When all else fails: the colo-duodenal anastomosis.

Total enterectomy is an exceedingly rare procedure performed out of necessity due to massive intestinal infarction, trauma, or peritoneal malignancy. This case describes a 47-year-old patient who has successfully undergone the procedure to manage mesenteric ischaemia. Bowel continuity was achieved with a duodenocolonic anastomosis, and the patient has been transitioned to life-long total parental nutrition. This case highlights that carefully selected patients can achieve long-term survival with good quality of life rather than palliation.

Correlation between white blood cell count and intestinal resection in patients with acute mesenteric vein thrombosis.

OBJECTIVE: Acute mesenteric vein thrombosis (AMVT) is an acute abdominal disease with onset, rapid progression, and extensive intestinal necrosis that requires immediate surgical resection. The purpose of this study was to determine the risk factors for nosocomial intestinal resection in patients with AMVT. METHODS: We retrospectively analysed 64 patients with AMVT diagnosed by CTA at the Affiliated Hospital of Kunming University of Science and Technology from January 2013 to December 2021. We compared patients who underwent intestinal resection (42 patients) with those who did not undergo intestinal resection (22 patients). The area under the ROC curve was evaluated, and a forest map was drawn. RESULTS: Among the 64 patients, 6 (9.38%) had a fever, 60 (93.75%) had abdominal pain, 9 (14.06%) had a history of diabetes, 8 (12.5%) had a history of deep vein thrombosis (DVT), and 25 (39.06%) had ascites suggested by B ultrasound or CT after admission. The mean age of all patients was 49.86 ± 16.25 years. The mean age of the patients in the enterectomy group was 47.71 ± 16.20 years. The mean age of the patients in the conservative treatment group (without enterectomy) was 53.95 ± 15.90 years. In the univariate analysis, there were statistically significant differences in leukocyte count (P = 0.003), neutrophil count (P = 0.001), AST (P = 0.048), total bilirubin (P = 0.047), fibrinogen (P = 0.022) and DD2 (P = 0.024) between the two groups. The multivariate logistic regression analysis showed that admission white blood cell count (OR = 1.153, 95% CI: 1.039-1.280, P = 0.007) was an independent risk factor for intestinal resection in patients with AMVT. The ROC curve showed that the white blood cell count (AUC = 0.759 95% CI: 0.620-0.897; P = 0.001; optimal threshold: 7.815; sensitivity: 0.881; specificity: 0.636) had good predictive value for emergency enterectomy for AMVT. CONCLUSIONS: Among patients with AMVT, patients with a higher white blood cell count at admission were more likely to have intestinal necrosis and require emergency enterectomy. This study is helpful for clinicians to accurately determine whether emergency intestinal resection is needed in patients with AMVT after admission, prevent further intestinal necrosis, and improve the prognosis of patients.

Evaluation of the safety and efficacy of perform enterectomy in colorectal cancer patients aged 80 or older. A meta-analysis and a systematic review.

BACKGROUND: Colorectal cancer (CRC) is one of the four most common cancers in the world. At present, human beings have stepped into an aging society, and the number of over eighties colorectal cancer patients has increased year by year. However, few high-quality studies focused on the post-operation complications and long-term outcomes of octogenarian patients with colorectal cancer. This meta-analysis, based on published studies, aims to assess the safety of treating octogenarian CRC patients with surgery. METHODS: Databases, including PubMed, Embase, and Cochrane Library were searched until July 2022. The incidence of preoperative comorbidities, postoperative complications, and mortality was assessed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Furthermore, the hazard ratios (HRs) with 95% CIs were applied for survival outcomes. RESULTS: A total of 13,790 patients with CRC in 21 studies were included. Our results demonstrated that octogenarian patients were associated with a higher burden of comorbidities (OR = 3.03; 95% CI: 2.03, 4.53; P = .000), high incidences of overall postoperative complications (OR = 1.63; 95% CI: 1.29, 2.06; P = .000), high internal medicine postoperative complications (OR = 2.38; 95% CI: 1.76, 3.21; P = .000), high in-hospital mortality (OR = 4.01; 95% CI: 3.06, 5.27; P = .000) and poor overall survival (OR = 2.13; 95% CI: 1.78, 2.55; P = .000). But there is no statistical difference in surgery-related postoperative complications(OR = 1.16; 95% CI: 0.94, 1.43; P = .16) and DFS (OR = 1.03; 95% CI: 0.83, 1.29; P = .775). CONCLUSIONS: Extremely elderly patients with colorectal cancer have the high burden of comorbidities, high postoperative complications and mortality. However, survival outcomes (DFS) in patients 80 years and older are similar to younger patients. Clinicians should administer individualized treatment for such patients. Physiologic age rather than chronological age should determine cancer management for each individual.

Extrapulmonary COVID-19 Presents As Spontaneous Small Bowel Perforation.

SARS-CoV2 is a well-recognized pathogen with a myriad of presenting symptoms. Well-documented pulmonary, neurological, gastrointestinal, and hematologic complications have occurred during the global COVID-19 pandemic. While gastrointestinal symptoms are the most commonly reported extrapulmonary symptom of COVID-19, the incidence of primary perforation has not been widely reported. In this case report, we describe a spontaneous small bowel perforation in a patient who was incidentally found to be COVID-19 positive. This peculiar case underlies the continued evolution of SARS-CoV2 understanding and potential unknown complications of the virus.

A secondary jejunal malignant melanoma from nasal mucosal melanoma: Case report.

Melanomas most commonly localized in the skin can arise anywhere in the body, and approximately 5% of all melanomas appear in other sites of mucosal surfaces out of skin. Primary melanoma from nasal mucosa is quite rare. We present this case: a 46-year-old man had complained a pain in the left upper abdomen for 2 months when he was admitted to the Northern Jiangsu People's Hospital. The pain was paroxysmal and enhanced when eating. There was no nausea, vomiting, or anorexia. There had been no change in weight in previous months. This patient had a past history of surgery for nasal mucosal malignant melanoma 2 years ago. Abdominal enhanced computed tomography (CT) indicated that a mass originated from small bowel and occupied the left upper abdomen. The patient underwent a laparotomy during which a black lesion measuring about 5 cm × 5 cm × 4 cm was found at the jejunum and resected totally together with partial jejunum. The patient was eventually diagnosed as secondary jejunal malignant melanoma from nasal mucosal melanoma. For patients with a history of melanoma, gastrointestinal metastasis should be considered when patients develop gastrointestinal symptoms. In addition, we recommend positive anti-tumor therapy after surgery.

Colovesical fistula in a young adult due to sigmoid colon diverticulitis undetected in computed tomography: Case report and review of literature.

INTRODUCTION: Colovesical fistula is the pathological communication between the colon and urinary bladder. It is related with high morbimortality rate and it is and uncommon complication of diverticulosis in young adults. CASE PRESENTATION: We report a case of a 38-year-old Brazilian man with fecaluria and pneumaturia for eight months, whose colovesical fistula was undetectable in CT scan and with surgical management. DISCUSSION: Diverticulosis is the main inflammatory condition causing colovesical fistulas and the sigmoid colon is the most common part involved. It is more prevalent in patients over 60 years old and in western countries due to low fiber diet. CONCLUSION: Colovesical fistula diagnosis is difficult, requiring high suspicious and proper investigation through good anamnesis, CT scan and also colonoscopy and cystoscopy when necessary.

Ewing sarcoma of the jejunum: A case report and literature review.

BACKGROUND: Ewing sarcomas (ESs) are highly aggressive malignancy and are predominant in the long bones of extremities of children and young adults with a slight male predilection and rarely presents at extra skeletal locations. CASE SUMMARY: A 55-year-old woman came to our hospital after finding elevated tumor biomarkers during her physical examination. Her enhanced computed tomography scan showed a jejunal mass. The patient underwent laparoscopic enterectomy. The mass was later diagnosed as ES, evidenced by fluorescence in situ hybridization whereby the GLP ES breakpoint region 1 probe was used, showing that more than 10% of the cells showed a red-green-yellow signal proving the breakpoint rearrangement of the ES breakpoint region 1 gene in chromosome 22. CONCLUSION: We describe a case of localized ES at the jejunum in China based on the literature.

Surgical treatment for gastrointestinal neuroendocrine tumors.

Neuroendocrine tumors (NETs) are rare neoplasms, with an estimated annual incidence of 6.9/100 000. They arise from cells of the diffuse endocrine system, which are mainly dispersed throughout the gastrointestinal (GI), pancreatic, and respiratory tracts. The incidence of GI-NETs has recently begun to show a steady increase. According to the Surveillance, Epidemiology, and End Results database, 53% of patients with NETs present with localized disease, 20% with locoregional disease, and 27% with distant metastases at the time of diagnosis. Surgery is the mainstay for the treatment of locoregional GI-NETs. Endoscopic resection is an option for well-differentiated early GI-NETs, which are thought to very rarely metastasize to lymph nodes. A lesion that is technically difficult to resect via endoscopy is an indication for local resection (partial resection without lymph node dissection). GI-NETs with possible lymph node metastasis is an indication for enterectomy with lymph node dissection. For NETs with metastatic lesions, cytoreduction surgery can control hormonal hypersecretion and alleviate symptoms; therefore, cytoreduction surgery is recommended. The indications for surgery vary and are based on the organ where the NET arose; therefore, an understanding of the patient's clinical state and individualized treatment that is based on the characteristics of the patient's GI-NET is needed. This review summarizes surgical treatments of GI-NETs in each organ.

Case report: Total enterectomy following complete small bowel ischaemia in the post-peritonectomy setting.

INTRODUCTION: This report presents the rare case of a patient with complete bowel ischaemia following parastomal hernia, leading to total bowel resection, with consideration of post-operative complications and wound management. PRESENTATION OF CASE: A 59 year old female was found to have complete small bowel ischaemia on exploratory laparatomy, on a background of recurrent appendiceal adenomucinosis, for which she had received previous peritonectomy, cholecystectomy, total colectomy, and partial small bowel resection. The patient was managed with total enterectomy and post-operative total parenteral nutrition. DISCUSSION: Total enterectomy represents a significant challenge in the postperitonectomy setting, including consideration of wound management with the empty abdomen, and the potential of small bowel transplant in management. CONCLUSION: Resection of the small bowel following total small bowel ischaemia is feasible in the post-peritonectomy setting, given appropriate post-operative care and wound management. However, long-term survival remains challenging, especially without small bowel transplant.

Distal Duodenogastrostomy or Proximal Jejunogastrostomy in the Management of Ultra-Short Bowel.

Inflammatory bowel disease, vascular disease, volvulus, adhesions, or abdominal trauma may necessitate extensive small-bowel resection resulting in an ultra-short distal duodenal or jejunal stump. If this distal duodenal or short jejunal stump is too short for stoma creation and bowel continuity restoration is hazardous or not possible at all, a distal duodenogastrostomy or proximal jejunogastrostomy in combination with drainage of the stomach is an option to prevent stump leakage. Although successful, this distal duodenogastrostomy has been described only in very few patients and in older records. We reintroduced this technique and describe a recent series of patients that confirms its usefulness in certain conditions. The technique of the distal duodenogastrostomy or proximal jejunogastrostomy with gastric drainage was used for the management of the difficult distal duodenum stump in five critically ill patients undergoing extensive bowel resection. Four patients with small-bowel ischemia and one patient suffering from perforating Crohn's disease and small-bowel volvulus were treated  successfully. The gastrostomies were subsequently converted to a duodenotransversostomy (in two patients) or the patients underwent small-bowel transplantation (two patients). One patient still has a jejunogastrostomy just after the duodenal-jejunal transition. In all five patients, the distal duodenogastrostomy or proximal jejunogastrostomy in combination with gastric drainage functioned well up to restoration of bowel continuity. In one patient, distal duodenogastrostomy and transabdominal gastric drainage functioned well for 5 years. No anastomotic leakage occurred. This procedure provides a feasible solution for an ultra-short bowel at emergency laparotomy. It enhances the surgical armamentarium and provides treatment options for these patients that were perhaps previously deemed unsalvageable.

Midgut neuroendocrine tumor presenting with acute intestinal ischemia.

Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms, which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.

Endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus:feasibility and efficacy / 实用医学杂志

Objective To investigate the feasibility and efficacy of endoscopic catheterization of ileus tube combined enterectomy for the treatment of elderly patients with acute sigmoid volvulus. Methods From August 2015 to August 2017,27 cases of elderly patients with acute sigmoid volvulus received treatment of endoscopic placement of ileus tube combined enterectomy in Pudong New Area Gongli Hospital.Retrospectively collected clin-ic parameters of pre-catheterization,post-catheterization,enterectomy and postoperative follow-up;the success rate of catheterization and enterectomy,compression efficiency,post-operative complications,and efficacy of the com-bined therapy were analyzed. Results Emergency catheterizations of anorectal ileus tube were succeeded in 27 (100%)patients;one patient who developed intestinal gangrene received emergency enterectomy,the hemogram and internal environmental disturbance of the 26 cases were significantly relieved,and the efficacy rate of decom-pression was 96.3%. The success rate of was enterectomy was 100%;the incidence of severe complications and mortality were 22.2% and 3.7%,respectively. During the follow-up,2(7.4%)patients developed ileus,and the efficacy rate of the combined therapy was 85.2%. Conclusions The catheterization of ileus tube could effectively depress intestinal pressure. The success rate of enterectomy was significantly improved and postoperative mortality was reduced. The therapy of endoscopic ileus tube catheterization combined enterectomy is a safe and effective method for the treatment of acute sigmoid volvulus in the elderly.

Intestinal Surgery.

A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions.

Laparoscopic resection of gastrointestinal stromal tumors (gist) / Ressecção laparoscópica de tumores estromais gastrintestinais (gist)

Background : Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully. Aim : Describe a single center experience on laparoscopic GIST resection. Method : Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique. Results : Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence . Conclusion : Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique.

Racional: Os tumores estromais ou mesenquimais gastrointetinais (GIST) são lesões originárias da parede do tubo digestivo cujo tratamento requer remoção cirúrgica. Diversas técnicas por via laparoscópica - gastrectomias e ressecções segmentares - têm sido empregadas com sucesso. Objetivo: Apresentar a experiência de um serviço de cirurgia com ressecção laparoscópica de GIST. Métodos: Foram avaliados 15 pacientes com GIST operados revisados retrospectivamente. Treze tiveram lesões gástricas, das quais 10 eram subepiteliais entre 2-8 cm. Três eram lesões exofíticas puras. Dois apresentavam lesões no intestino delgado. O tratamento cirúrgico por laparoscopia consistiu de duas gastrectomias distais; 11 ressecções gástricas em cunha e duas enterectomias segmentares. Sutura mecânica foi utilizada na maioria dos doentes, exceto em seis com suturas absorvíveis manuais. Não houve conversões para laparotomia. Resultados: O tempo médio das operações foi de 89±92 min (40-420). A hospitalização média foi de três dias (2-6). Não houve fístula, sangramento pós-operatório ou necessidade de reintervenção por complicação cirúrgica. O seguimento médio pós-operatorio foi de 38±17 meses (6-60). Três pacientes foram encaminhados para terapia adjuvante com mesilato de imatinib, um deles por recidiva precoce aos cinco meses, e os outros dois por apresentarem risco moderado para recidiva. Conclusão: A ressecção laparoscópica de GIST, mesmo os maiores de 5 cm, é procedimento factível e seguro.

More on 'No Gut Syndrome': A case report.

INTRODUCTION: No Gut Syndrome refers to a condition which results after a near total enterectomy (NTE) has been performed. These patients are unable to sustain life without life-long parenteral nutrition (PN). Re-establishment of bowel continuity, complications, quality of life (QoL), and overall outcomes are important aspects to be considered in patients who might need a NTE. We have previously reported two similar cases as well as a literature review in patients with No Gut Syndrome. In the present report, we present an additional case and an update of the literature. PRESENTATION OF THE CASE: A 62-year old man with multiple co-morbidities presented with features of acute small bowel obstruction. Exploratory laparotomy revealed severe mesenteric ischemia and extensive small bowel necrosis. Patient eventually underwent a NTE and was discharged on parenteral nutrition. DISCUSSION: Near total enterectomy (NTE) is a clinical condition in which a patient is left without or with minimal length of small bowel along with either gastrointestinal continuity or exteriorization of the proximal end. This condition has remained a dilemma for surgeons worldwide chiefly as a result of its perceived incompatibility with life. There are only a few available options for proceeding with treatment, however maintenance on long term parenteral nutrition has shown promising results. CONCLUSION: Long term parenteral nutrition serves as a viable treatment option for managing patients after a NTE.

Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years

BACKGROUND: Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied. METHODS: Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation. RESULTS: All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred. CONCLUSIONS: Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.

Laparoscopic partial gastrectomy and enterectomy for morbid obesity / 中华普通外科杂志

Objective To explore the short-term result and safety of laparoscopie sleeve gastrectomy and partial enterectomy for the treatment of morbid obesity.Methods Ten patients underwent laparoscopic sleeve gastrectomy,omentectomy,and partial enterectomy as a treatment option for weight reduction between December 2006 and September 2007.The procedure included 70%-75%vertical (sleeve)gastrectomy,omentectomy,and 1/3 to 2/5 enterectomy preserving proximal jejunum and most of the ileum. Results Laparoscopy was completed in all patients,no conversion to open surgery.The operation time averaged at 3.1 hours(range 2.5-3.5 hours),and there was no postoperative complications.The median postoperative hospital stay was 7 days(range 6-8 days).Mean preoperative BMI was 36.1(32.0-40.5)kg/m2.Mean decrease in BMI was 4.1(3.0-4.7)ks/m2,5.6(3.2-9.0)kg/m2,and 7.3(3.2-10.7)kg/m2 respectively,and mean weight loss at postoperative 1,3,and 6 months was 11.7(7-15)kg,17.5(8-25)kg,and 22.0(8-32)kg respectively.Conclusion Laparoscopic sleeve gastrectomy with omentectomy and partial enterectomy is an effective and safe surgical option for the treatment of morbid obesity.

Laparoscopic-assisted Resection of the Small Intestine for Stromal Tumors:Report of 15 Cases / 中国微创外科杂志

Objective To evaluate the efficacy of laparoscopic-assisted resection of the small bowel for stromal tumors.Methods From January 2003 to May 2007,laparoscopic abdominal exploration was carried out under general anesthesia on 10 patients with space occupying lesion and 5 patients with abdominal pain and hemafecia of unknown origin.After an intestinal lesion was found,a small incision was made at the proper site on the abdominal wall according to the location of the lesion.The diseased intestine was resected outside the abdominal cavity,and then end-to-end anastomosis was performed.Pneumoperitoneum was rebuilt after closing the abdominal cavity in order to observe the blood circulation of the small bowel and intra-abdominal hemorrhage.Results The operation was completed in all the 15 cases.The postoperative pathological examination showed stromal tumors with CD117 positive in 14 cases(93%)and CD34 positive in 9(60%).Three(20%)of the patients were at very low risk,5(33%)at low risk,4(27%)at moderate risk,and 3(20%)at high risk.The mean diameter of the tumors was(2.44?0.63)cm(ranged from 1.5 to 3.6).The operation time was 38 to 72 minutes with a mean of(57.8?10.4),and mean blood loss was(20.1?6.5)ml(10 to 30).The patients were discharged 4 to 7 days after the operation [mean,(5.3?1.1)days],and were followed up for 5 to 36 months [mean,(24.3?8.4)months].No patient had postoperative complications or recurrence in this series.Conclusion Laparoscopy is effective for resection of small bowel stromal tumors.