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Background: Ultrasound in avian patients is useful for identifying abnormalities within the coelomic cavity. A correlation between sonographic evaluation of jejunal thickness and body weight has been reported in mammals, but not the chicken (Gallus gallus domesticus). The purpose of this study was to prospectively assess the normal values of jejunal thickness in the chicken and compare this to body weight. Methods: Coelomic ultrasound was performed on 89 clinically normal chickens with no history or signs of gastrointestinal disease. Two populations of hens (commercial layers and backyard purebred and mixed-breed hens) were used. Breed and ultrasonographically measured jejunal wall thickness were recorded in all hens. Body weight was recorded in 45 of the hens (mixed-breed and purebred backyard chickens). Results and conclusion: There was no statistically significant correlation between body weight and ultrasonographically measured jejunal wall thickness. The mean thickness of the jejunal wall in healthy chickens was 2.1 ± 0.08 mm. Further studies comparing jejunal thickness in chickens with and without signs of GI disease would be useful.

Video Video 1 EGD, which showed obstructed distal flange of the gastrojejunal lumen-apposing metal stent (LAMS) by the contralateral jejunal wall. Two double-pigtail stents were placed across the LAMS to relieve the obstruction.

The laparotomy surgical procedure allows for the identification and correction of intestinal lesions associated with acute abdomen in horses. The clinician relies on various laparotomy techniques to diagnose and treat this syndrome, and to date, the postsurgical effects of these techniques have not been clarified. The aim of this study was to evaluate the effects of jejunal manipulation during three laparotomy techniques through physical and clinical parameters and echography. Fifteen healthy horses were randomly assigned to three groups: animals in G1 (n = 5) were subjected to an exploratory laparotomy, animals in G2 (n = 5) to a laparotomy with an enterotomy, and animals in G3 (n = 5) to a laparotomy with an enterectomy. Degree of pain, jejunal wall thickness, and clinical parameters were evaluated before and after surgery. Horses in G3 had higher heart rates, respiratory frequency, degree of pain, and jejunal wall thickness compared with G1. Clinical variables during the postsurgical period were compared among the laparotomy techniques, and higher values of erythrocytes, leucocytes, neutrophils, and proteins were found in horses belonging to G3 compared to those in G1. Intestinal manipulation during the surgical procedure altered the physical and clinical parameters, as well as the results of the echography evaluation, with more significant effects from laparotomy with enterectomy. In the postsurgical period, the heart rate of horses in G3 was higher (P = .02) than the values obtained in G1 and G2. Upon the evaluation of degree of pain, statistically significant differences (P = .04) were identified between horses in G1 versus G3. G3 animals presented a higher degree of pain. Regarding the erythrocytes (L/L), higher values were measured in G3 (P = .001) in comparison with G1 and G2. These results suggest that meticulous tissue handling is essential to minimize intestinal trauma and inflammation.

Aim: We developed a platform to painlessly deliver by mouth drugs that cannot be administered orally. This ingestible, capsule-like device deploys inside the small intestine and injects into its wall a biotherapeutic payload sealed inside a dissolvable microneedle. Results: We tested the delivery and examined the pharmacokinetics of several biopharmaceuticals, including recombinant human insulin, human immunoglobulin G, octreotide and teriparatide in anesthetized and conscious pigs and dogs. The bioavailability of these compounds delivered by the capsules was similar to that after subcutaneous delivery. For instance, the mean peak serum concentration of insulin after capsule delivery in 8 anesthetized pigs was 517 ± 109 pmol/l, versus 342 ± 50 pmol/l after subcutaneous injection in 9 other, sham-operated pigs. In vivo safety studies were conducted in 23 conscious beagles, which received between 2 and 18 capsules. All devices transited painlessly through the GI tract and were excreted within 96 h. The mean gastric residence time (GRT) of the capsules was 93 min, and subsequent intestinal deployment time (IDT) was 28 minutes. A pilot study in 10 fasting and 10 postprandial human volunteers examined the tolerability and safety of the capsule devoid of microneedle and payload. The mean GRT of the capsule was 217 ± 36 min in the postprandial and 100 ± 79 min in the fasting state, while the IDT were closely similar (100 ± 40 vs. 97 ± 30 min) in both groups. No subject perceived the device transit, deployment or excretion. Conclusions: The studies completed thus far in anesthetized or conscious animals have confirmed that this ingestible device can deliver drugs in sufficient amounts and rate to obtain therapeutic blood concentrations. Its oral administration was well tolerated by the human subjects. First-in-man studies are being planned to test the ability of this ingestible device to deliver pharmaceuticals in healthy human volunteers and patients. Disclosure R. Ruffy: Employee; Self; RANI Therapeutics. M. Hashim: Board Member; Self; Rani Therapeutics. Employee; Self; InCube Labs LLC. A. Dhalla: Employee; Self; Rani Therapeutics, LLC. R. Korupolu: None. P. Karamchedu: Employee; Self; Incube labaoratories, Rani Therapeutics. B. Syed: None. R. Abdul Wahab: Employee; Self; Rani Therapeutics. S. Beraki: Employee; Self; InCube Laboratories, RANI Therapeutics. A. Yamaguchi: Employee; Self; Rani Therapeutics. L. Fusaro: None. A. Garapaty: None. A. Dasari: None. L. Fung: Employee; Self; Rani Therapeutics. Z.T. Al-Shamsie: Employee; Spouse/Partner; Google. Employee; Self; Rani Therapeutics, InCube Labs LLC. A. Toledo: Employee; Self; InCube Labs LLC, Rani Therapeutics. V. Salgotra: Employee; Self; Incubelabs, Rani Therapeutics. S. Sharma: None. E. Liang: None. D. Gratta: Employee; Self; InCube Labs, Rani Theraputics. M. Imran: Other Relationship; Self; InCube Labs, InCube Ventures, Rani Therapeutics.

Summary Background Refractory external pancreatic fistula (REPF) is a rare but troublesome event. Fistulojejunostomy with direct suture of the fistula wall to jejunal wall has been demonstrated as a solution. However, it is sometimes technically difficult and some cases of failure were reported. Methods An embedding fistulojejunostomy (EFJ) was designed. The fistula tract was detached from the abdominal wall and impactedly inserted into a Roux-en-Y jejunal lumen without direct suture of the fistula wall to the jejunal wall. Five patients with REPF for > 3 months underwent this procedure in the past 10 years. The preoperatively-placed drainage tubes temporarily exteriorized the pancreatic fluid for 30 days. Results All fistulojejunostomy procedures were accomplished within 15 minutes. Four patients had uneventful recovery with a postoperative hospital stay ≤ 10 days. One patient had wound infection and needed hospitalization for 23 days. Except for one patient who required pancreatic enzyme supplements for 8 months, no other patient had pancreatic exocrine insufficiency. After follow up for 12–124 months, no patient required pancreatic enzyme supplements, and no patient had recurrent fistula or diabetes mellitus. Conclusion EFJ makes fistulojejunostomy easier and more secure with a satisfactory early and long-term outcome. It may be a desirable technique for REPF.

Pancreaticoenterostomy remains one of the most stressful parts of pancreatoduodenectomy. We introduce herein a new convenient and secure invagination procedure for pancreaticojejunostomy. We performed our new procedure during pancreatoduodenectomy in 15 consecutive patients (7 men, 8 women). The features of the procedure are as follows. First, it is performed using only four sutures. Second, the pancreas stump is invaginated into the jejunum, mainly by two sutures that penetrate the parenchyma and are continuously purse-string sutured to the jejunum. Third, all needle holes on the surface of the pancreas are covered with the jejunal wall. Eight patients were classified as showing no pancreatic fistula, and seven displayed a grade A fistula, according to the International Study Group on Pancreatic Fistula criteria. The median operating time for these 15 patients using the present procedure was about 60 min shorter than that for the previous nine patients who underwent duct-to-mucosa pancreaticogastrostomy in our hospital. The present method allows pancreaticojejunostomy to be performed swiftly and conveniently.

This article describes a case of small bowel perforation following ingestion of homemade chicken noodle soup. The acute abdominal emergency was due to chicken bone perforating through the jejunal wall. Preoperative and intraoperative images are provided. The following core competencies are addressed in this article: Medical knowledge, Patient care. Republished with permission from: Seamon MJ. Chicken noodle soup – - Comfort food? OPUS 12 Scientist 2009;3(1):19.

We have read the article Jejunogastric intussusception with internal herniation in the stomach by Khanna S, Kumar D, Khanna R, and Gupta SK [1] with interest. The authors have described a case, wherein a gangrenous jejunogastric intussusceptions (JGI) was reduced by gentle traction and about 30 cm of gangrenous bowel was subsequently resected. Presence of gangrene in the intussusceptions is an important consideration in deciding the operative procedure in individual patient and it also affects prognosis. Reduction of gangrenous JGI is difficult, often impossible, and even inadvisable. Rupture of the jejunal wall may occur at the site of necrotic areas [2] and cause peritoneal contamination.

The history of pancreaticojejunostomy in pancreaticoduodenectomy is described. Many types of operations have been devised in search of a more reliable method of anastomosis. To perform a safe and reliable pancreaticoenteric anastomosis it is necessary to understand the organ characteristics of the pancreas. We investigated factors required for a reliable pancreaticojejunostomy and devised a new surgical technique that meets those requirements. We introduce the theoretical substantiation and clinical usefulness of our new surgical technique while reviewing the history of pancreaticojejunostomy after pancreaticoduodenectomy. The unique aspect of our method is approximation of the pancreas stump and jejunal wall by six to eight interrupted sutures. It is speculated that too many sutures and tying too tight in the anastomosis may cause ischemia and necrosis of the pancreatic stump by restricting the tissue blood flow. Our method allows us not only to reduce the number of sutures, but also to avoid some of the complicated manipulations done in any other existing methods. The newly devised pancreaticojejunostomy is an excellent surgical technique with anastomotic failure seen in only two patients and no deaths out of 162 consecutive patients.

We herein describe the technical aspects of our method for end-to-side style pancreatojejunal anastomosis which we have been using when performing the Whipple procedure without any anastomotic complications. The method is simple and can be applied wherever an end-to-side pancreatojejunal anastomosis is required. It consists of three steps: First, a drainage tube is inserted into the pancreatic duct. Second, a direct anastomosis between the pancreatic duct and the mucosal layer of the jejunal loop is performed. The third step, which is the unique aspect of our method, is an approximation of the jejunal wall and the pancreatic stump by a one-layer suture technique that allows us not only to reduce the number of sutures but also to eliminate some of the sophisticated manipulations required by other methods. The results of our clinical experience have indicated that the present method may be comparable in terms of technical reliability to other existing methods.

Accidentally swallowed foreign objects are not uncommon but difficult to manage without complications. We describe the case of a 68 year old man who accidentally a swallowed sharp-pointed dental reamer that had reached deep in his jejunum. Double balloon enteroscopic retrieval was performed with polypectomy snare but the reamer was entangled in the wire loop of the snare and penetrated the jejunal wall. After releasing the reamer by pushing and pulling the snare for approximately 30 min, the reamer was retrieved with biopsy forceps. This is the first report of double balloon enteroscopic removal of a dental reamer. Furthermore, this is a novel case with regard to decision making in situations when sharp objects are swallowed.

The most difficult, time-consuming, and complication-prone step in pancreaticoduodenectomy is the pancreaticojejunostomy step. The largest disadvantage of this kind of anastomosis is the high incidence of postoperative anastomotic leakage. Once pancreatic leakage occurs, the patient death rate can be very high. The aim of this study was to design a pancreaticojejunostomy procedure using anastomotic chains, which results in the cut end of the jejunum being attached to the pancreatic stump without suturing, and to evaluate the safety and efficacy of this procedure in domestic pigs. The pancreaticojejunal anastomotic chains had the following structures: the chains consisted of two braceletlike chains made of titanium, named chain A and chain B. The function of chain A was to attach the free jejunal end onto the pancreatic stump, whereas the function of chain B was to tighten the contact between the jejunal wall and the surface of the pancreatic stump to eliminate gaps between the two structures and ensure tightness that is sufficient to guarantee that there is no leakage of jejunal fluid or pancreatic juice. The following procedure was used to assess the safety and efficacy of the procedure: pancreaticojejunostomies were performed on ten domestic pigs using anastomotic chains. The time required to complete the pancreaticojejunal anastomoses, the pressure tolerance of the pancreaticojejunal anastomoses, the pig death rate, and the histopathological examinations of the pancreaticojejunostomy tissues were recorded. The average time required to complete the pancreaticojejunal anastomosis procedure was 13+/-2 min. The observed tolerance pressure of the pancreaticojejunal anastomoses was more than 90 mm H(2)O. All ten domestic pigs that underwent operations were still alive four weeks after the operations. Pathological examinations showed that the anastomotic surfaces were completely healed, and the pancreatic cutting surfaces were primarily epithelialized. In conclusion, the use of anastomotic chains in pancreaticojejunostomy procedures results in a decrease in or elimination of pancreatic leakage. In addition, the procedure is simple to perform, is not time-intensive, and appears to be safe in a pig model.

Dieulafoy type ulcer was originally reported as a kind of characteristic ulcers of stomach which can cause massive bleeding. A recent experience with massive jejunal bleeding from tiny ulcer of Dieulafoy type as well as some device identifying the bleeding site intraoperatively is described.A 39-year-old woman was admitted because of abdominal pain and large amount of melena. Angiography revealed massive bleeding from a peripheral region of the first branch of the jejunal temporarily artery into jejunal lumen. To control the massive bleeding, transarterial embolization (TAE) using metallic coil was performed. Since precise bleeding point was accurately identified during operation by means of radiographic device using metallic coil for TAE as a landmark, only small resection of the jejunal wall was performed. Pathological examination revealed characteristic features of Dieulafoy type ulcer such as small shallow ulcer, rupture of persistent caliber artery, and middle-sized serpentine arteries in the submucosal layer.

The purpose of this study was to validate intestinal microdialysis as a detector of intestinal ischaemia using measurements of glucose, lactate and glycerol from the jejunal wall.Based on a previous study, the cut-off levels for the presence of regional intestinal ischaemia were defined for microdialysis glucose, lactate, glycerol and the lactate/glucose ratio. Changes of 60% in the metabolic compounds measured after 100 min were defined as the cut-off level for ischaemia. The cut-off levels were tested in a randomized, single-blinded study. Ten pigs were used; occlusive ischaemia was performed by clamping a segment of the mesentery to the intestine. Four catheters were inserted per pig, two in the ischaemic segment and two in the non-ischaemic segment. All catheters were numbered, randomly allocated and inserted in the intestine by the staff at the institute and unknown to the investigators.One pig was excluded because the clamping was insufficient. Technical problems with the catheters were registered in 15% of cases owing to damage of the microdialysis membrane, dislocation, or incorrect placement. The predictive values of presence of ischaemia for glucose, lactate, glycerol and the lactate/glucose ratio were: 0.91, 1,0.85 and 0.92, respectively.Using a 60% cut-off limit measured after 100 min, intestinal ischaemia can be detected and excluded using intestinal microdialysis, but some technical problems remain that need further investigation.

The macroscopic and histological appearance of jejunal antimesenteric incisions approximated with two different absorbable suture materials (monofilament versus multifilament) and three closure techniques (appositional single layer, crushing single layer, and double layer) were compared in healthy dogs at 14 or 28 days, postoperatively. No significant differences between the two suture materials were observed for most of the macroscopic or histological variables. However, the monofilament suture material caused significantly more fibrous tissue reaction in the muscular layer of the jejunum than did the multifilament suture material. Of the three enterotomy closure techniques used in this study, the appositional single-layer method proved to be the best. The double-layer closure method caused a significant decrease in the incisional circumference, the relative circumference, and volume of the jejunum, and a significant increase in jejunal wall thickness. Our findings suggest that canine jejunal enterotomy incisions can be closed using an appositional suture pattern with relatively rapidly absorbable monofilament suture material. The use of double-layer suture patterns for closure of jejunal enterotomy incisions should be avoided because the size of the intestinal lumen may be reduced.

After laparoscopic adjustable gastric banding (LAGB), early recognition and treatment of uncommon complications are important. A 36-year-old man who had undergone LAGB presented at our clinic with weight gain of 14 kg during the prior 6 months. During investigation, detachment of the connecting tube from the port and migration of this tube into the jejunal wall were found. The detached port was replaced with a new port, and laparoscopically-assisted jejunorraphy was performed.

Eighty-two percutaneous enterostomies were performed at three institutions with the Cope suture anchor for stomach or jejunal wall stabilization during alimentation tube placement. The anchors were successfully placed into the stomach or jejunum in 81 cases. Early in the series, two anchors were misplaced, with no sequelae. There were no other complications at the time of placement. In all successful cases, excellent immobilization of the viscus was achieved. Tract dilation and tube placement were easily performed, and there were no guidewire or tube dislodgments.

The authors describe a case of biliary atresia with ectopic proliferation of the bile ducts in the jejunal wall. This case supports a possible causal association between a defect in biliary ductal embryogenesis and the pathogenesis of certain cases of biliary atresia.

Os animais foram submetidos a procedimento operatório sob anestesia geral para a produção de dois ferimentos padronizados em colo não preparado, usando instrumento desenvolvido para esta finalidade. O primeiro ferimento foi produzido a 2 cm do ceco e o segundo 20 cm eqüidistante deste, no sentido caudal. Estes ferimentos foram reparados obedecendo a resultado de sorteio que determinou a técnica a ser usada, se com o lado seroso da parede de jejuno ou por sutura primária. Nas duas técnicas foram usados pontos separados de fio monofilamentar de poliglecaprone 4-0 , sendo que o animal serviu de controle para si mesmo. Realizou-se eutanásia no 7º P.O. para os animais do sub-grupo A e no 30º P.O. para os animais do sub-grupo B para avaliação macroscópica e microscópica. O experimento demonstrou que é viável o uso do lado seroso da parede de jejuno para reparar ferimento em colo não preparado e apresentou resultados com tendências a serem superiores aos da sutura primária , não dual de Maringá The present research aimed to compare the repair of colon wound using both the jejunal wall and the primary suture . Thirty young rabbits white New Zeland were used, weighing about 3,2 Kg. and were born and raised at the University of Maringá's Experimental farm. The animals were deeply anaesthetized and then submited to a surgery during wich two similar wounds were made in unprepared colon . An instrument created for this purpose was used. The first wound was made 2 cm away from the ceco , and the second one was made 20 cm from the first wound in the caudal location. The wounds were repaired using either the jejunal serosal wall or the primary suture. In both techniques were used separated stitches , made by monofilament poliglecaprone 4-0. The animal was used to control itself. The animals were submited to euthanasia either in the 7th or in 30th day after surgery, at random.Then a macroscopic and microscopic study was made. This research has come to prove that the use of jejunal's serosal wall is available. This techinique has shown better results than the primary suture : neither were there oclusion nor fistula. Besaid , the histologic studies have proved the existence of neomucous epithelium on the 7th day after surgery.

The proximal jejunum, containing four separate amyloid tumors, was resected from a chronically constipated 71-year-old male exhibiting IgG lambda monoclonal gammopathy. Amyloid was deposited in the jejunal wall, mesentery and regional lymph nodes, but was not seen in gastric and rectal biopsy samples. Two years after surgery, the patient is well, but the monoclonal gammopathy persists.

1. 1. Neither current operative technics nor primary duodenal drainage completely answers the problem of the difficult duodenal stump. 2. 2. The perforated duodenal stump remains a major cause of mortality following gastric resection. 3. 3. Primary closure of the dog's duodenal stump using intact jejunal wall was uniformly successful in this study. 4. 4. The use of intact jejunal wall to seal the leaking duodenal stump was similarly effective. 5. 5. Unoperated duodenal perforation was lethal in a high percentage of our control animals. 6. 6. These observations suggest that this principle of closure may be of value in treating (1) the occasional difficult duodenal stump and (2) the perforated duodenal stump.

The case herein reported is quite uncommon in that it is rarely possible for the surgeon to have an opportunity to survey the site of the anastomosis while the patient is alive. The observations made at this operation clinically (by direct vision) prove two points: First, if Figure 1 is noted, it becomes quite evident that the stomach enlarged to accommodate normal meals postoperatively following subtotal gastric resection by the out-pouching of the jejunal wall and second, a circular bundle of muscle fibers at the true gastric stoma became hypertrophic and by rhythmic contraction and relaxation showed all the characteristics of a true sphincter. Many surgeons have discussed the absence or presence of a hypothetical sphincter but never before, as far as we know, has it been possible actually to demonstrate its existence. We are at present engaged in experimental work to prove by means of microscopic sections whether such a sphincter usually forms. Figures 2 and 3 show roentgenograms taken of this patient. Note the contraction and relaxation as shown on the barium column passing through the true gastric stoma. Note also the downpouching of the lower gastric wall (jejunum).

Macroscopic and microscopic studies of the portal tract in liver specimens obtained at autopsy from 5 noncorrectable biliary atresia patients were performed. The studies disclosed that major intrahepatic bile ducts had disappeared for variable distances in noncorrectable biliary atresia patients. However, the topographic relationship between intrahepatic bile ducts and blood vessels was just the same as in normal livers. On the basis of these studies, we preformed more extensive portal exploration in order to get closer to the obstructed ends of major intrahepatic bile ducts. Hepatic portal enterostomy was also modified to avoid obstruction of the explored area by the jejunal wall to be anastomosed The results of 7 patients who received the new operation were encouraging with complete loss of jaundice in 6 of 7 patients.

Intestinal sucrase activity, absent in the suckling rat, is evoked precociously by thyroid hormones. Since enterocytes migrate from crypt to villus tip, the question arises: at which level of the villus--crypt columns do the enterocytes respond with an increase of sucrase activity to thyroxin (T4)? Suckling rats (11 days old) were injected daily, subcutaneously, with T4 (2 micrograms/g BW/day). They were sacrificed 1, 2, and 3 days later. Sucrase activity was determined in homogenates of the entire jejunal wall and in serial homogenates of the villus-crypt columns using cryostat sectioning. Maximal increase of sucrase activity was seen after 3 days in the lower villus. Experiments were also done using rats adrenalectomized on day 10 to exclude the effect via precocious maturation of adrenal cortex. The same results were obtained. In conclusion, T4-evoked increase of sucrase activity occurs first in enterocytes that are nearest the villus-crypt junction.