[A Case of Intestinal Lymphoma with Two Perforation in a Short Period Time].

An 86 years old man was diagnosed with jejunum tumor by detail examination of anemia. Eight days after endoscopy he developed abdominal pain, an emergency surgery was performed by a diagnosis of gastrointestinal perforation. They detected perforation in jejunum and performed jejunum resection, small intestinal lymphoma was diagnosed by histopathological examination. We were talked about chemotherapy against lymphoma, he was transferred at our hospital. The first chemotherapy was provided, abdominal pain appeared at 2 days after chemotherapy. Computed tomography revealed air bubbles out of intestinal tract, we performed emergency operation. A perforation of jejunum in the part where is different from the last time was existed, we performed jejunum resection. Chemotherapy was performed postoperatively, resulted in successful progress. Lymphoma of gastrointestinal tract often causes intestinal perforations, but reports that perforations heterochrony in separate parts multiple tumors of intestine is rare. We report a case of intestinal lymphoma with 2 perforations in a short period time.

[A Case of Jejunal Cancer Treated by Laparoscopic Partial Jejunectomy].

The patient was a 30s male visited our hospital with the complaints of abdominal pain and melena. The internal medicine physician could not detect the cause of the melena by upper and lower gastrointestinal endoscopy. Although the patient resolved with a fast as conservative management so he left our hospital once, he relapsed nausea and abdominal pain. He visited our department. We performed surgery under a preoperative diagnosis of intestinal obstruction. The histopathological diagnosis was moderate differentiated jejunal adenocarcinoma(Stage ⅡA). At present, 1 year 7 months since surgery, the patient survives although with lymphnode recurrence.

[A Case of Primary Jejunal Cancer Treated with Laparoscopic Jejunectomy with Appearance of Ileus].

An 83-year-old man visited our hospital for vomiting. Chest-abdominal computed tomography(CT)revealed that a tumor whose inside was imaged in the jejunum about 15 cm after leaving the Treitz ligament was pointed out, and dilation of the oral intestinal tract of the tumor was observed. Upper gastrointestinal endoscopy showed a type 3 circumferential tumor at the jejunum. He was diagnosed with obstructive ileus due to jejunal cancer. Laparoscopic-assisted partial jejunal resection was performed. Although the patient was followed up without chemotherapy, CT showed multiple lung and liver metastases and a mass lesion was found in the right entire chest, and a biopsy revealed skin metastasis 6 months after the operation. The patient is being followed up 10 months after surgery, there is no progression of liver, lung, and skin metastasis.

Misdiagnosis of multiple synchronous small bowel adenocarcinomas as intestinal tuberculosis: a case report.

BACKGROUND: Small bowel adenocarcinoma (SBA) is a rare malignancy that primarily occurs in the duodenum. Multiple synchronous SBA is unique rare and difficult to diagnose due to non-specific disease presentation. Protocols to identify multiple synchronous SBA during early disease stages are urgently required. CASE PRESENTATION: An elderly man experienced left lower abdominal pain and melena for 3 months. Abdominal CT showed thickening of the multiple segmental small intestinal walls. As the patient had pulmonary tuberculosis simultaneously, he was misdiagnosis as intestinal tuberculosis and received anti-spasm therapy. The treatment delayed radical resection surgery and the patient underwent palliative segmental resection of the jejunum after 4 months due to intestinal obstruction. Resected specimens showed multiple synchronous SBA (five tumors). The patient accepted chemotherapy postoperatively. Six months postoperatively, the patient died of brain metastasis. CONCLUSIONS: We highlight how multiple synchronous SBA is rare and easily misdiagnosed. We should rule out multiple synchronous SBA when diagnosing intestinal diseases (e.g. inflammatory bowel disease, IBS). Intestinal tuberculosis may also be one of the risk factors for multiple synchronous SBA. High-risk patients should be assessed for known tumor makers, and receive gastroscopy, enteroscopy or capsule endoscopy. Doctors should obtain the pathology under endoscopy to the greatest possible degree. For suspected patients, laparotomy should be performed.

A case of jejunal neurofibroma in von Recklinghausen's disease with active hemorrhage, detected and located with gastrointestinal bleeding scintigraphy: A case report with literature review.

A 69 year old patient was admitted to hospital with massive gastrointestinal hemorrhage. The clinical presentation of the patient, except for bleeding, was dominated by the presence of neurofibromatosis type 1 - Von Recklinghausen disease. The patient was referred to multislice computed tomography (CT) angiography, magnetic resonance imaging (MRI), esophagogastroduodenoscopy and colonoscopy, which were performed without successful detection of the bleeding site. The MRI examination showed the existence of a tumor located in the small pelvis. After that, gastrointestinal bleeding scintigraphy (GIBS) with technetium-99m (99mTc) pyrophosphate in vivo labeled erythrocytes was done. Gastrointestinal bleeding scintigraphy showed active intraluminal bleeding from the projection of jejunum, which flowed through the small intestine to the descending colon and the sigmoidal and rectal segment of the colon. Surgical resection of the abdomen revealed the existence of tumors in the jejunum with active bleeding and resection and anastomosis was done. Histopathological verification showed intestinal neurofibroma. In this case GIBS showed usefulness in proving the existence of active bleeding in the small intestine and its localization, and it was of a great help in planning the surgical treatment of a patient.

[Inflammatory fibroid polyp in the jejunum - a case report].

Inflammatory fibroid polyps (IFP) are rare type of benign tumours found in the gastrointestinal tract. IFP´s are in most cases small in size and without symptoms but can cause intussuception and haemorrhage. We present a case of a 25 year old female who presented with abdominal pain and symptoms and signs of anemia, hemoglobin was 36 g/L upon arrival. Further workup revealed a large tumor in the small intestine. The patient underwent a partial resection of the proximal jejunum. Pathology of the specimen showed inflammatory fibroid polyp.

Small bowel metastasis from pulmonary rhabdomyosarcoma causing intussusception: a case report.

BACKGROUND: Rhabdomyosarcoma (RMS), especially primary pulmonary RMS, is an extremely rare type of soft tissue sarcoma in adults. Small bowel is an uncommon site for metastases. CASE PRESENTATION: This report described an unusual case of jejunum metastasis from primary pulmonary RMS causing intussusception in a 75-year-old man. The patient consulted for 2 weeks of continuous dyspnea. Chest computed tomography (CT) demonstrated a large mass involving the left lower lobe. Transthoracic biopsy confirmed the existence of pleomorphic RMS. Immunohistochemical studies showed positive findings about desmin and MyoD1. The results of gastroscopy, colonoscopy and abdominal CT were all negative. Positron emission tomography/CT demonstrated a fluorodeoxyglucose-reactive large lesion in the left lower lobe without metastatic lesions. The patient received synchronous chemoradiotherapy. After 9 months, the patient presented with intermittent upper abdominal pain with nausea and vomiting. CT showed small bowel dilatation secondary to intussusception. The patient subsequently received laparotomy, and the intussuscepted small bowel segment was resected. Histological examination revealed pleomorphic RMS involving the mucosa, submucosa, and muscular tissues. CONCLUSIONS: RMS is highly aggressive and metastatic. The metastatic disease can rapidly progress to cause subsequent complications. The possibility of small bowel metastasis should be considered, although it is extremely rare.

Ruptured desmoid tumor imitating acute appendicitis - a rare reason for an emergency surgery.

BACKGROUND: Desmoid tumors, also known as aggressive fibromatosis, are extremely rare, accounting for less than 3% of soft-tissue sarcomas and less than 0,03% of all neoplasms. The diagnosis is usually delayed because of the lack of specific symptoms, and can sometimes lead to serious and, even fatal complications. CASE PRESENTATION: We report the case of a 27-year-old male patient presenting with the clinical picture of acute appendicitis. During the operation, we found a tumor in the jejunum with a necrotic zone and perforation on its surface, causing hemorrhagic effusion into the abdominal cavity and subsequent peritonitis. The tumor was removed with negative margins via resection of the small bowel. The final histological result showed aggressive fibromatosis. CONCLUSIONS: Aggressive fibromatosis remains a serious problem with the possibility of locally aggressive behavior with high rates of recurrence. Sometimes, its clinical and macroscopic recognition can be immensely tricky. As shown by our patient, on rare occasions, desmoid tumors can lead to acute surgical abdomen requiring an emergency operation.

Diffuse large B-cell lymphoma of the small intestine in a patient with refractory coeliac disease.

INTRODUCTION: Coeliac disease enteropathy is associated with an increased risk of lymphomas. Enteropathy-associated T-cell lymphoma is the principal malignancy related to coeliac disease. However, studies have shown that other types of lymphoma such as diffuse large B-cell lymphoma may also be associated with coeliac disease. CASE REPORT: We report a 54-year-old Caucasian man who presented with chronic diarrhoea and weight loss. He was diagnosed with coeliac disease based on positive serology results and duodenal, jejunal, and ileal biopsies that showed villous atrophy. Despite adherence to a gluten-free diet, there was no clinical remission and enteropathy-associated T cell lymphoma was suspected. Repeated endoscopic biopsy showed persistent mucosal disease but no evidence of lymphoma. Several weeks later he presented with a perforated jejunum. Histology of the resected jejunum showed diffuse infiltration of submucosa and muscularis propria by malignant lymphoid cells sparing the mucosa. The cells expressed CD20, CD79α, CD10 and BCL6 and ki67 of 80%, consistent with diffuse large B-cell lymphoma. DISCUSSION: It is suspected that the undetected lymphoma may have contributed to the persistent malabsorption syndrome rendering the patient unresponsive to treatment. Despite thorough clinical and endoscopic evaluation and multiple biopsies, histologic diagnosis of DLBCL was only confirmed following resection of the perforated jejunum.

[A Case of Jejunal Ectopic Pancreatic Cancer with Intestinal Perforation].

This patient was a 96-year-old woman. She was referred to our hospital with abdominal pain and vomiting. The levels of the tumor markers CEA and CA19-9 were elevated, at 39.47 ng/mL and 918.5 U/mL, respectively. She was diagnosed with peritonitis with digestive tract perforation by abdominal CT and an emergency operation was performed. At laparotomy, dirty ascites was observed in the peritoneal cavity. A perforation, 1 cm in diameter was found in the jejunum 15 cm from the Treitz ligament, and a mass, 2 cm in diameter was also palpated on the mesentery side. We performed jejunectomy including the tumor. The submucosal tumor was 2 cm in size and the mucosal surface of the perforation was ulcerated. Pathohistological inspection of the extracted sample revealed no heteromorphism in the small intestine mucosal plane. A moderately differentiated adenocarcinoma was diagnosed in the submucosal layer of the heterotopic pancreas of Heinrich typeⅡ. No tumor cells were found in the perforation. Thirteen previous cases of ectopic pancreatic cancer have been reported and this was the 14th case.

[A Case of Intussusception in the Jejunum Due to Small Intestinal Adenocarcinoma].

The patient was a woman in her 60's with an 11-month history ofpersistent epigastralgia and abdominal distension, without abnormal findings on upper endoscopy, abdominal ultrasonography, and abdominal computed tomography in other hospitals. She presented to our hospital with a complaint off requent vomiting; abdominal CT indicated intussusception in the jejunum due to a small intestinal tumor, and laparoscopic exploration and partial jejunectomy were performed. The histopathological diagnosis was tub1>tub2>pap, pT4(SE), pN1, pPM0, pDM0, pStage III A. She was treated with oral chemotherapy( S-1)and developed no recurrence 7 months after surgery. Laparoscopic exploration was useful to detect intussusception in the jejunum due to small intestinal adenocarcinoma.

[A case of jejunal neuroendocrine carcinoma complicated with dermatomyositis].

A 65-year-old woman who had been diagnosed with dermatomyositis presented to the hospital with a small bowel mass. She had tested positive for fecal occult blood test and anemia at a medical checkup;therefore, computerized tomography (CT) was performed at the previous hospital and it had revealed thickening of the intestinal wall. Abdominal contrast-enhanced CT, single-balloon assisted enteroscopy, and biopsy led to a diagnosis of poorly differentiated jejunal adenocarcinoma. The patient underwent laparoscopic segmental resection of the jejunum with dissection of mesenteric lymph nodes. A histological examination revealed that the tumor was neuroendocrine carcinoma (NEC), large-cell type of the jejunum, pT3, pN0, sM0, and pStage IIA. Immunohistochemically, the NEC component was positive for chromogranin A and negative for neural cell adhesion molecule and synaptophysin. The MIB-1 index was 60%. Four courses of postoperative chemotherapy using cisplatin and etoposide were administered. The patient is currently doing well without any recurrence or metastasis. To the best of the author's knowledge, this is the first report of dermatomyositis associated with primary jejunal NEC.

Small bowel intussusception due to malignant melanoma: primary lesion or metastases? A case report.

Intussusception is a rare condition in the adult population: it is responsible for 1% of all bowel obstructions. In most of intussusceptions a malignant tumor is involved; a lot of studies show that approximately 50% of malignant metastases causing small bowel intussusception are metastatic melanomas. In present paper a case of a small bowel intussusception probably due to metastases of an occult melanoma, in a 69-year-old patient, is presented. Surgery resection, careful research of possible primitive neoplasms and an accurate follow-up program has been the treatment of choice. All the investigations carried out did not allow to identify a possible primitive neoplasm. The last whole body PET carried out 44 months after surgery resulted disease-free.

A Rare Case of Intestinal Obstruction in an Elderly Woman.

Among intestinal obstruction, intussusception is one of the rare mechanical causes in the adult period. When it is met it present with abdominal pain, vomiting and other symptoms compatible with intestinal obstruction varying on the segments being involved. Compared to pediatric invagination which it is mostly idiopathic the adult form has an organic etiology causing a blurred symptomatology and needing advanced imaging diagnosis like computerized tomography. We present the case of a 70 year old woman with multiple Emergency Department presentations with abdominal pain and vomiting which received a clear diagnosis only the third time she came to hospital. Ultrasonography and plain abdominal x-ray were no specific and only the CT scan revealed the real cause of obstruction. Also conservative measures were useless the definitive treatment being surgery, the lesion necessitating enteral resection and end to end anastomosis. The pathology report revealed a benign tumor of proximal jejunum. In conclusion, adult intestinal invagination, although it is a rare condition, can present with symptomatology varying with segment of bowel involved into the intussusception. Unlike pediatric invagination, the adult one needs standard surgical revision unless there are certain contraindications.

Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis.

BACKGROUND AND AIMS: Enteroscopy (wireless or wired) is the reference standard for small-bowel (SB) diseases, and it has been applied to detect SB malignancies in complicated celiac disease (CD) with heterogeneous results. The aim of this meta-analysis was to obtain a diagnostic yield (DY) by pooling the data of studies that investigated the use of enteroscopy to detect SB adverse events in CD. METHODS: We performed an online search for studies estimating the DY of wireless and wired enteroscopy in predicting the presence of SB premalignant and/or malignant lesions. The DerSimonian and Laird random-effects method was used to pool the arcsine-transformed proportions of patients with the events. Three meta-analyses were performed considering the following events: the presence of a malignancy, premalignant damage (ulcerative jejunoileitis [UJ]), or the presence of a malignancy or UJ. A subgroup analysis was performed after extracting (if possible) patients with refractory CD (RCD). RESULTS: Of the 529 titles initially resulting from the search, 10 studies on capsule enteroscopy (CE) and 3 on double-balloon or push enteroscopy met the inclusion criteria. Overall, 439 and 76 patients were enrolled in these studies using CE and enteroscopy, respectively. Twelve tumors and 47 UJs were found by CE versus 8 tumors and 13 UJs detected by wired enteroscopy. For malignancies the CE yield was 1.9% (95% CI, .5%-3.8%) and wired enteroscopy yield 8.7% (95% CI, 0%-21.2%); similarly, for UJ the DYs were 8.4% (95% CI, 2.1%-17.7%) and 16.7% (95% CI, 8.7%-26.3%); for either UJ or neoplasia the DYs were 13.0% (95% CI, 5.6%-22.5%) and 27.7% (95% CI, 14.8%-42.6%). For RCD the DYs of all enteroscopic techniques were 1.8% (95% CI, 0%-7.7%) for neoplasia, 22.3% (95% CI, 8.2%-39.7%) for UJ, and 27.5% (95% CI, 13.1%-44.2%) for either. CONCLUSIONS: Enteroscopy is a powerful and efficient diagnostic tool for the detection of SB malignancies in complicated CD.

Gastrointestinal Bleeding Due to Gastrointestinal Tract Malignancy: Natural History, Management, and Outcomes.

BACKGROUND: Gastrointestinal (GI) tumor bleeding can vary from occult bleeding to massive hemorrhage and can be the presenting sign of malignancy. AIMS: Our primary aims were to: (1) characterize the natural history, treatment, and outcomes in patients with GI tumor bleeding and (2) compare and contrast bleeding in upper GI (UGI)/small bowel (SB) and lower GI malignancies. METHODS: Patients with endoscopically confirmed tumor bleeding were identified through search of consecutive electronic medical records: Bleeding was determined by the presence of melena, hematochezia, hematemesis, or fecal occult blood. Comprehensive clinical and management data were abstracted. RESULTS: A total of 354 patients with GI tumors were identified: 71 had tumor bleeding (42 UGI/SB and 29 colonic). GI bleeding was the initial presenting symptom of malignancy in 55/71 (77%) of patients; 26/71 patients had widely metastatic disease at presentation. Further, 15 of 26 patients with metastatic disease presented with GI bleeding. Visible bleeding was present in 14/42 (33%) and 4/29 (14%) of UGI/SB and colonic tumors, respectively. Endoscopic hemostasis was attempted in 10 patients, and although initial control was successful in all, bleeding recurred in all of these patients. The most common endoscopic lesion was clean-based tumor ulceration. Overall mortality at 1 year was 57% for esophageal/gastric, 14% for SB, and 33% for colonic tumors. CONCLUSIONS: When patients with GI malignancy present with GI bleeding, it is often the index symptom. Initial endoscopic hemostasis is often successful, but rebleeding is typical. Esophageal and gastric tumors carry the poorest prognosis, with a high 1-year mortality rate.

Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report.

Is a case report of a patient with overt obscure gastrointestinal bleeding due to a mesenteric hemolymphangioma with infiltration to jejunum. Diagnosed by capsule endoscopy and treated with double-balloon enteroscopy and surgery.

[A Case of Jejunal Ectopic Pancreatic Cancer with Small Bowel Obstruction].

Were port a caseof an 82-year-old man who presented with vomiting. Computed tomography(CT)revealed a jejunum tumor and small bowel obstruction. Enteroscopy revealed a protruded lesion and biopsy indicated adenocarcinoma. PET-CT revealed nothing without jejunal tumor. Therefore, with a preoperative diagnosis of primary small bowel cancer, we performed operation. Surgery indicated peritoneal disseminations and a jejunal tumor 40 cm distal from the ligament of Treitz, and we performed small bowel partial resection. Pathological examination revealed adenocarcinoma originating from a Heinrich type I ectopic pancreas in the jejunum. Ectopic pancreatic cancer in the jejunum is rare, and we review case reports in the literature.

Polidocanol injection therapy for small-bowel hemangioma by using double-balloon endoscopy.

BACKGROUND AND AIMS: Small-bowel hemangioma is a rare disease that often causes active bleeding. The standard therapeutic method for small-bowel hemangioma is surgical resection. The aim of this study was to evaluate the usefulness of polidocanol injection (PDI) for small-bowel hemangiomas. METHODS: This study included 12 patients with obscure GI bleeding (6 male; mean age 62 years) with 39 small-bowel hemangiomas; patients were treated with PDI by using double-balloon endoscopy (DBE). EUS with DBE was performed before PDI. The lesions were divided into 2 groups according to tumor size: Group A (size <10 mm; 20 lesions) and group B (size ≥10 mm; 19 lesions). The outcomes of PDI treatment for small-bowel hemangioma were evaluated between the 2 groups. Additionally, in order to standardize the amount of PDI injected, the total amount of polidocanol according to lesion size was calculated. RESULTS: There was no difference in the location of lesions and treatment times between the 2 groups. Group B had a significantly higher injection time per lesion (P < .05) and amount of polidocanol per lesion than group A (P < .01). Rebleeding occurred in only 1 case (8%). There were no adverse events related to PDI. The contribution ratio between the lesion size and amount of polidocanol showed a correlation (r = 0.77). The optimal amount of polidocanol for small-bowel hemangioma was determined to be 0.2 mL/mm. CONCLUSIONS: PDI is an easy, safe, and effective method to treat small-bowel hemangiomas.