Ileo-ileal Anastomosis Research Articles

Burkitt's Lymphoma Causing Intussusception in Adults:Report of two Cases and Review of the Literature

Background: Burkitt’s lymphoma (BL) related intussusception causing intestinal obstruction in adults is very rare. Two cases of BL related ileocecal intussusception were operated in our clinic and treatment options were explained with previous literature. Patients and Method: The English medical literature in the PubMed and Google Scholar databases was reviewed for adult related ileocecal intussusception, and 10 reports concerning 10 cases of intussusception due to BL were noticed. Our presented two cases of BL related ileocecal intussusception were 17 and 19 years old and both male. both operated due to acute abdomen. Results: The patients printed in the literature were aged from 16 to 52 years. According to the localization of lymphoma, 6 patients had ileo-colic intussusception, 2 had ileal, and 2 had colic intussusception. In terms of the diagnosis, 10 patients were diagnosed with computerized tomography (CT). Our patient one was 17 years old male complaining from abdominal pain, distention and not passing gas and flatus, having rebound and tenderness on the abdomen. Bowel sounds were increased and abdomen was distended. Laboratory values were normal. Patient was HIV negative and EBV was negative. CT target”-shaped soft-tissue mass with a layering effect of ileo-colic intussusception. At exploration ileum was invaginated through ileocecal valve to cecum. Cecum mass about 5 cm in diameter was noticed. Right hemicolectomy and ileocolic anastomosis was performed. Macroscopy showed 6×5.5 cm polypoid tumor formation blocked the lumen. A few lymph node with the largest 2.5×2 cm were dissected in the mucosa. On immunohistochemical studies; CD20 in CD10 staining were observed strong positive staining. TdT, CD23, CD5 and bcl-2 staining were not observed. Ki-67 proliferation index was evaluated as 100%. Tumor involvement was observed diagnosis was BL. Our other patient 19 years male patients with abdominal pain and constipation. There was no history of weight loss or fever. Physical examination showed defans and rebound in the right lower quadrant of abdomen in both patients. Bowel sounds were increased. No evidence of any lymph nodes during systematic examination appeared. Laboratory values were normal with negative HIV. In situ hybridization for EB virus was negative forms of sporadic BL. Intravenous contrast for abdominal tomography was taken and A “sausage”-shaped soft tissue mass with ileo-colic intussusception appeared. 4 cm mass in the terminal ileum was palpated. patient had ileal resection and ileoileal anastomosis. Pathology showed a tumor 4 cm in diameter blocked ileum completely and infiltrated serosa of ileum. immunohistochemical studies CD20, CD10 staining were positive, CD3, CD5, CD23, bcl-6 and TdT staining were negative. Ki-67 proliferation index was 100%. Burkitt's lymphoma was diagnosed in the location of terminal ileum. Both patients was discharged with good bowel movements without any complication and referred to the hematology for chemotherapy treatment. Complete resection is very important and improve survival. Conclusion: BL related intussusception is very rare in adults. Complete resection is required and improve patient survival.

Malignant Peripheral Nerve Sheath Tumour of Small Intestine Presenting as Ileo-Ileal Intussusception - A Rare Tumour with Unusual Complication

Malignant Peripheral Nerve Sheath Tumours (MPNST) arises from a peripheral nerve or exhibit nerve sheath differentiation on histology. Proximal portions of the upper and lower extremities and the trunk are the most common sites of occurrence. Around 50% are associated with Neurofibromatosis Type 1 (NF1) with incidence of two to five per cent in patients with NF1. The estimated incidence in general population without NF1 is 0.0001% of which gastrointestinal MPNST are extremely rare. A 45-year-old lady without pathological antecedent for NF1 was admitted with pain in right lower abdomen and multiple episodes of vomiting for 3 months. Preoperatively intussusception was diagnosed in the small bowel with USG and CECT abdomen showing characteristic target sign. On laparotomy Ileo-ileal intussusception (proximal ileum telescoping into distal ileum) was found 2 feet proximal to ileo-caecal junction with surrounding inflammed mesentery and presence of intraluminal tumour as lead point. Resection of involved segment of ileum along with its mesentery was done followed by ileo-ileal anastomosis. Histopathology was suggestive of high grade MPNST. Postoperative course and follow up for last 10 month is uneventful. This case is unique in terms of a rare tumour presenting with unusual complication and only one case had been reported so far in western literature.

Lap Ileal Ureter Following Extensive Ureteric Stricture

Ileal-ureteral substitution is a viable surgical procedure to provide a satisfactory solution to the problem of long segment ureteric defect. Laparoscopic harvesting of a segment of the ileum as a substitute for the ureter, followed by ureteroileal and ileo-vesical anastomosis with pure intracorporeal laparoscopic suturing was performed in a 45yr old female with mid and lower ureteric stricture following laparoscopic radical hysterectomy and postoperative radiotherapy for carcinoma cervix. Using transperitoneal five port technique we removed the strictured ureter and created an ileal ureter. Ileo-ureteric, ileo-vesical and ileo-ileal anastomosis was done completely by intracorporeal technique. Urinary drainage was satisfactory and renal function were improved. She did not complain of or had symptoms of urinary-tract infection or metabolic acidosis.

Searching for the Molecular Benchmark of Physiological Intestinal Anastomotic Healing in Rats: An Experimental Study

Purpose: This investigation focuses on the physiological characteristics of gene transcription of intestinal tissue following anastomosis formation. Methods: In eight rats, end-to-end ileo-ileal anastomoses were performed (n = 2/group). The healthy intestinal tissue resected for this operation was used as a control. On days 0, 2, 4 and 8, 10-mm perianastomotic segments were resected. Control and perianastomotic segments were examined with an Affymetrix microarray chip to assess changes in gene regulation. Microarray findings were validated using real-time PCR for selected genes. In addition to screening global gene expression, we identified genes intensely regulated during healing and also subjected our data sets to an overrepresentation analysis using the Gene Ontology (GO) and Kyoto Encyclopedia for Genes and Genomes (KEGG). Results: Compared to the control group, we observed that the number of differentially regulated genes peaked on day 2 with a total of 2,238 genes, decreasing by day 4 to 1,687 genes and to 1,407 genes by day 8. PCR validation for matrix metalloproteinases-3 and -13 showed not only identical transcription patterns but also analogous regulation intensity. When setting the cutoff of upregulation at 10-fold to identify genes likely to be relevant, the total gene count was significantly lower with 55, 45 and 37 genes on days 2, 4 and 8, respectively. A total of 947 GO subcategories were significantly overrepresented during anastomotic healing. Furthermore, 23 overrepresented KEGG pathways were identified. Conclusion: This study is the first of its kind that focuses explicitly on gene transcription during intestinal anastomotic healing under standardized conditions. Our work sets a foundation for further studies toward a more profound understanding of the physiology of anastomotic healing.

Ectopic Ovary: One New Location

Ectopic ovarian tissue is a rare gynecologic condition. Accessory ovaries were defined as excess ovarian tissue adjacent and connected to a normal ovary, while supernumerary ovaries were described as those ovaries situated away from normal ones. The one presented here is a case of a 20 year-old unmarried woman operated for recurrent abdominal pain. During laparoscopy we found a mass 2 × 1.5 cm in size in the ileum, located 80 cm from the ileocecal valve: the lesion was resected and an ileoileal anastomosis was performed, the anatomopathological examination of the mass proved to be ovarian tissue. The history of previous pelvic surgery with adhesiolysis, and the unusual location of the ectopic ovary, support the theory of an ovarian implant in the intestine, but the true ectopic ovary hypothesis is still probable because of the location of the ectopic ovary inside the intestinal wall. In any case, the location of ectopic ovary discussed here is unusual and perhaps unpublished before.

Bovine pericardium patch wrapping intestinal anastomosis improves healing process and prevents leakage in a pig model.

Failure of intestinal anastomosis is a major complication following abdominal surgery. Biological materials have been introduced as reinforcement of abdominal wall hernia in contaminated setting. An innovative application of biological patch is its use as reinforcement of gastrointestinal anastomosis. The aim of study was to verify whether the bovine pericardium patch improves the healing of anastomosis, when in vivo wrapping the suture line of pig intestinal anastomosis, avoiding leakage in the event of deliberately incomplete suture. Forty-three pigs were randomly divided: Group 1 (control, n = 14): hand-sewn ileo-ileal and colo-colic anastomosis; Group 2 (n = 14): standard anastomosis wrapped by pericardium bovine patch; Group 3 (n = 1) and 4 (n = 14): one suture was deliberately incomplete and also wrapped by patch in the last one. Intraoperative evaluation, histological, biochemical, tensiometric and electrophysiological studies of intestinal specimens were performed at 48 h, 7 and 90 days after. In groups 2 and 4, no leak, stenosis, abscess, peritonitis, mesh displacement or shrinkage were found and adhesion rate decreased compared to control. Biochemical studies showed mitochondrial function improvement in colic wrapped anastomosis. Tensiometric evaluations suggested that the patch preserves the colic contractility similar to the controls. Electrophysiological results demonstrated that the patch also improves the mucosal function restoring almost normal transport properties. Use of pericardium bovine patch as reinforcement of intestinal anastomosis is safe and effective, significantly improving the healing process. Data of prevention of acute peritonitis and leakage in cases of iatrogenic perforation of anastomoses, covered with patch, is unpublished.

English

Duplication of gut presenting as perforation, peritonitis in an adult is a very rare clinical presentation. Here we report a case of an adult female patient in generalized peritonitis was caused by perforation of tubular communicating, duplicated, Ileal loop which rotated at its attachment with main ileum. This condition was managed by performing laparotomy, excision of the duplicated gut segment followed by end to end ileoileal anastomosis. CASE REPORT: A 32 yrs. old female presented in surgical OPD with the history of generalized abdominal pain, gradual distension and vomiting off and on for the last 3-4 days. She had been suffering from episodes of these symptoms for past couple of months, suggestive of sub-acute intestinal obstruction. However for last few days, these symptoms were aggravated. Patient had been empirically put on ATT by clinicians whom she had been consulting before coming to our hospital. Patient had undergone laparotomy about 8 years ago for perforated appendix. Patient appeared quite ill, dehydrated with tachycardia tachypnea and mild fever. Physical examination, revealed distended abdomen with tenderness and guarding all over. Rebound tenderness was also present. No hepatosplenomegaly was detected. P/V and P/R examination were within normal limits. A right paramedian scar from previous surgery was present. Hematological profile revealed normal study. X-ray abdomen erect view showed multiple Air fluid levels. USG study of abdomen showed mesenteric thickening with mild fluid and dilated bowel loops. She was taken up for Exploratory Laparotomy after correcting her dehydration. Abdomen was opened through mid-line incision which revealed dilated small bowel loops with free fluid. Exploration revealed about one feet long tubular, dilated and duplicated gut which had rotated upon its own axis where it was joining with the main gut, communicating at both proximal and distal ends, causing obstruction and perforation. (Fig. 1, Fig. 2). The segment had no independent mesentery. It derived it's vascularity from the main ileal wall segment with which it was communicating (as shown by a hand inserted in the intervening empty space between the two segments in the Fig. 2). This segment was about 2.5 ft. away proximal to ileocecal junction. This duplicated gut segment was resected and an end to end ileoileal anastomosis was done. No evidence of abdominal Koch's was detected. Her post-operative period remained uneventful and she was discharged fifteen days after surgery.

Radical cystectomy with W-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples-long term follow-up

We retrospectively assessed our experience with the W-shaped orthotopic ileal pouch, which was constructed with non-absorbable titanium staples. For these purpose, we discuss the results of bladder capacity, urinary continence and early and long-term postoperative complications. We included in the study 17 patients who underwent radical cystoprostatectomy followed by construction of an orthotopic W-shaped ileal pouch between October 2000 and November 2009. A 65-70 cm segment of ileum was isolated and prearranged into a W-configuration, leaving two 10 cm intact segments on both sides of the ileal fragment. In our technique we entirely anatomized all adjacent limbs in order to create a sphere-shaped pouch. The ureters were directly anastomized to both intact segments of the ileal division. All our patients underwent pouchscopy 6 months after operation and annually. Mean operative time for neobladder reconstruction and ureteral anastomoses was 87 ± 7.67 minutes. In one patient a leak from the ileo-ileal anastomosis was confirmed on the 3rd day after operation. In 2 cases unilateral stricture of the ureteral-neobladder anastomosis was documented. Staple lines were mostly covered with ileal mucosa after 6 months. The mean functional bladder capacity was 340 ± 27.6 mL and 375 ± 43.4 mL at 6 and 12 months, respectively. First-year daytime and nighttime continence was good and acceptable in 90% and 78% of patients, while it increased to 95% during the 2nd year. The long term follow-up shows that non-absorbable titanium staples can be safely used for creation of an orthotopic ileal neobladder. However, these data should be further validated in a larger series of patients.

Combined adenocarcinoma-carcinoid tumor of transverse colon

A 65-year-old male presented with painless hematochezia associated with episodic cramps in upper abdomen, watery diarrhea, and a slowly growing mass in upper abdomen. Examination revealed a firm 6 x 5 cm, intra-abdominal, epigastric mass. Colonoscopy up to 90 cm showed a stenosing, ulcero-proliferative lesion in the transverse colon. No synchronous lesion was detected. Biopsy revealed mucin secreting adenocarcinoma. Exploration showed the growth involving the transverse colon proximal to the splenic flexure with a part of ileum, approximately three feet proximal to ileo-caecal junction, adherent to it. No significant mesenteric lymph node enlargement was evident. The patient underwent resection of the growth along with the segment of adherent ileum. Continuity was re-established by a colo-colic and ileo-ileal anastomosis respectively. Patient received adjuvant chemotherapy. Post-operative histopathology demonstrated a composite histological pattern with an admixture of carcinoid tumor and adenocarcinoma, invasion of ileal serosa and adenocarcinomatous deposits in mesocolic lymph nodes, the tumor staging being (T4, N0, M0/Stage II) for carcinoid and (T4, N1, M0/Stage III) for adenocarcinoma. Patient was followed-up for a year and was doing well without any evidence of recurrence.

Unique Presentation of Meckel Diverticulum in the Form of Cocoon Managed Successfully by Laparoscopic Surgery

We report a case of complicated Meckel diverticulum presenting with subacute intestinal obstruction in a 21-year-old man managed successfully by laparoscopic surgery. Despite a diagnostic laparoscopy and laparotomy performed elsewhere in the past, main pathology was missed. Diagnostic laparoscopy in our center revealed a fusiform mass arising from terminal ileum, which was treated by laparoscopic-assisted resection and end-to-end ileo-ileal anastomosis. Gross and microscopic examination revealed an encapsulated localized cocoon containing 40 cm of ileum entangled around an inflamed Meckel diverticulum. His intestinal obstruction and hematochezia got relieved.

Small bowel fibrosis and systemic inflammatory response after ileocolonic anastomosis in IL-10 null mice

BackgroundCrohn’s disease recurrence after an ileocecal resection is common; yet, its pathophysiology is poorly understood and available treatment is suboptimal. The purpose of this study was to examine the bacterial, local, and systemic immune changes that follow ileocolonic anastomosis in a rodent model of Crohn’s disease, the interleukin-10 gene–deficient (IL-10 null) mice. Materials and methodsWe divided wild-type and IL-10 null mice into three treatment groups: ileocolonic anastomosis, sham operation (ileo-ileal anastomosis), and control group without an operation. We sacrificed mice at 6 and 15 wks after the operation. At 6 wks, we assessed bacterial changes using the denaturing gel electrophoresis and similarity coefficient calculation. At both time points, we examined the small bowel for inflammation and fibrosis with histology. We measured the interferon gamma secretion by splenocytes stimulated with gastrointestinal bacterial antigens and splenocyte composition as a marker of systemic response. ResultsAt 6 wks, ileocolonic anastomosis resulted in increased similarity in bacterial species between the ileum and colon. The ileocolonic anastomosis did not lead to significant inflammation in the small intestine, but it resulted in an increased collagen deposition in all animals undergoing surgery, the most pronounced fibrosis of which was present in IL-10 null mice 15 wks after ileocolonic anastomosis. Furthermore, this was associated with significantly increased interferon gamma secretion by bacterial antigen-stimulated splenocytes and a decreased number of CD11+ cells in the same experimental group. ConclusionsIleocolonic anastomosis leads to bacterial changes in the terminal ileum. In the genetically susceptible host, it is associated with small bowel fibrosis and systemic immune alterations. The composition of immune cells in the spleen is altered and splenocytes hypersecrete proinflammatory cytokine (interferon gamma) when challenged with gastrointestinal bacterial antigens.

A rare combination of intestinal invagination and Meckel’s diverticulum in an adult: A case report

Intestinal invagination is a common pathology amongst children, while it is a rare entity in adults. Invagination is responsible for only 1-3% of adult-onset intestinal obstruction. Meckel's diverticulum, on the other hand, is the most common congenital anomaly of the gastrointestinal tract. Most of them are asymptomatic; they are recognized when they complicate, and can present with diverticulitis, gastrointestinal bleeding, intestinal obstruction, perforation, or invagination. A 16-year-old male patient presented to our emergency department with abdominal pain. There was a palpable mass at the right paraumbilical region. Gas-liquid level was seen on the direct abdominal radiography. On the abdominal ultrasonography, it was reported that the mass might be a result of invagination. As the patient had extensive peritonitis findings, with the pre-diagnosis of obstruction as a result of invagination, surgery was decided. During the operation, it was observed that the invaginated ileum loop was too ischemic for reduction; therefore, the invaginated part was resected and ileoileal anastomosis was performed. Examination of the resected segment revealed the Meckel's diverticulum as causing the invagination. In conclusion, with this case, we aimed to present the role of Meckel's diverticulum as an initiating factor of ileoileal invagination, with inversion into the ileum.

P205 A new rapid test for fecal calprotectin (FC) predicts mucosal healing in ulcerative colitis (UC)

tertiary IBD center were reviewed. Inclusion criteria: (1) Small bowel CD assessed by conventional techniques; (2) Detailed clinical history; (3) No stenosis/obstructions; (4) Small bowelCD assessed by entero-CT/-MRI, small intestinal contrast ultrasonography, barium follow through and/or ileocolonoscopy (IC) within 6mths from SBCE; (5) SBCE images reviewed by one single gastroenterologist. SBCE performed using the Given Pillcam SB (Given, Israel) after 2L PEG. Findings considered: (a) CD extent before vs after SBCE; (b) upper GI lesions (i.e. above the distal ileum proximal to the valve or to the anastomosis); (c) SBCE transit times; (d) impact rate. Results: A total of 40 CD pts (20M, median age 34 yrs, range 18 70) fulfilled the inclusion criteria. Previous ileo-colonic resection was shown by 29/40 (72.5%) pts (median interval 10mths, range 3 300). CD localization involved the ileum in 37/40 (92%) CD (recurrence in 26/37) and also the upper GI in 4/37 (10%), while 3 pts showed no recurrence. SBCE showed marked interindividual variations in terms of gastric (median 29min, range 3 360) and small bowel transit times (valve: median 350min, range 240 433 or anastomosis in resected CD: median 231 min, range 61 466). SBCE did not visualize the entire small bowel in 9/40 (22.5%) pts (5/11 CD not resected, 4/29 resected pts). Upper GI lesions were detected by SBCE in 23/40 (57.5%) pts, known before SBCE in only 4/40 (10%) pts. In one pt, SBCE visualized an ulcerated jejunal stenosis requiring surgery not detected by SBFT and IC. In 1/40 (2.5%) pts, SBCE impact requiring surgery within a “cul de sac” of an ileo-ileal anastomosis was observed. Conclusions: Upper GI lesions may be detected by SBCE in a high proportion of CD pts, although their clinical relevance needs to be determined. Before SBCE, CD pts need a careful selection due to possible incomplete small bowel visualization and to the impact risk occurring also in the absence of stenosis.

Gastrointestinal: A gastrointestinal stromal tumour (GIST) arising in a Meckel's diverticulum

A 39-year-old man who had 4 years previously undergone a laparoscopic appendicectomy for acute appendicitis was admitted with sudden onset severe lower abdominal pain. Initial examination revealed focal peritonism in the right iliac fossa, temperature of 39°C and tachycardia (96 bmp). White blood cell count was 16 × 109/l. Contrast enhanced abdominal CT was done 10 hrs after admission. The coronal reformatted image of the CT scan (Figure 1) demonstrated a segment of thickened ileum, inseparable from which was a blind ending loop of small bowel with a mixed attenuating mass within the lumen (arrow). There were no features of small bowel obstruction or free intraperitoneal fluid or air. A diagnosis of an inflamed Meckel's diverticulum or a small bowel tumour was suggested. At laparotomy, a large inflamed Meckel's Diverticulum was seen arising from the antemesenteric border of the ileum (Figure 2a). The diverticulum was resected along with a segment of ileum and a side-to-side ileo-ileal anastomosis was performed. Histological examination with haematoxylin and eosin stain (Figure 2b, magnification ×40) revealed a well-circumscribed lesion in the wall of the small bowel composed of fascicles of bland spindle cells with a central cystic area lined by inflamed small intestinal and pyloric epithelium. Immunohistochemistry confirmed an intermediate risk gastrointestinal stromal tumour (GIST) with positive staining with antibodies to CD34, CD117 and delay of gestation 1 (DOG1) antigen (Figure 2c, magnification ×10), and a Ki-67 proliferation index of 5%. A connection of the central cyst to the bowel lumen was not demonstrable, but in view of the appearance and position of the lesion the features were thought to be consistent with a GIST originating in a Meckel's diverticulum and occluding the neck of the diverticulum. Well differentiated endocrine carcinoma (carcinoid) is the most common tumour in this location and only 11 cases of GIST arising in a Meckel's diverticulum have been reported in the last decade. In the majority of histologically suspected GISTs a combination of CD117 and DOG1 immunostaining is sufficient to confirm the diagnosis. Modes of presentation including gastrointestinal bleeding, perforation, paraneoplastic deep vein thrombosis and incidental finding upon imaging or laparotomy. The patient made an uncomplicated recovery and as the GIST was completely excised and had a low proliferation index, no further therapy was necessary. He remains well two years postoperatively. Contributed by

Anastomotic sealing with a fibrin-coated collagen patch in small-diameter bowel

The aim of this study was to evaluate the complication rates and inflammatory response in TachoSil™-sealed small-diameter anastomoses with conventional and reduced suture number as a model for neonatal bowel surgery. Ileo-ileal anastomoses were performed in 73 rats. In the control group, the anastomosis was accomplished with the conventional technique, using nine interrupted sutures. In the other groups with nine, six, and three interrupted sutures, the anastomotic line was additionally sealed with a fibrin-coated collagen patch (TachoSil™). The rats were sacrificed on days0, 2, and 10. Clinical and functional parameters included the rates of ileus, insufficiency and death, operating time, adhesions, bursting pressure, and preanastomotic dilatation. The histological examination of the anastomoses concentrated on assessing the inflammatory cell infiltration of the TachoSil™ patch and the intestinal wall. Severe preanastomotic dilatation was observed in additionally sealed ileo-ileal anastomoses with conventional suture number and high complication rates (ileus, perforation, death) occurred in additionally sealed anastomoses with reduced suture number. We found a massive microabscess-forming inflammation in additionally sealed anastomoses. Inflammatory cell infiltration was highest in the collagen layer of the sealing patch (p < 0.05 vs. fibrin layer of the sealing patch and vs. intestinal wall). As a result of our findings, additional sealing of small-diameter intestinal anastomoses with TachoSil™ cannot be recommended.

Adult large bowel obstruction: A review of clinical experience

Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. This is a prospective study of adult patients with acute large bowel obstruction over a 6-year period. The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. If the obstruction involved the right colon resection and primary ileo-colic anastomosis was performed, while for a lesion in the left colon a resection and primary colocolic anastomosis was performed after intraoperative antegrade colonic irrigation. If the obstructing lesions were thought to be malignant and too advanced to merit any excisional or the patient's general condition was too poor to withstand resection, a biopsy was taken and a decompressive bypass procedure given pending the confirmation of the diagnosis. The clinical course and postoperative outcome were carefully documented. A total of 50 patients aged 20-80 years, with a median age of 49 years, presented with features consistent with large bowel obstruction. Of these, 32 had simple sigmoid volvulus and were offered sigmoid colectomy and primary colorectal anastomosis, while 3 further patients with compound sigmoid volvulus had double resection with primary ileo-ileal and colorectal anastomosis. A patient with sigmoid volvulus had a Hartmann's procedure. Twelve patients had colon cancer, four had left hemicolectomy and primary colocolic anastomosis; three, sigmoid colectomy and primary colorectal anastomosis; three, low anterior resection and primary colorectal anastomosis; one decompressive colostomy and one, a right hemicolectomy and primary ileocolic anastomosis. The two patients with functional obstruction (Ogilvie syndrome) had tube caecostomy. All resections and primary anastomosis involving the right colon were preceded by antegrade on-table colonic lavage. One clinical anastomotic leak occurred in a low rectal anastomosis and minor wound infection in 10 patients. Operative mortality occurred in three patients with sigmoid volvulus. Adult large bowel obstruction is infrequent in our community and is caused commonly by sigmoid volvulus. Resection and primary anastomosis of the acute left-sided large bowel obstruction seems safe after antegrade on-table colonic lavage, provided bowel gangrene with peritonitis or any additional risk factor for anastomotic breakdown is not present.

Early morphological and histochemical alterations in rats subjected to ileocystoplasty

To study morphologic and histochemical alterations arising at the ileocystoplasty site. Sixteen Wistar female rats were subjected to ileocystoplasty and sacrificed after eight weeks. Material collected was divided into four groups for histological and histochemical studies: Group I (control) - isolated ileum segment removed during ileocystoplasty; Group II - ileoileal anastomosis; Group III - ileovesical anastomosis and Group IV - ileal segment from the neobladder. Histological and histochemical study assessed dysplasia, metaplasia, acute and chronic inflammation, fibrosis, atrophy, hypertrophy, total mucins, sialomucins and sulfomucins. The non-parametric Wilcoxon and Mann-Whitney tests were employed in statistical analysis. None of the groups presented dysplasia. Acute inflammation and atrophy occurred in Groups II, III and IV, not reaching statistical significance. Metaplasia was significant only in Group III (p=0.012). Chronic inflammation, fibrosis and hypertrophy were significant in Groups II, III and IV. There was a significant increase in total mucin content in Group IV (p=0.014) and a reduction in Group III (p=0.016). Increases in sialomucins were observed in samples for Groups III (p=0.003) and IV (p=0.002) along with reduced sulfomucins in samples from Groups III (p=0.013) and IV (p=0.008). Ileocystoplasty in female rats caused squamous metaplasia, chronic inflammatory infiltration, fibrosis, hypertrophy, increase in sialomucin content, reduction in sulfomucins, and alterations in total mucin content with statistical significance, as well acute inflammatory infiltration and muscular atrophy with less intensity.

W1244 The Role of Adenine and Guanine in Beneficial Effects of the Gastric Pentadecapeptide BPC 157 (PL 14736) On Ileoileal Anastomosis Healing in Rats Impaired with Systemic Corticosteroid Application. Raman Spectroscopy Study

Safe in inflammatory bowel disease (PL14736 Pliva, Croatia), no toxicity reported (Gastroenterology, 2005), gastric pentadecapeptide BPC 157 (BPC 157) heals the intestinal anastomosis (Surg Today, 2007). Raman spectroscopy was used to show the beneficial effect of BPC 157 on anastomosis healing in rats impaired with systemic corticosteroid application. Assessed were Raman spectroscopy, ileoileal anastomosis dehiscence, histology, biomechanical presentation (the volume (ml) (infunded through syringe-perfusion pump system (1ml /10 sec)) and the leakage pressure (mmHg) (catheter connected with chamber and monitor, at 10 cm proximal to anastomosis), on days 1, 2, 3, 4, 5 and 6. BPC 157 10µg, 6-alpha-methylprednisolone (MP) 1 mg, given alone or together /kg i.p. (or an equivolume of saline 5ml/kg). First application was after surgery and last was 24 h before sacrifice. Raman spectroscopy. Measurements used Perkin Elmer Spectrum GX FT Raman spectrometer with 4 cm-1 resolution. Excitation was NdYaG laser at 1064 nm wavelength and used laser power was 500 mW. Spectra were recorded in the area between 300 and 2300 cm-1, with 50 scans for better S/N ratio. Prior to mounting on a universal holder, the specimen was cut to a 0.3 x 0.3 cm piece. Presenting almost constant intensity for all investigated samples, all spectra were baseline corrected and normalized to band at 1450 cm-1. Raman spectroscopy. To point out an advanced healing rate the spectral areas from 510 to 560 cm-1, 800 to 1150 cm-1 and band at 1490 cm-1 were individually observed. We focused the band at 1490 cm-1, assigned to vibrations of adenine and guanine, to be indicative for increased tissue regeneration, since it fully correlates with the evidenced healing process. BPC 157 rats showed an increase throughout the 1-6 days following surgery ; MP-rats did not show before day 6. This healing delay is fully counteracted when rats received BPC 157 simultaneously with MP. Macroscopic and histology data support these findings: adhesion formation attenuated, blood vessels filled, mild passage obstruction only temporary ; anastomosis without leakage sustains markedly higher both volume and pressure, with consistent increase to healthy values ; decreased edema, granulocyte number and necrosis, along with granulation tissue, reticulin and collagen formation substantially increased, and finally epithelization increased (BPC 157) ; (MP)causing aggravation. These data signify the role of adenine and guanine in the anastomosis healing process, BPC 157 has a beneficial effect, MP negative effect, and counteracted corticosteroid impairment by BPC 157 application.

Parameters of Healing in Approximative Intestinal Anastomosis

The restoration of bowel continuity using multiple classic anastomoses is mostly impossible in unstable critically ill extremely low birth weight neonates. The parameters of healing of approximative anastomoses in which integrity and continuity of bowel is achieved with limited number of stitches were evaluated in an experimental study. Small bowel anastomoses were performed in twenty-two adult male rats. An approximative ileo-ileal anastomosis was performed with five seromuscular-interrupted sutures only; in the control group the anastomosis was performed with the conventional technique of interrupted sutures. The mechanical and biochemical parameters were compared. All anastomoses in both groups healed well without obstruction. The mean operating time needed for an approximative anastomosis was shorter (16 +/- 7.1 min versus 23.6 +/- 6.2 min, p = 0.016). The strength of the approximative anastomoses on the 1st day after surgery was 55 +/- 15 torr; the strength of the conventional anastomoses was 55 +/- 42 torr. The strength of the approximative anastomoses after 7 days was 249 +/- 39 torr; the strength of the conventional anastomoses was 218 +/- 23 torr (p = 0.118). The activity of the collagenolytic enzymes matrix metalloproteinase-2 and matrix metalloproteinase-9 in the anastomotic area was significantly increased compared with the activity in samples of non-operated bowel. There was no significant difference in collagenolytic activity between both types of anastomoses. The approximative anastomosis is a time-saving alternative to conventional anastomoses with a comparable course of anastomotic healing, anastomotic strength, and changes in collagen metabolism.

Gallstone Obstructive Ileus 3 Years Post-cholecystectomy to a Patient with an Old Ileoileal Anastomosis

The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.