Distal Ileum Research Articles

Reduction of particle size of field peas (Pisum sativum L.) increases net energy and digestibility of starch when fed to growing pigs, but there is no difference in nutritional value between peas from the United States and peas from Canada.

Two experiments were conducted to test the hypotheses that particle size of field peas and location where peas are grown do not affect apparent total tract digestibility of nutrients and gross energy, digestible energy (DE), metabolizable energy (ME), and net energy (NE), apparent ileal digestibility (AID) of starch, or standardized ileal digestibility (SID) of crude protein (CP) and amino acids (AA). In both experiments, 3 sources of field peas were used. One source was obtained from the United States and 2 sources were obtained from Canada (i.e., Canada 1 and Canada 2). The U.S. field peas were ground to 678, 457, or 265 µm, whereas the 2 sources of Canadian peas were ground to 411 and 415 µm, respectively. Therefore, 5 batches of field peas were used in both experiments. A basal diet contained corn and soybean meal as the only source of energy, starch, and AA, and 5 diets containing corn and soybean meal and 50% of each source of field peas were also formulated. The ratio between corn and soybean meal was 1.92:1 in all diets. In experiment 1, an N-free diet was also used to calculate basal endogenous losses of AA and CP, but in experiment 2, no N-free diet was used. In experiment 1, 7 barrows (initial body weight = 60.6 ± 2.1kg) that had a T-cannula installed in the distal ileum were allotted to a 7 × 7 Latin square design with 7 diets and 7 periods. In experiment 2, 24 pigs (initial body weight = 30.8 ± 1.0kg) were housed in 6 calorimeter chambers with 4 pigs per chamber. The 6 chambers were allotted to one of the 6 diets using a 6 × 6 Latin square design with 6 consecutive periods of 15 d. Results of experiment 1 demonstrated that the SID of CP and AA was not influenced by the origin of the peas or by the particle size, but the AID of starch increased (linear, P < 0.001) as particle size was reduced from 678 to 457 or 265 µm. Results of experiment 2 indicated that growing location did not affect concentrations of DE, ME, or NE of field peas, but concentrations of DE, ME, and NE increased (linear, P < 0.05) when particle size was reduced from 678 to 457 or 265 µm. In conclusion, field peas grown in Canada or the United States have the same nutritional value, but starch digestibility and NE increase if the particle size of field peas is reduced.

Intestinal Behçet's and suspected intestinal Behçet's disease: a report of four surgical cases.

Intestinal Behçet's disease (BD) is often associated with ulceration that requires surgery, including perforation and abscess formation. However, no consensus has been reached on the optimal extent of resection or treatment strategy. This study reviewed four cases of intestinal or suspected intestinal BD. In Case 1, a 74-year-old woman diagnosed with BD 2years earlier was treated with anti-tumor necrosis factor α antibody (Infliximab) and steroids. She had oral and pubic ulcers. After close investigation of abdominal pain, perforation of the gastrointestinal tract was suspected and surgery was performed. Multiple perforating ulcers and abscesses were found in the distal ileum, and the small intestine was resected. Postoperatively, the patient was treated with an increased steroid dose and symptoms have remained stable. Case 2 involved a 69-year-old woman with oral and pubic ulcers, ocular ulcer, and skin lesions. She experienced sudden onset of abdominal pain during treatment for lymphoma. She showed multiple perforating ulcers throughout the ileum and underwent resection of the small intestine and ileostomy. Upper abdominal pain appeared during postoperative treatment for high-output syndrome. The patient underwent omentoplasty after perforation of the upper gastrointestinal tract was diagnosed. Postoperatively, anti-interleukin-1 beta antibodies (canakinumab) was administered to control the disease. Case 3 involved an 81-year-old, previously healthy woman. She presented to her previous physician with complaints of pubic ulcer, hemorrhage and abdominal pain. Colonoscopy showed multiple ulcers throughout the entire colon. Steroid therapy was started, but bleeding proved difficult to control and total proctocolectomy was performed. Histopathology revealed multiple perforating ulcers and BD was diagnosed. Postoperatively, the patient remains under steroid control. Case 4 involved a 43-year-old man with abdominal pain who showed abscess formation in the ileocecal region. After excision of the ileocecal area, multiple ulcers were diagnosed. Two years later, abdominal pain recurred and free air was found in the abdomen on close imaging. Emergency anastomotic resection was performed due to ulceration and perforation of the anastomosis. Intestinal BD may flare up after surgical treatment and require multiple surgeries. Introducing pharmacotherapy as soon as possible after surgical treatment is important to control the disease.

Influence of particle size and origin of field peas on apparent ileal digestibility of starch and amino acids and standardized ileal digestibility of amino acids when fed to growing pigs.

The objective was to test the hypothesis that particle size and origin of field peas influence the apparent ileal digestibility (AID) of starch, crude protein (CP), and amino acids (AA) and the standardized ileal digestibility (SID) of AA. Three sources of field peas were procured. One source was from the United States and two sources were from Canada. The U.S. source and one of the sources from Canada (i.e., Canada 1) were each divided into two batches and ground to achieve a target particle size of 250 or 450µm, whereas the other source from Canada (i.e., Canada 2) was only ground to a target particle size of 250µm. Each batch of field peas was included in one diet as the only source of AA. An N-free diet was used to determine the basal endogenous losses of CP and AA. Six barrows (initial weight: 50.5kg; SD = 3.7) that had a T-cannula installed in the distal ileum were randomly allotted to a 6 × 6 Latin square design with six diets and six 7-d periods. Ileal digesta from pigs were collected for 2d after 5d of adaptation. Data were analyzed using a statistical model that included batch of field peas as the fixed effect and animal and period as the random effects. Contrast statements were used to analyze the effects of particle size, origin, and the interaction between particle size and origin. Results indicated that the AID of starch was increased by reducing the particle size in the U.S. source of field peas, but that was not the case for the Canada 1 source (interaction; P < 0.001). Particle size did not influence the AID of CP or AA, but the Canada 2 source of field peas had greater (P < 0.05) AID of Trp, Ala, Cys, Gly, and Tyr than the field peas from the United States. The SID of CP and AA was also not affected by the particle size of field peas. The SID of CP and Trp was greater (P < 0.05), and the SID of His, Ile, and Thr tended (P < 0.10) to be greater in the Canada 2 source compared with the U.S. source, but no differences between the two Canada sources were observed. In conclusion, a few differences in SID of AA between field peas produced in the United States and peas produced in Canada were observed, but there was no effect on SID of AA of reducing the particle size of field peas from 450 to 250µm, whereas the AID of starch increased by reducing the particle size only in the field peas from the United States.

Congenital Absence of Ileum, Caecum and Appendix in a Preterm Neonate: A Rare Case Report

There are numerous birth defects that can affect the gastrointestinal tract, starting from the oesophagus or stomach to the small and large intestines. Intestinal atresias are one of the most common causes of intestinal obstruction in newborns. The most common location is the jejunum, followed by the duodenum and the colon. Congenital absence of the ileum, caecum, and appendix is an extremely rare condition. Here, an exceptional instance of congenital absence involving the distal jejunum, ileum, caecum, and appendix in a male child is presented, who presented with chief complaints of multiple episodes of bilious vomiting after initiating the first feed and non passage of meconium. Upon initial examination, the patient was suspected to have an intestinal obstruction and subsequently underwent an exploratory laparotomy. However, intraoperative findings revealed a grossly dilated proximal jejunal loop, and the next segment of the intestine was the narrow ascending colon. In due course, the baby recovered well and was discharged. Currently, there is no documented occurrence of a comparable case involving a viable neonate in the existing body of scholarly literature. Surgeons need to understand positional variations and congenital anomalies, as well as the procedures needed to identify these abnormalities during surgery.

An Effectiveness of Ayurveda Management in Crohn’s Disease

Abstract Crohn’s disease (CD) is segmental, noncontinuous, subacute, or chronic inflammation that can affect any part of the digestive tract from the mouth to the anus, with a predilection for the distal ileum and colon. The incidence of CD is increasing and is now 5–10 per 100,000, with a prevalence of 50–100 per 100,000. A 47-year-old patient presented to the outpatient department of the Department of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, with complaints of spasmodic abdominal pain and passage of mucoid stool with increased frequency of defecation from last 2 months. This case was diagnosed as CD in the colonoscopy report. The patient was treated with Panchkarma procedures and Ayurvedic oral drugs and found satisfactory results with no side effects. Colonoscopy, contrast-enhanced computed tomography enterography, and liver function test were considered objective parameters of assessment. Improvement was assessed on the basis of relief in subjective and objective parameters. After the course of treatment, significant improvement was seen in the grading of subjective parameters and laboratory investigation. This case study illustrates that Ayurvedic medicament can be the choice for treating ailments of the gastrointestinal tract.

A Rare Postoperative Complication of Acute Appendicitis: Portal Vein Thrombosis Required Small Intestine Resection

This case report aims to present the diagnosis and treatment process of portal vein thrombosis, which occurred one week after laparoscopic appendectomy and required small bowel resection. A thirty-eight-year-old man was admitted with abdominal pain in the periumbilical and epigastric regions. He had a history of appendectomy and occlusive cerebrovascular disease. In the physical examination of the abdomen, tenderness was detected in the epigastric region on deep palpation. Leucocytosis, increased levels of alanine transaminase level, aspartate transaminase, gamma-glutamyl transferase, lactate dehydrogenase, c-reactive protein, and d-dimer were detected in laboratory analyses. CT scan revealed total thrombus in the portal vein, oedema in the segment of approximately 10 cm in the distal ileum, and free fluid in the pelvic region. Enoxaparin sodium was started. During follow-up, widespread defence and rebound in all quadrants of the abdomen occurred. 20 cm ileal resection with end ileostomy was performed. Enoxaparin sodium treatment was continued. On the 6th day of the service follow-up, the patient had left leg pain, and a subacute thrombus was detected in the main femoral, superficial femoral and deep femoral veins on doppler USG. Edoxaban tosylate 60 mg tablet every 24 hours started as an anti-coagulant treatment, and the patient was discharged without complications on the 18th day of hospitalisation.

A NEW EIMERIA SPECIES (APICOMPLEXA: EIMERIIDAE) PARASITIZING COMMERCIAL CHUKAR PARTRIDGES (ALECTORIS CHUKAR) IN SOUTHERN ONTARIO.

A commercial producer hatching and rearing chukar partridges (Alectoris chukar) in Ontario, Canada had flocks experiencing coccidiosis. Microscopic analysis of Eimeria species isolated from a field sample indicated the presence of 2 distinct oocyst morphotypes; the most abundant species was determined to be Eimeria chapmani, based on oocyst morphology and sequence-based genotyping, and the less abundant, second Eimeria sp. was an undescribed parasite. Oocysts of the unknown Eimeria sp. were large and oval-shaped; dimensions averaged 27.9 μm by 17.0 μm (shape index = 1.65 μm). Oocysts contained at least 1 polar granule and 4 almond-shaped sporocysts with average dimensions measuring 12.5 μm by 6.9 μm (shape index = 1.83). Each sporocyst featured a Stieda body, sub-Stieda body, and sporocyst residuum; a sporocyst contained 2 sporozoites that each possessed a small anterior refractile body and a larger posterior refractile body. Virtually all oocysts sporulated after 24 hr when suspended in potassium dichromate at room temperature (22 C) on a rotary platform. Experimental infections with various doses of oocysts demonstrated elevated parasite shedding from birds gavaged with higher challenge doses; fecundity generally decreased in heavier infections. The approximate prepatent period of the parasite was 4-5 days (unsporulated oocysts observed histologically at 90 hr postinfection and in feces by day 5) and patency lasted until day 12 postinfection. To characterize the endogenous development of the Eimeria sp., tissues were collected at 8 regions along the intestinal tract (including the ceca and rectum) every 6 hr throughout the estimated prepatent period. Parasites were observed to infect the descending and ascending duodenum, midjejunum, proximal and distal ileum, and the ceca. The endogenous stages identified included intracellular sporozoites, 3 generations of merogony, and gametogonic stages. Sequences of the mitochondrial genome (GenBank MW934555) and nuclear 18S ribosomal DNA (GenBank MW934259) were obtained using polymerase chain reaction amplification for Sanger sequencing, and these were unique from all published sequences on GenBank. Molecular data, in conjunction with the unique biology of the Eimeria sp. isolated from the chukar partridge flock, support that this coccidium is new to science.

Decreased FXR Agonism in the Bile Acid Pool Is Associated with Impaired FXR Signaling in a Pig Model of Pediatric NAFLD.

The objective of this study was to investigate whether the impairment of farnesoid X receptor (FXR)-fibroblast growth factor 19 (FGF19) signaling in juvenile pigs with non-alcoholic fatty liver disease (NAFLD) is associated with changes in the composition of the enterohepatic bile acid pool. Eighteen 15-day-old Iberian pigs, pair-housed in pens, were allocated to receive either a control (CON) or high-fructose, high-fat (HFF) diet. Animals were euthanized in week 10, and liver, blood, and distal ileum (DI) samples were collected. HFF-fed pigs developed NAFLD and had decreased FGF19 expression in the DI and lower FGF19 levels in the blood. Compared with the CON, the HFF diet increased the total cholic acid (CA) and the CA to chenodeoxycholic acid (CDCA) ratio in the liver, DI, and blood. CA and CDCA levels in the DI were negatively and positively correlated with ileal FGF19 expression, respectively, and blood levels of FGF19 decreased with an increasing ileal CA to CDCA ratio. Compared with the CON, the HFF diet increased the gene expression of hepatic 12-alpha-hydrolase, which catalyzes the synthesis of CA in the liver. Since CA species are weaker FXR ligands than CDCA, our results suggest that impairment of FXR-FGF19 signaling in NAFLD pigs is associated with a decrease in FXR agonism in the bile acid pool.

Effects of a Bentonite Clay Product and a Preservative Blend on Ileal and Fecal Nutrient Digestibility in Pigs Fed Wheat Naturally Contaminated with Deoxynivalenol.

The objectives were to determine the effects of dietary deoxynivalenol (DON) on apparent ileal digestibility (AID) of nutrients and to evaluate the efficacy of a bentonite (BEN) and a preservative blend (PB) product for alleviating DON effects on the nutrient digestibility of pigs. Twelve crossbred barrows with an initial body weight of 69.4 kg (standard deviation = 3.5) equipped with a T-cannula in the distal ileum were allotted a triplicated 4 × 2 incomplete Latin square design with four dietary treatments and two periods. Dietary treatments were (1) an uncontaminated diet, (2) a contaminated diet (CD) mainly based on contaminated wheat with 1.6 mg/kg DON, (3) CD + 0.25% PB consisting of preservation components as major sources, antioxidants, microorganisms, and amino acids (AA), and (4) CD + 0.25% BEN. The AID and ATTD of dry matter, organic matter, crude protein, most minerals, and most AA were not affected by DON contamination. Dietary DON decreased the AID and ATTD of sodium (p < 0.05) but were restored by supplementing the PB product (p < 0.05). The AID of zinc was increased (p < 0.05) by dietary DON, but supplementing BEN decreased zinc digestibility (p < 0.05). The AID of Arg, Ile, Thr, and Asp was decreased (p < 0.05) by BEN addition. In conclusion, dietary DON affected the digestibility of some minerals but not AA in pigs. Supplemental BEN can negatively affect the nutrient digestibility of some minerals and AA in pigs. The addition of a PB product in pig diets can restore digestibility of sodium but not of other nutrients. Based on these observations, feed additives for alleviating DON effects on nutrient digestibility of pigs can be carefully selected by swine diet formulators.

Systemic and targeted steroids for the treatment of IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is a common glomerulonephritis partially correlated with mucosal immune system dysfunction. Progressive renal failure occurs in many patients, with about 30-50% of the patients with IgAN developing end-stage kidney disease (ESKD). Many treatments have been used for decades, despite uncertainty about their effectiveness and the ideal dose. Randomised controlled trials reported that systemic glucocorticoids can be an effective treatment for patients with persistent and significant proteinuria despite renin-angiotensin system inhibitors use possibly causing systemic side effects. The primary focus of IgAN management should be based on optimised supportive care, including renin-angiotensin system (RAS) blockade and now SGLT2 inhibitors. The novel targeted-release formulation (TRF) of budesonide has been tested to reduce the adverse events of systemic steroids by delivering the drug to the distal ileum. The local efficacy of TRF-budesonide may represent a novel and promising approach to treating IgAN. Two clinical trials showed that TRF-budesonide could significantly reduce proteinuria and haematuria and possibly preserve renal function while significantly reducing the side effects. However, the limited number of treated patients and the relatively short follow-up suggest caution before considering budesonide superior to the current six-months steroid pulses scheme. Long-term data on the efficacy and safety of TRF budesonide are awaited, together with the design of trials with a head-to-head comparison with systemic steroids before considering TRF-budesonide as the standard of care treatment for IgAN nephropathy.

Amino acid standardized ileal digestibility together with concentrations of digestible and metabolizable energy in Saccharomyces cerevisiae yeast and soybean meal for gestating sows.

The standardized ileal digestibility (SID) of amino acids (AAs) plus crude protein (CP), in addition to digestible energy (DE) and metabolizable energy (ME) concentrations, was assessed through two experiments on Saccharomyces cerevisiae yeast (SCY) combined with soybean meal (SBM) for gestating sows. SCY and SBM were subjected to experiment 1 for the determination of CP and AAs in terms of SID. Under a randomized complete block design, three dietary treatments were provided for a total of 24 Landrace × Yorkshire gestating sows (parity 2), with the distal ileum clipped by a T-cannula at gestational day 33 based on body weight (BW) (194.1 ± 7.1, 195.3 ± 8.5, and 195.3 ± 8.6kg). SCY and SBM were used as the only source of nitrogen to prepare two semi-purified diets and a nitrogen-free diet was also utilized to examine CP plus AAs for basal ileal endogenous losses. The gestating sows were initially fed these diets for 5 d to allow for adaptation, and ileal digesta was collected 2 d later for analysis. CP and all AAs in SCY, except for Trp and Gly, showed significantly lower SID than those in SBM (P < 0.05). Among the essential AAs, the range of SID was 68.8% for Thr to 92.2% for Arg in dried yeast, and from 79.9% for Thr to 98.6% for Met in SBM. DE plus ME were measured via experiment 2 with a randomized complete block design on SCY and SBM. Eighteen day-35 Landrace × Yorkshire pregnant sows (parity 3) were allocated to three diets based on BW (233.3 ± 16.0, 233.4 ± 9.6, and 233.4 ± 10.3kg). Three diets were adopted for the experiment, namely, a corn-based diet as well as two diets containing 20.2% SCY and 20.0% SBM samples. The full fecal collection method, comprising a 5-day adaptation period before a 5- to 6-d experimental period for quantitative urine and feces collection, was employed for metabolic trials. The DE and ME for SCY were remarkably decreased compared with those for SBM (3812 kcal/kg DM vs. 4264 kcal/kg DM and 3714 kcal/kg DM vs. 4157 kcal/kg DM), respectively (P < 0.05). No differences were observed in the apparent total tract digestibility (ATTD) of organic matter, CP, and gross energy between SCY and SBM, but ATTD was significantly reduced in SCY for acid detergent fiber, dry matter, and neutral detergent fiber by contrast with SBM (P < 0.05). In conclusion, most AAs and CP in SCY had lower SID, DE, and ME than SBM in this study. These findings can be applied to diet formulation with the aforementioned ingredients for sows.

Malignant Transformation of Long-Standing Ileal Crohn's Disease Likely Favors Signet Ring Cell Adenocarcinoma Histology.

Signet ring cell adenocarcinomas (SRCCs) are a rare and aggressive histological subtype of adenocarcinomas typically with poor prognosis usually secondary to late stage at detection. In the small bowel, they constitute only 1% of all malignancies. In the last decade, there have been multiple case reports and small case series that have identified SRCCs, typically in the ileum, in patients with Crohn's disease. Crohn's disease is a transmural inflammatory condition that normally manifests in the distal ileum and colon, and is known to temporally increase the risk of malignancy. Given the profound rarity of SRCCs, establishing an association between Crohn's disease and SRCC is challenging. In this study, we performed a systematic review of case reports and small case series describing small bowel SRCCs in Crohn's disease patients. Most cases were found in the distal/terminal ileum, at a mean age of 59 years old. Virtually all tumors were locally advanced (pathological T stage 3 and 4), typically with at least N1 nodal disease. Two case studies (one is a case-control study and the other a cohort design) demonstrated that small bowel SRCC, as opposed to conventional adenocarcinoma, was significantly correlated to a history of Crohn's disease (35% vs. 0%, 73.5% vs. 28.5%), with a propensity to arise in the ileum (95% vs. 30%, 66.7% vs. 42.1%), and at earlier mean age (43 vs. 68 years, 53.7 vs. 61.7 years). We additionally used the Surveillance, Epidemiology, and End Results (SEER) database for insights into the clinicoepidemiological characteristics of ileum SRCCs. SRCCs composed 28.1% of all ileal SRCCs, compared to 11.0% for the adenocarcinomas, with a younger age at diagnosis (60.7 vs. 64.6 years), more distant disease at presentation (41.3% vs. 26.4%), and shorter overall median survival time (20 vs. 39 months). In summary, while there is limited direct evidence to support an association between small bowel SRCC and Crohn's disease, the phenomenon has been increasingly documented in the literature in the last decade. Clinicians treating Crohn's disease patients should consider this in their differential diagnosis, particularly when managing disease complications, as early detection and surgical intervention offer the best prognosis.

Imaging of Strictures in Crohn's Disease.

Crohn's disease (CD) is a chronic inflammation of the digestive tract, and it frequently affects young patients. It can involve any intestinal segment, even though it frequently affects the distal ileum. Up to 80% of patients with CD present with inflammatory behavior, and 5% to 28% develop stricturing disease. Based on the predominant mechanism causing them, strictures can be categorized as inflammatory, fibrotic, or mixed. Determining the relative amounts of inflammation and fibrosis in a stricture can influence treatment decisions. Imaging is an extremely useful tool in patients with small bowel stricturing CD to confirm the diagnosis and to evaluate disease characteristics, usually using CT or MRI. The aim of this paper is to describe how imaging can evaluate a patient with small bowel CD stricture.

Lymphoid Malignancies in Shwachman-Diamond Syndrome: Incidence, Clinical Features, and Outcomes from the North American SDS Registry

Introduction: Many marrow failure conditions are associated with myeloid malignancy predisposition and a subset carry an increased risk of both myeloid and lymphoid malignancies. The increased risk of myeloid malignancy is known in Shwachman-Diamond syndrome (SDS), however, the risk of lymphoid malignancy in SDS has not been previously reported. Through the North American SDS Registry (SDSR), we identified patients with SDS diagnosed with lymphoma. We report the clinical features and outcomes in these patients as well as the incidence rates of lymphoma, MDS, and AML in this cohort. Methods: Patients with biallelic SBDS mutations enrolled on the SDSR were included for analysis. Age- and sex-specific incidence rates from the SEER Program (2016-2020) were multiplied by person-years of observation to obtain expected numbers of events. The crude rate per 100,000 (100,000*observed number of malignancies/person-years of follow-up) and the standardized incidence ratio (SIR) were calculated. Results: Out of a total of 217 patients with SDS with biallelic SBDS mutations in the SDSR, we identified 3 subjects who developed lymphoma. Case 1: A male patient with biallelic SBDS mutations (c.258 + 2T&amp;gt;C; c.653G&amp;gt;A, p.Arg218Gln) presented with dyspnea and was diagnosed with primary mediastinal B-cell lymphoma at age 16 years. Bone marrow exam was negative for lymphoma but revealed a new del20q clone. He received 6 cycles of R-CHOP. His course was complicated by febrile neutropenia, pleural effusion, deep vein thrombosis, and decreased cardiac ejection fraction requiring subsequent omission of doxorubicin and carvedilol initiation. He is in remission &amp;gt;3 years from diagnosis. Case 2: A male patient with biallelic SBDS mutations (c.258 + 2T&amp;gt;C; c.183_184TA&amp;gt;CT, p.Lys62*) was diagnosed at age 23 years with diffuse large B-cell lymphoma (DLBCL) of the distal stomach and duodenal bulb. Bone marrow exam was negative for malignancy but demonstrated an abnormal karyotype: 46,XY,t(11;16)(q23;q24), del(20)(q11.2q13.3)[9]/46,XY[11]. He received 5 cycles of R-CHOP therapy, which was complicated by febrile neutropenia and S. aureus sepsis. Four years later, he was diagnosed with relapsed DLBCL of the distal ileum and concurrent AML with 5q deletion. He achieved complete remission of both malignancies after 2 cycles of cyclophosphamide, vincristine, prednisone, obinutuzumab, azacitidine, and venetoclax. Therapy was complicated by B. cereus bacteremia with brain abscesses and endocarditis and C. difficile infection. He underwent a matched unrelated donor hematopoietic stem cell transplant and is in remission &amp;gt;180 days from transplant. Case 3: A male patient with biallelic SBDS mutations (c.258 + 2T&amp;gt;C; c.183_184TA&amp;gt;CT, p.Lys62*) was diagnosed with Stage IVB classical Hodgkin lymphoma at age 12 years after presenting with mediastinal syndrome. Bone marrow biopsy was negative for findings suggestive of MDS or malignancy, however, the initial PET-CT was consistent with medullary involvement. He initiated therapy with steroids, doxorubicin, vinblastine, dacarbazine, and brentuximab vedotin and received focal radiation. His course was complicated by recurrent febrile neutropenia, C. difficile colitis, and cellulitis. Due to infectious complications and delayed count recovery after 2 cycles, despite chemotherapy dose reductions, he was transitioned to brentuximab and nivolumab. He demonstrated complete response by Deauville criteria prior to cycle 5 of brentuximab and nivolumab. Among 217 patients with biallelic SBDS mutations in the SDSR, the median age was 12.8 years (range: 0.3 - 52.8). The observed number, rates, and SIR for lymphoma, MDS, and AML are given in Table 1. A high SIR indicates a higher incidence in the SDSR relative to the SEER population in 2016-2020. The observed rate of lymphoma was 28.5 times higher in SDS than the expected rate in the general population. Conclusions: The incidence of lymphoma among patients with SDS is increased relative to the general population but is lower than the incidence of MDS or AML. Increased toxicity with standard therapies was observed in these patients. Given the increased risk of MDS/AML in SDS, which may be further increased by antecedent chemotherapy, non-genotoxic therapies should be investigated for lymphoma in SDS. Our results show that SDS should be added to the list of marrow failure conditions predisposing to both myeloid and lymphoid malignancies.

EGS P23 A rare case of gallstone ileus post Roux-en-Y Gastric Bypass: Stone migration from large duodenal diverticulum

Abstract Background Small bowel obstruction following Roux-en-Y gastric bypass is common and is mainly attributed to adhesions or internal herniation. Intraluminal formation of stones, usually in areas of stasis due to the anatomical changes post-RYGB, and migration to the distal ileum to cause acute bowel obstruction is rare. Impacted stones at the duodenal diverticulum can trigger diverticular inflammation, back pressure to the common bile duct and pancreas resulting in abdominal pain, nausea and vomiting, intermittent derangement of liver enzymes and episodes of cholangitis and pancreatitis. The impaction at the distal ileum is an emergency requiring prompt diagnosis and intervention to prevent complications. Methods This is a case report of a 56-year-old female who presented at East Surrey Hospital in February 2023 with recurrent upper abdominal pain, nausea and vomiting. She previously underwent an open cholecystectomy for cholelithiasis and cholecystoduodenal fistula (2003) and a Roux-en-Y gastric bypass (2018). Her symptoms were initially thought to be secondary to inflammation and periduodenal abscess managed with antibiotics, but as time and scans (CT, MRCP, water-soluble contrast, gastroscopy) progressed without resolution of her symptoms it became evident that she had developed mechanical bowel obstruction. We described her case and the diagnostic challenges leading to the final surgical management. Results To investigate the patient’s symptoms, her intermittently raised inflammatory markers, deranged liver enzymes and amylase a series of radiological examinations was rperformed. Initial CT scan showed an inflamed large duodenal (D3) diverticulum and fluid filled proximal duodenum. Subsequent MRCP demonstrated dilated common bile duct and intrahepatic ducts without any ductal stone. Repeat CT scan two weeks later, confirmed small bowel obstruction due to a heterogenous bolus at the ileocecal valve with resolution of the duodenal inflammation and dilatation. The patient underwent a laparoscopic extraction of a stone impacted at the ileocecal valve causing small bowel obstruction and recovered well. Conclusions Even though small bowel obstruction due to stone aggregation is uncommon post-RYGB, a high index of suspicion for the diagnosis and a low threshold for early laparoscopic intervention can prevent further serious complications. Reporting these cases in literature offers a guidance for the workup and management of these unusual scenarios amongst surgical teams and improves patients’ outcomes.

Not Only Length Matters! Impact of the Ileal Width on the Capacity of the Orthotopic Neobladder: The AADAPT Formula Tested on the Animal Model

BackgroundThe capacity of a given shape of an orthotopic ileal neobladder (ONB) varies significantly, although the same length of preterminal ileum is utilised. ObjectiveTo investigate the variability of the human ileal width and to create a mathematical formula that calculates its impact on the neobladder capacity. Design, setting, and participantsDuring 50 consecutive cases of robotic pelvic surgery, a segment of preterminal ileum was identified and the width was measured. A mathematical formula was created to calculate, for a given ileal length and width, the neobladder capacity and, for a given ileal width and neobladder capacity, the length of the (pre)terminal ileum to harvest. The accuracy of our model was tested on 28 pouches created by swine ileum. Outcome measurements and statistical analysisThe interindividual variability of the ileal width and its impact on the ileal neobladder capacity was investigated. Results and limitationsThe mean hemicircumference of the human distal ileum is 2.43 ± 0.39 cm (range 2–3.5 cm). According to our geometric model and as confirmed in the swine model, an increase of 1 cm in ileal width increases the neobladder capacity by 85%. The Pearson correlation coefficient reported a strong positive relationship between the formula-calculated and effective volumes of the pouch (r = 0.97). Moreover, for the same target capacity, 1 cm of difference in the ileal width implies harvesting 20 cm less ileum. A lack of testing on humans and application only to spheroidal neobladders are the main limits. ConclusionsThe ileal width impacts the capacity of the ONB. For a given type of ONB, no standard length of ileum should be harvested; instead, the length should be tailored to the width of the ileum for a given patient. Clinical studies are required to confirm our model. Patient summaryWe demonstrated the variability of the ileal width among humans, and we provided a mathematical formula tested on swine that evaluates the impact of the ileal width on the capacity of the orthotopic ileal neobladder.

PSV-29 Plasma Citrulline Is Strongly Correlated with Jejunum and Ileum Citrulline Concentrations in Pigs at Weaning

Abstract Pigs at weaning are abruptly exposed to numerous stressors that negatively affect gut health. While the term gut health lacks a clear definition, it is best measured by its key functions, including nutrient digestion, absorption, and metabolism, mucosal immunity, and barrier function. The gut is the main endogenous source of citrulline, a potential biomarker of gut function. The objective of this study was to determine the relationship between plasma and intestinal concentrations of citrulline and citrulline precursors in pigs. Pigs (initial BW = 7,233 ± 683 g) were either weaned at 21 d age and euthanized at 23 d age (W; n = 9) or were not weaned, remained with the sow, and euthanized at 23 d age (NW; n = 9). At euthanasia, blood, jejunum, and ileum tissue was collected and snap-frozen in liquid nitrogen; segments of mid jejunum and distal ileum were collected for morphological analysis. Plasma and tissue glutamine (Gln), glutamate (Glu), proline (Pro), ornithine (Orn), and citrulline (Cit) concentrations were determined by reverse-phase HPLC following pre-column derivatization with 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate. Data were analyzed with the generalized linear mixed model and correlation procedures of SAS (version 9.4). Pearson correlation coefficients between 0.50 and 0.69 were considered as moderate, between 0.70 and 0.89 as strong, and between 0.90 to 1 as very strong. Jejunum villus height was reduced in W compared with NW pigs (370 versus 246 ± 18 µm; P &amp;lt; 0.001), whereas ileum villus height was not different between NW and W pigs (257 versus 215 ± 27 µm; P = 0.27). Among precursors for gut Cit synthesis, plasma Pro was strongly correlated with jejunum Pro (r = 0.83; P &amp;lt; 0.001) and very strongly correlated with ileum Pro (r = 0.91; P &amp;lt; 0.001). Plasma Glu was moderately correlated with ileum Glu (r = 0.58; P = 0.014), but not with jejunum Glu (r = 0.18, P = 0.48), whereas plasma Gln was moderately correlated with ileum Gln (r = 0.57; P = 0.016) and strongly correlated with jejunum Gln (r = 0.80; P &amp;lt; 0.001). Plasma Orn was strongly correlated with both jejunum Orn (r = 0.73; P &amp;lt; 0.001) and ileum Orn (r = 0.78; P &amp;lt; 0.001). Plasma Cit was strongly correlated with jejunum Cit (r = 0.77; P &amp;lt; 0.001) and very strongly correlated with ileum Cit (r = 0.95; P &amp;lt; 0.001). Plasma Cit can be used to estimate gut Cit content and may be predictive of gut function in nursery pigs undergoing weaning stress.

253 Understanding the Health Benefits of Feeding Treated Wheat Straw for Weanling Pigs

Abstract Two experiments were conducted to understand the growth and health benefits of including treated wheat straw in weanling pig diets. The first experiment evaluated feeding treated versus untreated wheat straw on young pig growth performance and localized immunological markers. One hundred and ninety-two (PIC 359 x Yorkshire) pigs were weaned at 26.8 ± 1.1 d old (8.3 ± 1.1 kg) and randomly allotted to 24 pens with 8 pigs per pen. Three dietary treatments were fed over a 28-d period, control (CON), control plus 5% untreated wheat straw (UWS), and control plus 5% treated wheat straw (TWS). Diets were formulated to meet or exceed all nutrient requirements of NRC, 2012. Growth performance data was recorded on a weekly basis. One pig per pen (equal number of males and females) was randomly selected for sacrifice and sample collection on d 28. The second experiment evaluated the impact of 5% dietary TWS on the local and systemic health of nursery pigs experiencing a vaccination-induced immune challenge. Twenty barrows (PIC 800 x Yorkshire) were weaned at 27.7 ± 0.75 d (8.6 ± 1.2 kg) and assigned to four pens, with 5 pigs per pen. A heavy and light-weight pen for each treatment (CON and TWS) resulted. All pigs were sacrificed for sample collection on d 42. In both experiments, before euthanasia, blood was collected to assess plasma immunoglobulin A (IgA) and intestinal fatty acid binding protein (iFABP) concentration. Upon sacrifice, segments of the distal ileum and ascending colon were removed to collect mucosal scrapings for the analysis of localized immunological markers interleukin (IL) 6 , IL-10, IL-12, and tumor necrosis factor-alpha (TNF-α). In experiment one, overall ADG and ADFI were similar among treatments. Gain-to-feed ratio of TWS pigs was greater (P &amp;lt; 0.05) than that of UWS pigs and tended to be greater (P = 0.07) than that of CON pigs (0.70, 0.67, and 0.68, respectively; SEM = 0.01). Both straw treatments decreased the expression of ileal and colonic mucosa IL-6, in addition with less expression of ileal IL-12. Plasma IgA concentrations in UWS pigs were greater than those in CON and TWS pigs (P &amp;lt; 0.05). In experiment two, TWS pigs had greater gene expression of colonic TNF-α and IL-6 (P &amp;lt; 0.05). Ileal gene or protein expression of markers did not differ, nor did amounts of plasma IgA or iFABP. Overall, feeding 5% treated wheat straw in the nursery pig diet does not negatively impact growth and results in increased feed efficiency. Nursery diets with 5% treated wheat straw can impact the expression of immune markers in the gut, but the question of how this is related to performance and overall health needs further elucidation.

Amino acid supplementation during the adaptation period did not affect the standardized ileal digestibility of amino acids in corn and soybean meal fed to pigs.

The objective was to determine the influence of amino acid (AA) supplementation during the adaptation period on the ileal digestibility of crude protein and AA in corn and soybean meal (SBM) fed to pigs. Six barrows with an initial body weight of 30.9±2.6 kg fitted with a T-cannula at the distal ileum were assigned to a 6×6 Latin square design with 6 dietary treatments and 6 periods. Two experimental diets contained corn or SBM as the sole AA source and an N-free diet was additionally prepared. For AA supplementation groups, an AA mixture consisted of Gly, Lys, Met, Thr, Trp, Ile, Val, His, and Phe was added to the corn diet and the N-free diet at the expense of cornstarch, and an AA mixture of Lys, Met, and Thr was added to the SBM diet. All diets contained 0.5% of chromic oxide. The 6 experimental diets were fed to the pigs for four and half days, and the 3 diets containing an AA mixture were switched to the respective diets without AA mixture during the following two and half days. Ileal digesta were collected on days 6 and 7. The addition of an AA mixture during the adaptation period increased apparent ileal digestibility of Arg and Trp in corn (p<0.05) but did not affect that in SBM. The addition of an AA mixture during the adaptation period increased apparent ileal digestibility of Pro and Gly regardless of feed ingredient (p<0.05) but did not affect that of other AA. All AA except Pro in corn and SBM were unaffected by the addition of the AA mixture during the adaptation period. The addition of amino acids to a low-protein diet during the adaptation period does not affect the standardized ileal digestibility of indispensable amino acids in pigs.

PSIII-5 Endosperm Hardness in Corn Affects the Digestibility of Energy and Fiber, and Increased Drying Temperature Reduces Amino Acid Digestibility

Abstract Two experiments were conducted to test the hypothesis that corn source and drying temperature influence the ileal digestibility of starch and amino acids (AA), as well as apparent total tract digestibility (ATTD) of gross energy (GE) and total dietary fiber (TDF) in diets for growing pigs. Two corn sources (i.e., soft or hard endosperm) were procured, and sources were divided into two drying batches (i.e., 35 or 120 oC). Therefore, four corn sources were used. In experiment 1, ten pigs (67.00 ± 2.98 kg) with a T-cannula installed in the distal ileum were allotted to a replicated 5 × 5 Latin square design with five diets and five periods giving ten replicates per diet. A nitrogen-free diet and four diets containing each source of corn as the only AA source were formulated. Data were analyzed in a 2 × 2 factorial arrangement of treatments using the MIXED procedure of SAS. The model included corn source, drying temperature, and the interaction between corn source and drying temperature. Results indicated that neither source nor drying temperature influenced the apparent ileal digestibility of starch in corn (Table 1), but the standardized ileal digestibility of most AA was less (P &amp;lt; 0.05) in corn dried at 120 oC compared with corn dried at 35 oC. In experiment 2, 40 pigs (20.82 ± 1.74 kg) were housed in metabolism crates and allotted to four diets with ten replicate pigs per diet. The four corn-based diets used in experiment 1 were also used in experiment 2. Feces and urine were collected using the marker-to-marker approach with 5-day adaptation and 4-day collection periods. Data were analyzed as explained for experiment 1. Results indicated that diets containing hard endosperm corn had greater (P &amp;lt; 0.05) ATTD of TDF compared with diets containing soft endosperm corn. The ATTD of GE and the concentration of metabolizable energy (ME) in hard endosperm corn were also greater (P &amp;lt; 0.05) compared with soft endosperm corn. Diets containing corn dried at 120 oC had greater (P &amp;lt; 0.05) ATTD of TDF compared with diets containing corn dried at 35 oC, but drying temperature did not influence ATTD of GE or ME. In conclusion, endosperm hardness did not influence the digestibility of AA and starch; however, drying corn at 120 oC resulted in reduced digestibility of AA. Hard endosperm corn had greater ATTD of GE and TDF, but drying temperature did not influence energy digestibility.