in LP, MP and HP groups was 0-1, 1-2, and 2-3 respectively. There was significant change in intestinal pathomorphism after operation in both HP and MP groups. The levels of D-lactic acid before operation were not significantly different among all the four groups, but increased significantly in each group after operation (all P<0.05). HP group had the highest level of plasma D-lactic acid and presented with delayed bowel sound return (4.5 d), time to first flatus (5.4 d), and intake (6.0 d) as compared to the other 3 groups (all P<0.05).

CONCLUSIONSLaparoscopic radical gastrectomy is safe and minimally invasive. Higher pneumoperitoneal pressure is harmful to the recovery of intestinal mucosa and function. Therefore the pneumoperitioneum pressure should be maintained as low as possible under clear visualization during operation.

When abdominal neoplasms originating from the pancreas or nearby organs locally involving the superior mesenteric artery (SMA), complete resection is still the only hope for cure. However, SMA resection and reconstruction is a complex surgical procedure associated with high postoperative morbidity and mortality. Intestinal autotransplantation has recently emerged in clinical practice as a treatment option for selected patients with neoplasms involving the SMA. The original procedure involved en bloc removal of a tumor together with the intestine, ex vivo resection and reconstruction of gastrointestinal tract by an intestinal autograft. To further refine this complex procedure, a modified method was developed in which a segmental bowel autograft is selected and harvested first during the initial stage of the operation, and radical resection of the neoplasm is carried out thereafter. The modification would better protect a healthy bowel autograft from potential damage due to prolonged warm ischemia and allow the subsequent lengthy process of dissection to be performed in an unrushed manner. Furthermore, this alteration would better adhere to the general principles of minimal tumor manipulation during operation and potentially decrease the risks of tumor implantation during in vitro organ perfusion. Although intestinal autotransplantation has expanded eligibility for resection of otherwise unresectable lesions involving the SMA, its operative complexity, high risks, and post-operative complications largely limit its clinical applications.
Humans ; Intestines ; Mesenteric Artery, Superior/surgery* ; Pancreatic Neoplasms ; Transplantation, Autologous

The superior mesenteric artery (SMA) is one of the visceral branches of the abdominal aorta. It has multiple branches to supply blood and nutrition to the intestinal segment, and these form an anastomosis with each other. SMA injuries are usually classified as major visceral artery injuries, and have an incidence of <1%. The clinical manifestations of patients with SMA injuries include intra-abdominal bleeding and peritoneal irritation. The compromised blood supply can lead to intestinal ischemia and perforation. These injuries are often not diagnosed in time and have significant mortality rates of 25%‍-‍68% due to the lack of specific features (Maithel et al., 2020). Not only that, but patients with less severe trauma or no visible damage on initial examination may still have clinically significant intra-abdominal injuries (Nishijima et al., 2012). Emergency departments often encounter multiple cases that require urgent diagnosis and treatment (Li et al., 2021; Zhang et al., 2021; Zhou et al., 2021), and therefore, it is imperative to diagnose and manage these rare injuries expeditiously.
Humans ; Mesenteric Artery, Superior/surgery* ; Abdominal Injuries/diagnosis* ; Intestines

Intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine is a very rare long-term complication after complete urethral reconstruction of the bladder. The probability of its occurrence is low. However, in recent years, it has been proved to be objective, but there is rare literature about its diagnosis and treatment methods. This article describes a case of cystectomy and Studer ileal conduit in Peking University Third Hospital due to bladder cancer. After 9 years, he was discovered with a primary intestinal-derived adenocarcinoma in the bladder substitutes by the intestine. A male patient, 64 years old, with persistent abdominal pain in the lower abdomen for two weeks. There was carrion-like material in the urine, no gross hematuria, no urinary frequency, urgency, dysuria, and no abnormalities in the examination. Urinary CT showed intestinal metaplasia in the bladder. There was 5.7 cm×2.4 cm×4.8 cm irregular tissue shadow, and ureteroscopy found, on the right side, the bladder tumor whose diameter was 4-5 cm. We performed open lumpectomy and repaired the bladder, and postoperative pathology showed middle-high differentiated adenocarcinoma. The patient recovered well after the surgery. This article reviewed the similar intestinal primary intestine-derived adenocarcinoma of the bladder substituted by the intestine and found that it had the highest incidence in the elderly male population. The pathogenetic factor was most closely related to the smoking. If the patients developed hematuria, carrion-like substances in the urine, and bladder irritation, the possibility of tumor development should be suspected. Then the patients should promptly take the tests, such as urine exfoliation cytology, urine FISH, urinary system B-ultrasound, cystoscopy, etc. The microscope was the most direct observation of the lesion site examination. If the pathological tumor occurred ,and then the tumor should be immediately removed, and a new urinary diversion was needed to avoid further progress of the tumor. And postoperative smoking was strictly prohibited, also the patients should strictly control their eating habits and regularly adhere to the follow-up at least 4 years or more, but the lifelong follow-up and review was a must. The mechanism of intestinal primary intestinederived adenocarcinoma of the bladder substituted by the intestine is still unclear. Studies suggest that it may be related to N-nitroso compounds, smoking, and postoperative inflammatory reactions.
Adenocarcinoma/surgery* ; Cystectomy ; Humans ; Intestines ; Male ; Middle Aged ; Urinary Bladder Neoplasms/surgery* ; Urinary Diversion

Blunt bowel injury (BBI) is relatively rare but life-threatening when delayed in surgical repair or anastomosis. Providing enteral nutrition (EN) in BBI patients with open abdomen after damage control surgery is challenging, especially for those with discontinuity of the bowel. Here, we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3. Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed. Postoperatively, the patient was transferred to our trauma center for septic shock and hyperbilirubinemia. Following salvage resuscitation, damage control laparotomy with open abdomen was performed for abdominal sepsis, and a temporary double enterostomy (TDE) was created where the anastomosis was ruptured. Given the TDE and high risk of malnutrition, multiple portions EN were performed, including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube. Besides, chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube. Hyperbilirubinemia was alleviated with the increase in chyme reinfusion. After 6 months of home EN and chyme reinfusion, the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet. For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen, the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.
Male ; Humans ; Middle Aged ; Enteral Nutrition ; Intestines/surgery* ; Intestinal Diseases ; Abdomen/surgery* ; Anastomosis, Surgical ; Abdominal Injuries/surgery*

Incretin hormones are produced by enteroendocrine cells (EECs) in the intestine in response to ingested nutrient stimuli. The incretin effect is defined as the difference in the insulin secretory response between the oral glucose tolerance test and an isoglycemic intravenous glucose infusion study. The pathophysiology of the decreased incretin effect has been studied as decreased incretin sensitivity and/or β-cell dysfunction per se. Interestingly, robust increases in endogenous incretin secretion have been observed in many types of metabolic/bariatric surgery. Therefore, metabolic/bariatric surgery has been extensively studied for incretin physiology, not only the hormones themselves but also alterations in EECs distribution and genetic expression levels of gut hormones. These efforts have given us an enormous understanding of incretin biology from synthesis to in vivo behavior. Further innovative studies are needed to determine the mechanisms and targets of incretin hormones.
Bariatric Surgery ; Biology ; Enteroendocrine Cells ; European Union ; Glucose ; Glucose Tolerance Test ; Incretins* ; Insulin ; Intestines* ; Physiology