1/75. A case of aberrant pancreatic cancer in the jejunum.We report a case of aberrant pancreatic cancer of the jejunum in a 63 year-old man. The patient was admitted to our hospital with epigastric discomfort and vomiting due to obstruction of the jejunum. laparotomy revealed a submucosal tumor on the jejunum with multiple liver metastases. Histological examination showed the tumor to be a well differentiated tubular adenocarcinoma originating from aberrant pancreatic tissues lacking islets. Only 1 case of aberrant pancreatic cancer in the jejunum has been previously reported in the literature.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/75. Dieulafoy's lesion of the jejunum.Dieulafoy's lesion is a rare vascular anomaly but a potentially life-threatening disease. This lesion can also be found in the small intestine, which can be diagnosed only by angiography. However, the angiography may be normal when the bleeding is inactive. We report a case of jejunal Dieulafoy's lesion with a repeated attack of massive gastrointestinal bleeding with a normal initial angiography. The pathological examination found an unusual picture as a dilated submucosal vessel protruded like a submucosal tumor.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
3/75. Clinical and pathologic overlap in nonsteroidal anti-inflammatory drug-related small bowel diaphragm disease and the neuromuscular and vascular hamartoma of the small bowel.diaphragm disease (DD) is a radiographically subtle cause of small bowel obstruction and is part of the spectrum of diseases associated with nonsteroidal anti-inflammatory drug injury. The neuromuscular and vascular hamartoma (NMVH) is a nonepithelial hamartomatous, submucosally based proliferation of mature submucosal elements capable of causing small bowel obstruction. The authors report two patients in whom the clinical setting and gross pathology are that of DD, but the histologic characterization is identical to that described for NMVH. It is probable that in some patients the two diseases overlap so that some patients readily fit the criteria for both entities.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
4/75. peutz-jeghers syndrome: case report.A case of peutz-jeghers syndrome (PJS) in an African girl is presented to document the clinical presentation, management and follow up of this condition. The patient who presented with black buccal mucosal hyperpigmentation and clinical features of jejuno-jejunal intussusception was successfully managed by operative reduction of the intussusception and polypectomy. She is being followed up for evidence of malignant transformation in associated intestinal polyps and development of extra-intestinal malignancies at other sites. The management of PJS in light of recent trends is discussed, especially with reference to suggested protocols for screening and surveillance of sites at supposed risk of tumour development.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
5/75. Nonspecific ulcerated jejunitis as an unusual complication of laparoscopic cholecystectomy: report of a case.We describe herein the case of a 65-year-old man in whom a lower gastrointestinal hemorrhage developed a few days after he underwent an elective laparoscopic cholecystectomy. A laparotomy was performed on postoperative day 16 and a jejunal segment containing mucosal changes and oozing ulcers was resected. Pathologic examination of the specimen revealed "nonspecific ulcerated jejunitis." There is no explanation for the etiopathogenesis of this pathology; however, we concluded that this clinical picture may be attributed to ischemia-reperfusion injury that occurred following an ischemic period caused by the pneumoperitoneum during laparoscopic surgery.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
6/75. 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 = 2keywords = mucosa (Clic here for more details about this article) |
7/75. A new etiology of acute abdominal emergencies in cirrhotic patient: secondary pneumococcal peritonitis with jejunitis.We report the first case of secondary pneumococcal peritonitis associated with acute jejunitis in a 52-year-old homeless child-Pugh C cirrhotic man without ascitis. The patient was admitted with clinical signs of peritonitis, and jaundice. Morphologic examination was unremarkable. A laparotomy revealed a diffuse peritonitis, and an acute jejunitis with prenecrotic lesion. The lesion was located within the first centimeters of the jejunum, immediately after the duodeno-jejunal angle, extented on 15 cm. A resection of the first 15 cm of the jejunum was performed with duodeno-jejunal side-to-side manual anastomosis. Gram-stain and cultures of blood, peritoneal pus, and jejunal mucosa revealed a penicillin-sensitive streptococcus pneumoniae. Appropriate parenteral antibiotic treatment was initiated (aminopenicillin). The postoperative course was marked by a transient hepatic failure associated with an ascitis controlled by diuretics. The patient was discharged on the 26th day after surgery. This case reports a new etiology of acute abdominal emergencies in cirrhotic patients.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
8/75. Recurrent hemorrhaging from stomal ulcers following a side to side longitudinal pancreaticojejunostomy for chronic pancreatitis: report of a case.Gastrointestinal (GI) hemorrhaging secondary to stomal ulcers following a pancreaticojejunostomy for chronic pancreatitis is a rare postoperative condition that has not hitherto been reported in the literature. A 25-yr-old Japanese female was referred to Ryukyu University Hospital with GI hemorrhaging of unknown origin. She had undergone a modified Puestow procedure (Partington procedure) for chronic pancreatitis with pancreatolithiasis and an associated dilatation of the main pancreatic duct at 19 yr of age. A technetium-99m blood-flow scan demonstrated the pooling of radionuclides in the area of the jejunal loop, which was highly suggestive of bleeding into the jejunum. Over the next day, she demonstrated persistent melena. At exploratory laparotomy, the anastomotic jejunal loop was filled with clotted blood. Operative endoscopy through an incision of the jejunal loop in close proximity to the anastomosis showed oozing blood from the anastomotic jejunal mucosa. Following a resection of the affected anastomotic segment of the jejunum, a side to side longitudinal pancreaticojejunostomy was again performed on this patient. The resected jejunum showed pathologically pseudopolyp-like edema, congestion, and an ulceration of the stomal mucosa. The patient showed a good postoperative course and has been doing well for the past 8 yr since reoperation.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
9/75. NSAID-induced small bowel diaphragms and strictures diagnosed with intraoperative enteroscopy.Nonsteroidal anti-inflammatory drugs are known to cause mucosal damage in the stomach and duodenum, which may lead to hemorrhage and perforation. However, these medications may also cause damage in the more distal small bowel. Due to the location of these lesions, currently available diagnostic testing may yield false negative results. Two cases of nonsteroidal anti-inflammatory drug-induced small bowel diaphragms presenting as obscure gastrointestinal hemorrhage and recurrent small bowel obstruction, respectively, are discussed. Intraoperative enteroscopy was used to confirm this diagnosis after other diagnostic tests failed to identify the etiology. This procedure may increase the accuracy of exploratory laparotomy in these challenging cases.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
10/75. Intraoperative localization of ectopic gastric mucosa in the nonduplicated intestinal lumen with technetium 99m pertechnetate scanning.The occurrence of ectopic gastric mucosa in Meckel's diverticula and duplications of the intestinal tract is a source of serious morbidity from bleeding and perforation in children. Intraoperative localization of the ectopic mucosa is aided by its occurrence in the duplicated intestinal segment or Meckel's diverticulum. However, its identification in the nonduplicated intestine poses problems for the surgeon faced with removal of the affected segment. The authors present a case of ectopic gastric mucosa in a nonduplicated jejunal segment and discuss the use of technetium 99m pertechnetate scanning in its localization.- - - - - - - - - - ranking = 7keywords = mucosa (Clic here for more details about this article) |
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