11/21. blind loop syndrome, vitamin E malabsorption, and spinocerebellar degeneration. A 72-year-old man had severe malabsorption, progressive retinopathy, and spinocerebellar degeneration 32 years after gastric surgery, blind loop formation, and intestinal bacterial overgrowth. Clinical and pathologic features were typical of vitamin e deficiency; vitamin E was nearly undetectable in serum and profoundly low in adipose tissue. Vitamin E blood levels initially improved on treatment with antibiotics; after additional vitamin E supplementation, there was clinical improvement. ( info) |
12/21. osteomalacia complicating a blind loop syndrome from congenital megaesophagus-megaduodenum. A young female with osteomalacia complicating a blind loop syndrome associated with congenital megaduodenum is described. In this case, the correction of vitamin d malabsorption by administration of antibiotics highlights the role of massive intraluminal bacterial overgrowth from destruction of vitamin d, or decreased unicellar solubilization due to deconjugation of biliary acids. The importance of cutaneous vitamin d synthesis in patients with osteomalacia of gastrointestinal origin is emphasized. The detection of megaduodenum and megaesophagus in the patient's father may be the first report of a familial association of these gastrointestinal abnormalities. ( info) |
13/21. Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass. Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass. ( info) |
14/21. Chronic pseudo-obstruction secondary to side-to-side intestinal anastomosis. An unusual late complication of side-to-side intestinal anastomosis, chronic small-bowel obstruction with massive proximal ileal dilation despite a widely patent anastomosis, occurred in a patient. The classic blind loop syndrome was not present. Several potential mechanisms are suggested, including regional absence of normal peristalsis on a mechanical basis and bacterial overgrowth. This report adds support to the concept that side-to-side intestinal anastomosis should be avoided whenever possible. ( info) |
15/21. Unusual abdominal complications of a suicidal overdose of analgesic and psychotropic drugs in an elderly patient. A suicidal 67-year-old woman with manic-depressive psychosis took an overdose of asprin, amitriptyline and diazepam. The initial effects were pyrexia, tachycardia, hyperpnea, metabolic acidosis, electrocardiographic changes, hypoprothrombinemia, gastritis, and pancreatitis. Four to six weeks later, she was examined because of persistent abdominal pain with mausea, anorexia anemia, and possibly a malabsorption syndrome. An exploratory laparotomy was performed. The surgeon found several previous adhesions, a small intestinal volvulus, and a nodular pancreas. This suggested previous perforation of the small bowel from enteritis, causing a "blind-loop" syndrone. The invilved section of the small bowel was resected. With appropriate treatment, the patient is well three months after operation. ( info) |
16/21. ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity. ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy. ( info) |
17/21. The development of "stagnant loop" syndrome following surgery for peptic ulcer disease. Although gastric resection may cause a variety of functional gastrointestinal disorders, malabsorption is rare. When such a disturbance occurs other complicating factors are mostly involved. Two patients who developed a severe malabsorption after partial gastric resection are presented. They both had the prerequisites for intestinal stasis--one had small bowel diverticula and the other a "blind loop" after previous surgery. Their malabsorption was cured by surgical correction of stasis. ( info) |
18/21. Malabsorption secondary to Meckel's diverticulum. This case report of a patient with a large Meckel's diverticulum with associated stagnation and bacterial proliferation demonstrates the resultant metabolic and nutritional alterations that have classically been described with the blind loop syndrome. A lesion as large as the one presented herein has rarely been reported with iron, vitamin B12, and folic acid deficiency anemias secondary to the contaminated small bowel (ileum) syndrome. A discussion of the pathophysiology, diagnosis, and treatment of this disorder and the multiple disease entities incorporated in the contaminated small bowel syndrome are included. ( info) |
19/21. Acute febrile neutrophilic dermatosis. Sweet's syndrome. Acute febrile neutrophilic dermatosis (AFND) (Sweet's syndrome) is characterized by warm, erythematous plaques, accompanied by arthralgias, fever, and leukocytosis. A 53-year-old man was seen with chronic, recurrent, and unusually persistent AFND. The patient had a history of a gastrojejunostomy for peptic ulcer disease and had symptoms of the blind loop syndrome. Medical therapy for the blind loop syndrome failed to control his skin lesions, fever, or leukocytosis. His symptoms did respond to prednisone therapy, however. The relationship of AFND to the bowel bypass syndrome is discussed. ( info) |
20/21. blind loop syndrome: multiple ileal ulcers following side-to-side anastomosis. A 59 yr old woman who had multiple ileal ulcers following side-to-side anastomosis without bowel resection is reported. She had a surgical history of adhesive ileus 15 yrs earlier, and was admitted with a complaint of lower abdominal pain. A barium meal study showed a stagnant and dilated distal ileum. At laparotomy, a previously performed side-to-side ileal anastomosis was encountered, and a markedly dilated bypassed loop was recognized. The affected intestine was resected revealing multiple longitudinal ulcers and small shallow ulcers mostly located on the mesenteric side. This feature is similar to that of ischemic enteritis. This case further supports the fact that when side-to-side anastomosis is performed as a bypass operation, multiple ulcers may develop in a bypassed loop after a long period of time. ( info) |