1/11. Bowel perforation during chemotherapy for non-hodgkin's lymphoma.Bowel perforation in patients with primary malignant lymphoma usually occurs at the site of tumor. A 78 year-old man underwent chemotherapy for malignant lymphoma. He presented with abdominal pain. An emergency operation was performed under a diagnosis of panperitonitis. At laparotomy, an anal-side perforation approximately 20 cm from the Treiz ligament was observed. drainage and partial resection of the jejunum was performed. Histopathologic examination demonstrated that there was no characteristic finding of malignant lymphoma around the perforation site in the case. Perforation of the small intestine is one of the most critical complications during the chemotherapy for malignant lymphoma. In cases of chemotherapy for malignant lymphoma, especially systemic administration, we should keep in mind the possibility of perforation of the small intestine. Fortunately, emergency surgery saved the patient presented in this report. Early diagnosis and treatment are important to improve prognosis of bowel perforation in patients with primary malignant lymphoma.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/11. Massive bleeding from multiple jejunal diverticula associated with an angiodysplasia: report of a case.We report herein the case of a 70-year-old woman who presented with massive bleeding from multiple jejunal diverticula. She was initially admitted to our hospital with massive melena. An upper gastrointestinal endoscopic examination revealed no bleeding site. colonoscopy revealed clotted and red blood throughout the colon, and a small diverticulum in the ascending colon which was thought to be the source of bleeding. Following admission, she was treated conservatively at first, but melena continued and the anemia did not improve despite blood transfusions. A laparotomy was performed and multiple jejunal diverticula, distributed from 10 to 40 cm distal to the ligament of Treitz, were found. A segment of the jejunum containing all diverticula was resected. The most distal diverticulum contained a clot of blood, but no ulceration was observed. A histological examination revealed many dilated blood vessels in the mucosa and submucosa of this diverticulum, which were compatible with the findings of angiodysplasia. Based on these findings, we believe that angiodysplasia was the cause of bleeding from the jejunal diverticula in this case.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/11. Jejunal obstruction and perforation resulting from herniation through broad ligament.Internal herniation of small bowel through broad ligament causing obstruction is rare. A case of jejunal herniation through broad ligament defect with resultant obstruction and perforation is presented.- - - - - - - - - - ranking = 6keywords = ligament (Clic here for more details about this article) |
4/11. Jejunal perforation in a patient with adult T-cell leukemia.We present a case of adult T-cell leukemia (ATL) with jejunal perforation at the site of intestinal involvement by ATL. A 39-year-old woman presented with sudden-onset abdominal pain. physical examination showed generalized severe abdominal tenderness and intraabdominal free air was seen on radiographic examination. Under a diagnosis of peritonitis due to intestinal perforation, an emergency operation was performed. A pinhole-like perforation was found in the jejunum 80 cm distal to Treitz's ligament, and the patient underwent partial resection of the affected jejunum. Microscopic examination revealed diffuse infiltration of abnormal lymphocytes into the entire wall of the jejunum and mesenteric lymph nodes. A diagnosis of ATL was confirmed by the presence of antibody to human T-lymphotropic virus type 1 (HTLV-1) in the serum, a positive result for T-cell markers and the HTLV-1 proviral genome in the mononuclear cells in the specimens. The final diagnosis was thus lymphoma subtype of ATL. Combination chemotherapy was repeated until the patient died 14 months postoperatively. Emergent surgery followed by intense chemotherapy might improve survival in patients with ATL and perforated intestine.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/11. A case of proximal jejunal ectopic pancreas causing sporadic vomiting.Aberrant rests of pancreatic tissue can be found throughout the gastrointestinal system and are known as pancreatic heterotopia or ectopic pancreas (EP). Authors report a 12-year-old girl with jejunal EP with a long-lasting history of sporadic bilious vomiting. Upper gastrointestinal (GI) study showed delayed passage beyond duodeno-jejunal junction. During laparotomy a 2x2 cm mass was encountered on the mesenteric border of the jejunum, 3 cm distal to the ligament of Treitz. Histopathologic examination revealed pancreatic tissue. The mass was excised and end-to-end anastomosis was performed. Postoperative course of the patient was uneventful and she is doing well after 10 months. intestinal obstruction due to EP has been reported to occur only if it causes intussusception. intestinal obstruction without intussusception due to jejunal EP has not been reported. In our case, the EP tissue was located just beneath the mucosa and involved the muscular layer. The foreign body effect of the EP tissue involving the muscular layer may cause dysmotility and/or local spasm, which we think were responsible for the long-lasting sporadic bilious vomiting in our patient.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/11. Laparoscopic management of an internal double omental hernia: a rare cause of intestinal obstruction.INTRODUCTION: Internal hernia is a very rare cause of intestinal obstruction (0.2-0.9% of cases), associated with 45% mortality. A review of the literature revealed just eight reported cases of double omental hernia since 1950 of which our patient is the first case successfully treated laparoscopically. CASE PRESENTATION: We report on a 29-year-old man who presented with signs and symptoms of intestinal obstruction. The patient underwent emergent exploratory laparoscopy. This revealed herniation of a 20-cm jejunal loop through the gastrocolic ligament and reemergence through a defect in the gastrohepatic ligament. The strangulated loop was reduced with slight traction, and the defect was repaired. The patient was discharged from hospital in just 5 days' time, and after 6 months of follow-up, the general condition of the patient was normal. CONCLUSIONS: laparoscopy is a good technique with minimal complications compared with laparotomy. As many cases are missed due to nonspecific signs and symptoms, an urgent laparoscopy or laparotomy is highly recommended in such a situation.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
7/11. Obstruction of the proximal jejunum by an anomalous congenital band--a case report.A case of proximal jejunal obstruction by a congenital band is reported. The band ran from the antimesenteric wall of the proximal jejunum just distal of the Treitz's ligament to the root of the mesentery. Lysis of the band and enterotomy were performed to make sure no intrinsic obstruction cured the patient. No recurrence was found after 3 months of follow-up. To the best of the authors' knowledge, this is the second case with an anomalous congenital band causing proximal jejunal obstruction reported in the English-language literature.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
8/11. Double jejunal intussusception in an adult with chronic subileus due to a giant lipoma: a case report.We present a case of a 40-year-old male with a clinical history of intermittent intestinal occlusion, abdominal pain and moderate weight loss. physical examination and laboratory tests were unremarkable. diagnostic imaging including CT, MR and small-bowel barium x-rays provided evidence of a jejunal lesion of an unknown nature downstream of the ligament of Treitz. Only at surgery was it possible to identify a double intussusception due to a giant stalked polyp which the histological examination revealed to be a submucosal lipoma.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
9/11. Case of spontaneous gastrojejunal fistula due to gastric cancer.A rare case of gastrointestinal fistula secondary to gastric cancer is presented. Fluoroscopic examination visualized the passage of contrast medium from the stomach to the small intestine. Gastric fiberscopy revealed cancer on the greater curvature of the corpus perforating into the jejunum. The scope could be inserted readily into jejunum through this perforation. laparotomy showed that the cancer infiltrated and perforated from the stomach to the jejunum at about 10 cm. from the ligament of Treitz. Distal gastrectomy and resection of 10 cm. of the perforated jejunum were performed. The resected specimen revealed a Borrmann III gastric cancer of the greater curvature perforating the jejunum.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
10/11. Internal herniation through a broad ligament defect after obturator hernia repair.A case of internal herniation into a broad ligament pouch 5 months after obturator herniorrhaphy is reported. We believe this to be the first reported postoperative case of internal herniation into such a defect in the broad ligament following obturator herniation repair. Computed tomography was useful in the preoperative diagnosis.- - - - - - - - - - ranking = 6keywords = ligament (Clic here for more details about this article) |
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