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Background: Neonatal surgical pathology presents highly technical complexity and few opportunities for training. Many of the neonatal surgical entities are not replicable in animal models. Realistic 3D models are a cost-effective and efficient alternative for training new generations of pediatric surgeons. Methods: We conceptualized, designed, and produced an anatomically realistic model for the open correction of jejunoileal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content validity questionnaires. Results: The model was validated by eleven experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 41 and 42 min, respectively. Six non-experts and one expert did not complete the procedure by the designed time (45 min) (p = 0.02). The mean score of face validity was 3.1 out of 4. Regarding construct validity, we found statistically significant differences between groups for the correct calculation of the section length of the antimesenteric border (Nixon's technique) (p < 0.01). Concerning content validity, the mean score was 3.3 out of 4 in the experts group and 3.4 out of 4 in the non-experts group. Conclusions: The present model is a realistic and low-cost valid option for training for open correction of jejunoileal atresia. Before drawing definitive conclusions, future studies with larger sample sizes and blinded validators are needed. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gallstone ileus is a rare complication of cholelithiasis, predominantly affecting older women and carrying a risk of high mortality and morbidity rates. While Rigler's triad radiologic features can aid in diagnosis, they are only present in a portion of patients. Surgery is a primary method for symptom relief, but discussions persist about the most suitable surgical strategy. This report details a case of gallstone ileus causing jejunal obstruction, successfully treated with laparoscopic-assisted enterolithotomy. [ABSTRACT FROM AUTHOR]

Background: Lupus mesenteric vasculitis (LMV) is a serious complication of systemic lupus erythematosus (SLE) that can lead to a range of gastrointestinal issues, such as intestinal bleeding, necrosis, and perforation. The optimal surgical approach for cases of intestinal necrosis in LMV remains a topic of debate. Case presentation: We present the first documented instance of jejunal necrosis in a 56-year-old woman undergoing SLE treatment. The patient presented with symptoms including abdominal distension, pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, rebound pain, and muscle tension. Following surgery and steroid therapy, the patient experienced successful recovery and was discharged from the hospital. Conclusions: Patients with jejunal necrosis due to SEL, during intraoperative exploration, surgical decisions should be made based on careful observation. In cases of extensive jejunal necrosis that cannot be preserved, it is advisable to resect the necrotic tissue as much as possible, with a recommended extended resection margin of 2–3 cm. [ABSTRACT FROM AUTHOR]

Introduction: Jejunogastric intussusception (JGI) is a rare but potentially lethal complication following gastrectomy or gastrojejunostomy surgeries. Diagnosis of this condition can be challenging due to its rarity and non-specific symptoms. This article presents a case report of a 60-year-old male with a history of trans mesocolic gastrojejunostomy who developed acute symptoms of JGI. Case report: The patient presented with acute epigastric pain, vomiting, and hematemesis. Physical examination and laboratory tests indicated dehydration, tachycardia, and leukocytosis. Computed tomography (CT) revealed intussuscepted loops within the stomach. Emergency laparotomy was performed, and the intussusception was manually reduced without the need for resection. The patient recovered well and was discharged five days post-surgery. Discussion: Retrograde jejunogastric intussusception is a rare complication, often occurring years after gastric surgery. It can be classified into acute and chronic forms, with the former presenting with intense pain and potential hematemesis. The condition can arise in different surgical contexts and even spontaneously. The cause of JGI remains unclear, but factors such as hyperacidity, abnormal motility, and increased intra-abdominal pressure have been implicated. Diagnosis can be made through endoscopy or alternative imaging modalities such as CT. Surgical intervention is the treatment of choice, with various options available based on intraoperative findings. Conclusion: Retrograde jejunogastric intussusception is challenging to diagnose and treat due to its rarity and lack of understanding of its causes. Imaging techniques and endoscopy play important roles in diagnosis, while surgery remains the primary treatment option. Vigilance is necessary among medical professionals to consider JGI in cases of acute abdominal pain and vomiting following gastric surgery, allowing for prompt diagnosis and intervention to prevent bowel necrosis. Further research is needed to establish optimal surgical strategies and evaluate recurrence rates. [ABSTRACT FROM AUTHOR]

A group of diseases resulting from the abnormal aggregation of amyloid fibrils, mainly in the extracellular spaces of tissues, is known collectively as amyloidosis. Clinical presentations of gastrointestinal (GI) amyloidosis are mainly GI bleeding, malabsorption, protein-losing enteropathy, and dysmotility. Here, we describe an 87-year-old woman presenting with acute onset of sharp, constant, and non-radiating epigastric pain that was accompanied by nausea or vomiting. After a thorough investigation, we finally found an isolated jejunojejunal intussusception by laparotomy. The pathological study revealed massive small bowel involvement by amyloidosis in immunostaining. To our knowledge, this is the first report of small intestinal obstruction resulting from intussusception due to intraluminal amyloid polypoid nodules, as the first presentation of light-chain amyloidosis. Amyloidosis should be considered in old patients with intraluminal masses of the proximal small bowel. [ABSTRACT FROM AUTHOR]

Hepaticojejunostomy is an essential component of many surgical procedures, including pancreaticoduodenectomy. Biliary leaks after HJS represent a major complication leading to relevant clinical problems: the postoperative mortality rate could reach 70% for surgical re-intervention, whereas endoscopic management is technically difficult due to the postoperative anatomy. Interventional Radiology plays a pivotal role for these patients. The case of a percutaneous biliary rendez-vous procedure performed to treat an HJA dehiscence after duodeno-cephalo-pancreasectomy is presented, which is successfully guaranteed to avoid a new surgical approach. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Peutz--Jeghers syndrome (PJS) is characterized by mucocutaneous pigmentation with multiple hamartomatous polyps of the gastrointestinal tract and/or a familial history with autosomal dominant inheritance pattern having incomplete penetrance, with some cases arising from spontaneous mutations. We present this case of a 12-year-old female who presented with jejunojejunal intussusception and on exploration revealed a polypoidal mass around 50 cm from duodenojejunal flexure acting as a lead point. A segmental jejunal resection with anastomosis was performed and histopathology confirmed a solitary Peutz--Jeghers (PJ) hamartomatous polyp. She neither had mucocutaneous pigmentation nor family history of PJS or any other polyps anywhere in the gut on further evaluation by endoscopies. A solitary PJ polyp in the jejunum is a rare entity, and to the best of our knowledge, only around 13 cases have been reported in world literature so far. Regular follow-up is essential in young children, so that future manifestations of the PJS are not missed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 79-year-old female with massive gastrointestinal bleeding from jejunal diverticular arterial haemorrhage. Topics discussed include the rarity of jejunal diverticular bleeding, the use of capsule endoscopy for investigation, and the consideration of surgical intervention for management.

Objectives: To describe a new sonographic feature of the C‐sign for prenatal diagnosis of jejunal atresia and evaluate its role in prenatal jejunal atresia, particularly preceding bowel dilatation and polyhydramnios. Methods: This was a retrospective study from a tertiary maternal hospital. Patients with prenatal sonographic examination and confirmed small bowel atresia postdelivery were included. All sonographic images were reviewed by two senior sonographers. Comparison of sonographic images between prenatal jejunal and ileal atresia using the C‐sign resembles the shape of the entire duodenum and other traditional sonographic features. The control group without bowel atresia was assessed for the presence of the C‐sign. Results: The C‐sign and combined bowel dilatation with polyhydramnios were more frequent in jejunal atresia than ileal atresia, but the C‐sign can be used to detect jejunal atresia earlier. The C‐sign can be more likely to diagnose jejunal atresia in persisting bowel dilatation and polyhydramnios. The C‐sign was not reported in any of the control fetuses. Conclusion: The C‐sign is a new sonographic feature that can be used to improve the prenatal accuracy and early detection of jejunal atresia. However, further prospective validation is needed. [ABSTRACT FROM AUTHOR]

Ectopic pancreas is typically asymptomatic anomaly that can present anywhere along the GI tract. It is often found incidentally and may become clinically evident when complicated by inflammation, bleeding, obstruction, or malignant transformation. Here, we present a case of ectopic pancreas who presented with gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]

A stallion zebra (Equus quagga boehmi) showed severe symptoms of acute colic. Clinical examination revealed a small intestinal mechanical obstruction. The surgical diagnosis was volvulus of 360° of the aboral part of the jejunum and the majority of the ileum. The ischemic segment was resectioned, and a side‐to‐side, hand‐sewn jejunocecostomy (JC) was performed. The recovery and postoperative periods passed without complications. The stallion zebra's 48‐month survival data recorded no colic incidence. To the authors' knowledge, this is the first report of a successful resection and JC in a zebra. This case report describes the successful management of a small intestinal obstruction through a technically demanding surgical procedure and provides details about the postoperative treatment tailored to the animal's nature. [ABSTRACT FROM AUTHOR]

A 6-month-old boy presented with features of intestinal obstruction. Laparotomy revealed Type IIIa jejunal atresia. The proximal and distal bowel loops were in continuity through multiple fistulae between the adjoining bowel loops. To the best of our knowledge, it is the first report of congenital Type IIIa intestinal atresia surviving beyond the neonatal age without surgery. [ABSTRACT FROM AUTHOR]

Objectives: A regimen of S-1 combined with oxaliplatin (SOX) has been widely used as the first-line regimen for advanced gastric cancer. To further improve the antitumor efficacy for gastric cancer patients with peritoneal metastasis, we added nab-paclitaxel to the established SOX regimen (NSOX). Nab-paclitaxel (nanoparticle albumin-bound paclitaxel) has effective transferability to tumor tissues and strong antitumor effects for peritoneal metastasis. We performed a phase 1 study of this regimen to determine the maximum tolerated dose (MTD) and the recommended dose (RD) in patients with gastric cancer with peritoneal metastasis. Methods: The NSOX regimen involved 21-day cycles with escalated doses of nab-paclitaxel (50 [level 1] to 80 [level 4] mg/m2 on days 1 and 8) and fixed doses of oxaliplatin (100 mg/m2 on day 1) and S-1 (80 mg/m2/day for 2 weeks). Results: Six patients with gastric cancer with peritoneal metastasis were enrolled. The MTD was determined to be dose level 2, as 2 of 3 patients experienced dose-limiting toxicities (DLTs), grade 4 non-hematological toxicities. One patient experienced acute myocardial infarction, and the other patient developed jejunal perforation. There were no treatment-related deaths. No patients experienced DLTs, so the RD was determined to be dose level 1. Conclusions: The NSOX regimen was shown to be a tolerable regimen and may be a promising triplet therapy for patients with gastric cancer with peritoneal metastasis. [ABSTRACT FROM AUTHOR]

Objectives: Aim of this study is to determine the incidence, etiological factors, demographic profile, mechanism of injury, anatomical distribution, diagnostic methods, management and outcome of hollow viscus perforation due to abdominal trauma. Methods: This is a prospective study, including patients with abdominal trauma leading to hollow viscus perforation admitted to Dr. Ram Manohar Lohia hospital New Delhi, over a period of 3 years (January 2016 to December 2018). A total of 105 patients with hollow viscus injury due to abdominal trauma, who underwent laparotomy in our institute, were reviewed for various parameters. Results: Out of 105 patients, 88.5% were male, and 11.5% were female. The mean age of patients was 31 ± 14.12 years. The most common site of injury was jejunum (34.2%), followed by ileum (20%). Blunt trauma abdomen was the most common mechanism of injury (46.9%), followed by a road traffic accident (28.2%). Free gas under the diaphragm on erect abdomen radiography was seen in 80% of cases, while preoperative CT Abdomen was done in 45% of cases. Treatment consisted of simple closure of the perforation (58.2%), resection and anastomosis (21.8%) and stoma formation (14.2%). The major complications were burst abdomen (5.32%), stitch abscess (17.8%), sepsis (14.7) and anastomotic leak (2.9%). The average hospital stay was 13±6 days. The overall mortality rate was 22.8%. Conclusion: Early recognition of intestinal injuries from abdominal trauma is very important due to its great life-threatening potential. Age of the patient, associated injuries, anatomical site and time of presentation are probably the main prognostic factors in terms of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Jenunoileal atresia is a congenital defect that causes small bowel obstruction in newborns. They are classified into 5 types and simple abdominal x-ray can aid in the diagnosis and with prompt resuscitation and surgery provides positive outcome. We present a 5-day-old newborn male baby was presented with features of intestinal obstruction since birth. Diagnosis of atresia of the small bowel was made through plain abdominal x-ray and was successfully operated. During the recovery, the baby developed surgical site infection which was managed promptly. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the morphological and morphometric parameters of the various parts of the intestinal tract in Bronze adult male turkey (Meleagris gallopavo). The current study was carried out on total number ten healthy males turkey which were weighted and the mean was 5307.42 ± 930.22 g. The current study observed that the small intestine was relatively long and more coiled. It composed of three portions includes duodenum, Jejunum and ileum. The duodenum was the first part formed-'U' shaped structure, while the Jejunum was the second and longest part was composed of the numerous loops. Whereas the ileum is the shortest and straight tube, it is extended from end of jejunum to the ileocecal junction. The large intestine consist of the short straight rectum and two ceca, they are appeared as blind ended sacs connected with distal end of the ileum and rectum. [ABSTRACT FROM AUTHOR]

The present study aimed to know the morphological description and histological structure by using light microscope of jejunum in Iraqi black partridge (Francolinus francolinus). To conduct this investigation, 20 healthy Iraqi black partridge were collected from local suppliers. Birds were euthanized, dissected and then specimens were processed for histological and histochemical staining techniques. The results showed the jejunum was tubular long shape of an open coil irregular and suspended by the dorsal abdominal wall through the mesenteric membrane. Histologically, the wall of the jejunum was consisted of four tunicae mucosa, sub-mucosa, muscular is and serosa. The mucosa had a distinctive feature by the presence of villi had many shapes finger, club and cylindrical shape, the crypts of lieberkuhn, which covered by simple columnar epithelium with goblet cells. The goblet cells gave positive reaction with PAS stain. [ABSTRACT FROM AUTHOR]

Introduction: Jejunojejunal intussusception after Roux-en-Y gastric bypass (RYGBP) for morbid obesity is a rare but potentially catastrophic complication. There are limited data regarding the incidence of intussusception and the different surgical options for management of this disease.Methods: This is a retrospective review of all patients that underwent RYGBP and subsequently developed intussusception at the jejunojejunostomy. Data were collected between 1/1/2008 and 5/31/2018 and included demographics, details related to the index procedure, presentation, and management of intussusception. Perioperative outcomes and complications were also collected.Results: 665 patients underwent RYGBP. A total of 34 patients developed intussusception, with 31 (4.7%) of them having undergone RYGBP in our hospital. Demographics included age, gender, and BMI at both the index surgery and at the time of intussusception. The jejunojejunostomy was created during RYGBP using a linear stapler in all patients with 64.5% of them achieving a length of 90 mm. All intussuscepted patients presented acutely with abdominal pain. All but one patient required surgical intervention. 42.4% of the patients were found to have intraoperative intussusception which appeared to be retrograde in 78.6% of them. Reduction followed by enteropexy or just enteropexy was performed in 20 patients (60.6%) that required surgery. No immediate post-operative complications were noted but 8 patients (26.5%) had recurrence of intussusception requiring another surgical intervention. In the reoperated group, 75% of the patients were treated with reduction followed by enteropexy or just enteropexy.Conclusions: This is the largest case series describing jejunojejunal intussusception following RYGBP. All patients that developed intussusception had jejunojejunostomy length greater than 60 mm. The most commonly performed surgical repair was reduction of the intussuscepted segment (if present) followed by enteropexy. Jejunojejunostomy length greater than 60 mm might be associated with the occurrence of intussusception and could explain the higher incidence noted in our series. Minimal intervention with enteropexy can offer effective treatment for most patients. [ABSTRACT FROM AUTHOR]

Background: Jejunogastric intussusception (JGI) is a rare but severe complication after gastric surgery. JGI can occur from a few days to 55 years postoperatively and has a reported incidence of < 0.1% in patients who undergo gastric surgery. We firstly report a male patient with duodenal cancer who underwent Whipple's procedure with side-to-side gastrojejunostomy and who subsequently developed JGI. A literature review is provided.Case Presentation: A 68-year-old man was admitted to our emergency department with left upper quadrant abdominal pain and hematemesis of 4 h' duration. He had undergone Whipple's procedure (duct-to-mucosa pancreaticojejunostomy and side-to-side gastrojejunostomy) with B-II reconstruction for duodenal papillary adenocarcinoma 5 years earlier. His vital signs were stable with a blood pressure of 163/93 mmHg, temperature of 37.0 °C; and heart and respiratory rates of 86 per/min and 20 per/min, respectively. Physical assessment showed mild tenderness in the left upper quadrant, only. A complete blood count showed white cell and platelet counts of 11.69 × 103/L and 196 × 103/L, respectively, and a hemoglobin level of 13.5 g/L. Abdominal computed tomography (CT) suggested a retrograde intussusception of the intestines into the stomach with dilatation of the remnant stomach. The patient immediately underwent exploratory laparotomy, which revealed a 20-cm retrograde efferent limb at the remnant stomach that had travelled through the previous gastrojejunostomy. There was no evidence of malignancy. We manually reduced the intussuscepted loop using gentle traction, and the viability of the intestinal loop was preserved. The patient had an uneventful postoperative recovery.Conclusion: JGI is a rare but potentially fatal complication after gastric surgery, especially following Whipple's procedure. Early diagnosis and treatment are crucial, and surgery is considered the most effective treatment for JGI. [ABSTRACT FROM AUTHOR]

Jejuno-gastric intussusception is a rare but lethal complication of gastric surgeries with a reported incidence of 0.15%. A high index of suspicion is required to diagnose this condition in a patient with a history of gastric surgery. With advances in minimal access surgery, reduction of the intussusceptum is possible through laparoscopy or endoscopy. We present an elderly male who had undergone a Billroth II procedure before 27 years. The patient was diagnosed with jejuno-gastric intussusception based on ultrasound and endoscopic findings. The patient was successfully managed under laparoscopy. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by intestinal hamartomatous polyps in association with skin and mucosal macular melanin deposition. There is a lifetime chance of 93% of cancers when all cancers are combined and the incidence of the disease is variable between 1 in 8300 and 1 in 280,000 live births (Daniell et al., Familial Cancer 17(3):421-427, 2018). Here, we present a 14-year-old Indian boy presenting to surgical emergency with intestinal obstruction secondary to jejunojejunal intussusception for which resection and anastomosis were done. Post-operative histopathological examination showed a single polyp leading to intussusception. He classically showed mucocutaneous pigmentation on general examination. Early identification of Peutz-Jeghers syndrome on a routine visit to healthcare can decrease complications like intestinal obstruction and help in starting early surveillance for cancers. [ABSTRACT FROM AUTHOR]

Purpose: To present radiological aspects of jejunoileal diverticulosis and its complications. Results: Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Jejunoileal diverticulosis is far less common than colonic diverticulosis. Acquired small bowel diverticula are often numerous but the complication rate is low. Acute diverticulitis is the most frequent complication; its classic presentation involves the jejunum and is often non-severe. Diverticular hemorrhage is the second most common complication; CT scan examination is essential to determine the accurate topography of the pathological diverticula. Small bowel obstruction can occur through several mechanisms: adhesions, enterolith, and intussusception. Extra-intestinal gas without perforation and "pseudo-ischemic" appearance are non-pathological conditions that are important to diagnose in order to avoid surgery. Conclusion: Jejunoileal diverticulosis usually does not show any symptoms but can lead to diagnostic challenges requiring evaluation by CT. CT scan signs of these complications and some pitfalls must be known. [ABSTRACT FROM AUTHOR]

Villus to crypt ratio (VCR) is used to quantify the microanatomical response of the intestine to various treatments. In early age chickens, comparative effects of the in ovo (i.o.) and s.c. methods of administration (moa) of the Marek's disease (MD) vaccine on 2 types of measurement of small intestinal VCR at 0 and 4 h post-hatch (poh) were investigated. The effects of moa and 4 and 18 h pre-placement holding times (pht) on the VCR measurements at 168 h (7 d) poh were also investigated. In the jejunum of the small intestine, a standard method for VCR determination, based on 10 villus and crypt length measurements, was utilized for the calculation of villus to crypt length ratio (VCLR). In that same region, a single histomorphometric determination of the crypt and total mucosa areas using image analysis software was also used. Subtraction of the crypt area from the total mucosa area provided the villus area, allowing for calculation of the villus to crypt area ratio (VCAR). Across 0, 4, and 18 h of poh bird age, the VCLR of birds that received an s.c. vaccination was higher in comparison to that of those that received an i.o. vaccination. The highest and lowest VCAR values were observed in the s.c. treatment at 0 h poh and in the i.o. treatment at 4 h poh, respectively. Furthermore, at 168 h poh, VCLR values in the 18 h pht and s.c. vaccination group were higher than those in the 4 h pht and s.c. vaccination or 18 h and i.o. vaccination groups. In conclusion, the effects of pht and MD vaccine moa on VCR were dependent on the use of either the VCLR or VCAR method of measurement. However, regardless of method, s.c. injection overall led to a higher VCR through 4 h poh in Ross 708 broilers, and the effects of moa on VCLR at 168 h were influenced by pht. [ABSTRACT FROM AUTHOR]

The article presents three case studies related to 50-year-old man with a history of end-stage renal disease and recurrent sigmoid diverticulitis has presented with a one-week history of epigastric pain with nausea and vomiting, 70-year-old man with a history of hypertension and hyperlipidemia has presented one-day history of left lower abdominal pain, and 55-year-old man with a history of hypertension initially has presented with a one-week history of abdominal pain.

Spontaneous perforation of the nonspecific small bowel ulcer is a rarely seen condition that causes acute abdomen and mostly diagnosed perioperatively. A 72-year old female patient was admitted to emergency service with abdominal pain. Her physical examination was compatible with acute abdomen and peritonitis. Abdomen computerized tomography showed free air under the right diaphragm. She was operated with a presumptive diagnosis of gastrointestinal perforation. An isolated jejunal perforation on the opposite side of the mesentery was found perioperatively. A biopsy was taken, and the perforation was repaired with primary sutures. The patient died in the intensive care unit due to pulmonary complications on the fifth postoperative day. Although the biopsy was taken from the superficial tissue, it was consistent with an ulcer. Nonspecific jejunal ulcer perforations can be life-threatening because of the delayed diagnosis. Especially in elderly patients, it should be kept in mind as a cause of acute abdomen. [ABSTRACT FROM AUTHOR]

Abstract Enterotoxigenic Escherichia coli (ETEC), as a universal pathogen, often causes diarrhea in animals and humans. However, whether ETEC infection induces apoptosis in host remains controversial. Herein, we use ETEC-infected piglet to investigate apoptosis in the jejunum. Apoptosis and the activation of capase-3 are observed in piglet jejunum after ETEC infection. Additionally, ETEC infection induces the activation of caspase-8 pathway, but inhibits the activation of caspase-9 pathway in piglet jejunum. These findings demonstrate that ETEC infection may inhibit the intrinsic pathway and activate the extrinsic pathway of apoptosis in piglets. Highlights • ETEC infection causes apoptosis in piglet jejunum except for triggering diarrhea in piglets. • ETEC infection inhibits the activation of intrinsic pathway of apoptosis involving Caspase-9. • ETEC infection induces the activation of extrinsic pathway of apoptosis involving Caspase-8. [ABSTRACT FROM AUTHOR]

Neuroendocrine tumors (NETs), belong to a group of neoplasms that arise from neuroendocrine cells and express markers such as synaptophysin and chromogranin A. The digestive system (DS) is the most common site of NET development. The World Health Organization classification divides NETs into low grade (G1-G2) tumors (NETs) and high grade carcinomas [neuroendocrine carcinomas (NECs)], based on mitotic index and histological criteria. NET prognosis depends on tumor stage and grade. Low grade G1 NETs are characterized by a low proliferative rate and an indolent clinical course with a 5-year survival rate ranging between 38% (pancreas) and 88% (rectum). The present study reports a case of a low grade (G1) multifocal jejunal tumor with histologically confirmed features of aggressiveness, namely peritoneal carcinomatosis, lymph node metastasis and vascular carcinomatous emboli. Prediction of clinical behavior and survival in such a case is challenging. Although multiplicity and nodal metastases is not unusual for low grade NETs in this part of the gastrointestinal tract, peritoneal carcinomatosis is an extremely rare finding. Surgeons and histopathologists should be familiar with such eventualities and tumor boards are required in order to conclude whether aggressive therapeutic interventions may have any impact on patients' long term survival. [ABSTRACT FROM AUTHOR]

Aim: To investigate the intra-observer and interobserver variability of quantitative apparent diffusion coefficient (ADC) measurements in children with inflammatory bowel disease.Materials and Methods: Nine readers were recruited. Six magnetic resonance imaging (MRI) enterography cases with known active disease in the jejunum, terminal ileum, or colon were analysed. Readers measured repeat ADC values from the known diseased site and an unaffected site, at two sittings.Results: Seven readers completed the study. The Lin concordance coefficient for intra-observer agreement was poor (0.844, 95% confidence interval [CI]: 0.77, 0.896). Bland-Altman limits of agreement for intra-observer agreement were 0.66×10-3 mm2/s (95% CI: 0.46, 0.86), and -0.56×10-3 mm2/s (95% CI: -0.36, -0.76). Therefore, a single measured value would be compatible with no disease, superficial ulceration, or deep ulceration according to published thresholds. Interobserver variability was poor to moderate across all observers (intraclass correlation coefficient [ICC]: 0.51, 95% CI: 0.27, 0.77). Between the two best-agreeing observers, agreement was good using the ICC (ICC 0.85, 95% CI: 0.43, 1.0), but poor using the Lin correlation coefficient (Lin 0.83, 95% CI: 0.65, 0.93), and Bland-Altman.Conclusion: The intra-observer and interobserver agreement is inadequate to allow accurate characterisation of disease activity using previously published thresholds. Qualitative ADC assessment may be preferable. [ABSTRACT FROM AUTHOR]

Felids are the only definitive hosts of Toxoplasma gondii. To lay a foundation for screening the T. gondii-felids interaction factors, we have developed a reproducible primary culture method for cat intestinal epithelial cells (IECs). The primary IECs were isolated from a new born cat's small intestine jejunum region without food ingress, and respectively in vitro cultured by tissue cultivation and combined digestion method with collagenase XI and dispase I, then purified by trypsinization. After identification, the ds cDNA of cat IECs was synthesized for constructing pGADT7 homogenization three-frame plasmid, and transformed into the yeast Y187 for generating the cDNA library. Our results indicated that cultivation of primary cat IECs relays on combined digestion to form polarized and confluent monolayers within 3 days with typical features of normal epithelial cells. The purified cells cultured by digestion method were identified to be nature intestinal epithelial cells using immunohistochemical analysis and were able to maintain viability for at least 15 passages. The homogenizable ds cDNA, which is synthesized from the total RNA extracted from our cultured IECs, distributed among 0.5-2.0 kb, and generated satisfying three-frame cDNA library with the capacity of 1.2 × 106 and the titer of 5.2 × 107 pfu/mL. Our results established an optimal method for the culturing and passage of cat IECs model in vitro, and laid a cDNA library foundation for the subsequent interaction factors screening by yeast two-hybrid. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old man with complaints of upper abdomen pain, fever and weight loss. It notes that while the patient has not suffered major ailments in the past, his family has a history of tuberculosis. It adds that after the patient undergone endoscopic ultrasound-guided aspiration cytology, the diagnosis of adrenal histoplasmosis has been concluded.

We describe a case of a previously healthy 6-year-old-girl presenting with a one-day history of bilious emesis, periumbilical pain, and feeding intolerance. Initial abdominal radiographs were unremarkable. Following continued episodes of bilious vomiting, an upper GI series was performed, which demonstrated coating of a non-occlusive intraluminal mass within the proximal jejunum. Serial abdominal radiographs document movement of the mass from the left upper quadrant to the right lower quadrant along with progressive dilatation of the proximal small bowel, suggesting small bowel obstruction. An abdominal CT confirmed a small bowel obstruction at the level of the barium coated intraluminal mass. At surgery, the obstruction was discovered to be due to a jejunal trichobezoar. Upon further retrieval of clinical history, it was determined that the patient had a history of eating her hair and couch cushions. A jejunal bezoar is a rare cause of small bowel obstruction. It can be a diagnostic challenge and can lead to significant complications if there is a delay in diagnosis. Throughout this case, we describe the clinical presentation of the patient and demonstrate the progression of radiographic findings of a small bowel trichobezoar. [ABSTRACT FROM AUTHOR]

We report a case of sealed perforation of jejunoileal diverticulitis in an 88-year-old man presented with transient abdominal pain. An urgent computed tomography of the abdomen and pelvis showed foci of extraluminal free air suspected of perforation. The patient was treated with intravenous antibiotics and regular follow-ups. He recovered after 2 months of conservative treatment. [ABSTRACT FROM AUTHOR]

Ectopic pancreas is not uncommon. It is often seen as an incidental finding and clinically remains undiagnosed. We report one such incidental jejunal ectopic pancreas, with a separate branch of jejunal blood vessel supplying it and not connected with pancreas any way. Same was histologically confirmed as pancreatic tissue. [ABSTRACT FROM AUTHOR]

We report a rare case of late complication of a complex intestinal malformation. At day 1 of life, a baby girl underwent resection of an atretic jejunal segment, associated with an enteric duplication harboring foci of gastric and duodenal heterotopia. After an asymptomatic period of 19 years, the patient presented with acute bowel obstruction. Recurrence of the jejunal occlusion at the previous anastomotic site was caused by mucosa hyperplasia in association with heterotopic gastric and duodenal tissue. A Wnt/β-catenin pathway deregulation was hypothesized but not confirmed by CTNNB1 exon 3 mutation analysis. This case illustrates a rare association of 3 pathologies--namely, intestinal atresia, enteric duplication, and heterotopia, with a late-occurring acute complication. [ABSTRACT FROM AUTHOR]

Gastrointestinal disorders become more prevalent with ageing. This study is aimed to describe morphological changes that occur in the jejunal mucosa of male albino rats as a result of ageing and the protec-tive effect of green tea (GT) extract.~Introduction~Background~The experiment was performed on sixty rats: thirty young-adult (6-month old, body mass 200-220 g) and thirty old (24-month-old, body mass 220-260 g) animals. Each group was further divided into two subgroups (n = 15 each): control rats and GT-treated rats that received 1.5 mL (300 mg/kg/day) of GT extract for 14 weeks by oral gavage. Sections of the jejunum were stained with hematoxylin and eosin, periodic acid Schiff, toluidine blue and Mallory trichrome methods. The presence of proliferating cell nuclear antigen (PCNA)- and CD68-positive cells was evaluated by immunohistochemical staining. Ultrathin sections were prepared and examined by a transmission electron microscope (TEM).~Material and Methods~Methods~Jejunal sections of the old control rats showed distortion of submucosa and attenuated muscularis externa with decreased height of intestinal villi. The villi also showed partial loss of acidophilic brush border with wide spaces between enterocytes. Swollen, short, blunt or broad villi with abundant mononuclear cell infiltration of lamina propria and congested blood vessels were evident both by light and electron microscopy. The number of PCNA- and CD68-positive cells in jejunal mucosa of old rats was higher than in young rats. The activity of glutathione peroxidase (GPX) and total antioxidant capacity (TAC) in the mucosa of old control rats were lower, whereas malondialdehyde (MDA) levels were higher in the jejunal homogenates of old rats as compared to young control rats. Administration of GT extract protected the jejunal mucosa from age-related changes by restoring its histological structure. The treatment of old rats with GT extract significantly decreased MDA levels in the jejunum and increased TAC and GPX activity.~Results~Results~The age-related changes of the morphology of rat jejunum could be ameliorated by prolonged supplementation of the green tea extract.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Background: Incidence of and risk factors for intestinal free perforation (FP) in patients with Crohn's disease (CD) are not established.Aim: To establish rate of and risk factors for FP in a large cohort of CD patients.Methods: Medical records of CD patients who visited Asan Medical Center from June 1989 to December 2012 were reviewed. After matching the FP patients to controls (1:4) by gender, year, and age at CD diagnosis, and disease location, their clinical characteristics were compared using conditional logistic regression analysis.Results: Among 2043 patients who were included in our study cohort, 44 patients (2.15%) developed FP over a median follow-up period of 79.8 months (interquartile range 37.3-124.6), with an incidence of 3.18 per 1000 person-years [95% confidence interval (CI) 2.37-4.28]. All 44 patients underwent emergency surgery, and eight patients underwent reoperation within 12 months (8/44, 18.2%). Multivariable-adjusted analysis revealed that anti-TNF therapy [odds ratio (OR), 3.73; 95% CI 1.19-11.69; p = 0.024] was associated with an increased risk of FP.Conclusions: The incidence of FP in a large cohort of Korean CD patients was 2.15%, which was similar to that in Western reports. Anti-TNF therapy could be risk factors for FP. [ABSTRACT FROM AUTHOR]

1. The current objective was to assess (1) differences in mucosal transepithelial short-circuit current (Isc) and tissue conductance (GT), (2) the effect of a glucose stimulus and (3) epithelial paracellular permeability in the proximal and distal jejunum of laying hens. 2. Proximal and distal jejunal segments used in the Ussing chambers were collected at 9 ± 0.5 and 73 ± 3.4% (SEM) of jejunal length, respectively. The proximal jejunal mucosa showed a small negative Isc(−1.3 µA/cm2), whereas the distal jejunum had a higher Isc(32.9 µA/cm2). Similarly, GTwas 2.5-fold greater in the distal compared to the proximal jejunum. 3. Increased paracellular permeability in the distal jejunum was displayed as demonstrated by a 5-fold higher mucosal to serosal flux of fluorescein isothiocyanate and horseradish peroxidase, representing molecules of low and high molecular weight, respectively. 4. Addition of glucose to the mucosal side (5 mmol/l, final concentration in the chamber) to stimulate an absorptive effect caused 3-fold greater GTin the distal compared to the proximal jejunum. 5. In conclusion, the present results supported site-specific electrogenic transport processes for the jejunal mucosa of laying hens. Therefore, precise description of the jejunal site may contribute to an improved comparability of electrophysiological data. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-year-old man from Russia was admitted with disseminated extensively drug-resistant (XDR) tuberculosis. He had clinical, radiological, and microbiological evidence of pulmonary tuberculosis and tuberculosis meningitis. Culture of the Mycobacterium tuberculosis from his cerebrospinal fluid revealed it to be XDR.

Obscure gastrointestinal bleeding is defined as persistent or recurrent bleeding without an obvious cause after endoscopic and radiological evaluation. Obscure gastrointestinal bleeding originates most commonly from the small intestine. Jejunal diverticulosis is an uncommon diagnosis in which multiple mucosal herniations are present in the mesenteric border of jejunum. There is always a delay in diagnosis as it is a rare clinical entity. This is a case report of a 35-year-old male who presented with overt gastrointestinal bleeding and was managed at another center with surgery and embolization. He was evaluated, and a bleeding jejunal diverticulum was identified as the source of bleed during on-table enteroscopy after exhausting other investigation modalities and having delay in definitive management due to difficulty in localizing the source of bleed. Awareness of jejunal diverticulosis and its complications is very important in obscure gastrointestinal hemorrhage to prevent the diagnostic delay. A stepwise approach is very important to identify the source of obscure gastrointestinal bleed. [ABSTRACT FROM AUTHOR]

Background: Primary anaplastic large cell lymphoma, ALK positive in small intestine is clinically rare and the clinical, radiological and pathological information are generally not available. Here, we report a case of 32-year-old male with ALK positive anaplastic large cell lymphoma at the junction of jejunum and ileum, and highlight the clinicopathological features and the differential diagnosis of this type lymphoma. Case presentation: The patient presented with right middle abdominal mass for 1 month with sporadic pain. Computed tomography (CT) showed a mass measured 8.5 × 7.4 × 4 cm at the junction of jejunum and ileum. The diagnosis was made after pathological examination of the excised tissue by enterectomy. Grossly, the mass was located predominately in intestinal wall with grayish appearance and blurry boundary. Microscopically, almost all layers of the intestinal wall were infiltrated by pleomorphic tumor cells with diffuse and cohesive growth pattern. The neoplastic cells were mainly medium to large size with moderate basophilic cytoplasm. Most of them had hyperchromatic nuclei and prominent nucleoli. “Hallmark” cells were easily detected. Immunohistochemically, tumor cells are characterized by CD30, ALK, CD5, TIA-1, Granzyme B, EMA positive staining, and CD2, CD3, CD7, CD4, CD8, CD20, CD79a negative staining. The Epstein-Barr virus encoded RNAs (EBERs) genome was also negative. A diagnosis as primary small intestinal ALK positive anaplastic large cell lymphoma was finally made. The patient received CHOP chemotherapy and is alive till now without recurrence 5 months after enterectomy. Conclusions: Primary small intestinal ALK positive anaplastic large cell lymphoma is rare. The accurate diagnosis should be based on combined consideration of clinical characteristics, CT image and pathological features, and should be distinguished from other lymphomas or solid tumors in small intestine. [ABSTRACT FROM AUTHOR]

Angioleiomyoma being a type of true smooth muscle gastrointestinal tumors can lead to serious life-threatening gastrointestinal bleeding. We report a case of 21-year-old male patient with recurrent midgut bleeding. Contrast-enhanced CT revealed highly vascular small bowel neoplasm. The patient underwent laparotomy with bowel resection and recovered uneventfully. Histopathology revealed jejunal angioleiomyoma. [ABSTRACT FROM AUTHOR]

The aim of our experiment was to study how synbiotics are able to deal with the problems of post-weaning piglets. Lactobacillus plantarum - BiocenolTM LP96 (CCM 7512), Lactobacillus fermentum - BiocenolTM LF99 (CCM 7514) and flaxseed (rich in n-3 polyunsaturated fatty acids) were administered to 36 conventional piglets from a problematic breed with confirmed presence of enterotoxigenic Escherichia coli and Coronavirus. The experimental piglets were supplied with probiotic cheeses and crushed flax-seed in the period starting 10 days before weaning and lasting up to 14 days post-weaning. Piglets in the control group were supplied only control cheese. The impact of such additives on the release of lactate dehydrogenase (LDH; spectroscopic and electrophoretic assay), alteration of immunity (index of metabolic activity), jejunum histology (light microscopy), and health of conventional piglets from a problematic breed (monitoring of hematology, consistency and moisture of feces and body temperature) were examined. We found significant decrease in LDH leakage in the blood serum and tissue extracts, indicating better cell membrane integrity in the individual organs of animals. Probiotics and flaxseed applied together seem to be a good source of nutrients to improve the immune status and the integrity of jejunum mucosa during infection. © 2015 Japanese Society of Animal Science [ABSTRACT FROM AUTHOR]

Gastrointestinal metastases from lung cancer are rare and usually asymptomatic. We report a case of small bowel metastases from primary lung cancer revealed by abdominal pain and severe recurrent anaemia. The diagnosis was obtained with capsule endoscopy. This noninvasive procedure thus represents a valuable method contributing to a rapid and detailed diagnosis while reducing underdiagnosis, and it should thus be considered for lung cancer patients complaining of abdominal symptoms, which may indeed be related to gastrointestinal metastases. [ABSTRACT FROM AUTHOR]

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Primary sarcomatoid carcinoma of the jejunum is an extremely rare condition, with only 16 cases reported in the literature to date. We herein report an additional case of a giant sarcomatoid carcinoma of the jejunum in a 62-year-old male patient, presenting as massive intra-abdominal hemorrhage. During emergency laparotomy, ~5 litres of bloody ascites was found in the peritoneal cavity and the tumor was located in the proximal jejunum. The tumor involved the entire wall of the jejunum and had directly invaded the neighboring parietal peritoneum, omentum, transverse colon and mesentery, with metastatic lymph nodes. The patient underwent palliative resection of the tumor; however, the course was rapidly progressive and he succumbed to progression of abdominal and liver metastases 4 weeks after surgery. The tumor was found to be positive for epithelial and mesenchymal markers on immunohistochemical analysis. This case emphasizes the aggressive clinical course and metastatic nature of this malignant tumor, with a supplementary review of the previously published literature. [ABSTRACT FROM AUTHOR]

Hydrogen sulphide (H2S) is generated endogenously from l-cysteine ( l-Cys) by the enzymes cystathionine- β-synthase ( CBS) and cystathionine- γ-lyase ( CSE). In addition, l-Cys is commonly used as a precursor in the food and pharmaceutical industries. The aim of the present study is to determine whether l-Cys regulates intestinal nutrient transport. To that end, the presence of CBS and CSE in the jejunum epithelium was assessed by immunohistochemistry, Western blotting and the methylene blue assay. In addition, in vivo l-Cys (100 mg/kg, administered immediately after the glucose load) significantly increased blood glucose levels 30 min after the oral administration of glucose to mice. This effect of l-Cys was completely blocked by amino-oxyacetic acid ( AOA; 50 mg/kg; administered at the same time as l-Cys) an inhibitor of CBS. Measurements of the short-circuit current ( Isc) in the rat jejunum epithelium revealed that l-Cys (1 mmol/L; 6 min before the administration of l-alanine) enhances Na+-coupled l-alanine or glucose transport, and that this effect is inhibited by AOA (1 mmol/L;10 min before the administration of l-Cys), but not d, l-propargylglycine ( PAG;1 mmol/L; 10 min before the administration of l-Cys), a CSE inhibitor. Notably, l-Cys-evoked enhancement of nutrient transport was alleviated by glibenclamide (Gli;0.1 mmol/L; 10 min before the administration of l-Cys), a K+ channel blocker. Together, the data indicate that l-Cys enhances jejunal nutrient transport, suggesting a new approach to future treatment of nutrition-related maladies, including a range of serious health consequences linked to undernutrition. [ABSTRACT FROM AUTHOR]

CASE DESCRIPTION: A I-year-old castrated male dog residing in Indiana was examined because of intermittent vomiting of 4 months' duration. CLINICAL FINDINGS: The dog's condition did not resolve with medication. Diagnostic imaging revealed a possible partial obstruction at the ileocecal junction. An exploratory laparotomy was performed. The jejunum contained diffusely distributed, nodular, intramural lesions; 2 biopsy specimens were collected from representative lesions. The pancreas was grossly swollen, and pancreatitis was presumed present. No other abnormalities were observed in the abdomen. Histologic examination of the submitted biopsy specimens revealed infection with Heterobilharzia americana. TREATMENT AND OUTCOME: After diagnosis, the dog was treated with fenbendazole suspension (48 mg/ kg [21.8 mg/lb], PO, q 24 h) for 10 days. This treatment was subsequently repeated I I and 80 days later. One week after the end of the last fenbendazole treatment, several H americana eggs were detected in a fecal sample via saline sedimentation, and the dog was given praziquantel (25 mg/kg [I 1.4 mg/lb], PO, q 8 h) for 2 days. N o gastrointestinal signs were evident 4 months after that treatment. CLINICAL RELEVANCE: The dog described in this report was the first autochthonous canine case of H americana infection in Indiana, to the authors' knowledge; this case has confirmed that the distribution of this parasite in the Midwestern United States is broader than previously known. Increased awareness of the distribution of H americana should aid veterinarians in early, noninvasive diagnosis and appropriate treatment of affected animals. Repeated treatments and recheck fecal examinations may be necessary when managing these cases. [ABSTRACT FROM AUTHOR]