Intestinal Bleeding Research Articles

UNCOMMON PRESENTATION OF MECKEL DIVERTICULUM IN AN INFANT

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Painless intestinal hemorrhage is a frequently occurring complication that relates to Meckel's diverticulum in children. Bowel obstruction is a rare complication of Meckel's diverticulum in children. This is to report a case of 1 month old male infant presented with sudden history of abdominal distention and not passing stool for 4 days

Usefulness of indocyanine green fluorescence-guided small intestinal bleeding site identification in small bowel resection: a report of two cases and literature review.

Small bowel bleeding that does not respond to conservative therapy requires surgical resection. However, identifying the bleeding sites intraoperatively is challenging. Indocyanine green (ICG) fluorescence imaging improves diagnosis of small bowel bleeding and surgical decision-making by visualizing blood flow. Herein, we reported two cases of small bowel bleeding that were successfully treated by using ICG to identify the bleeding sites and determine the extent of small bowel resection. The patients were a 46-year-old and a 75-year-old woman, both of whom presented with melena. Contrast-enhanced computed tomography and arteriography confirmed small bowel bleeding, and rebleeding occurred in both patients after transcatheter arterial embolization. Emergent surgeries were performed, and intraoperative selective angiography with ICG injections was conducted to identify obscure bleeding sites. ICG fluorescence identified all bleeding sites in both cases, and small bowel resections were successfully performed. The postoperative courses were uneventful, and both patients had a favorable postoperative course without recurrence of bleeding. ICG fluorescence imaging can safely identify the sites of intestinal bleeding and determine the appropriate extent of bowel resection.

Clinical determinants and impact of hemorrhagic lesions on intestinal pathology in preterm infants with surgical necrotizing enterocolitis.

We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC). A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology. The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5 % vs 76.9 %; p = 0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; p = 0.034), lost more bowel length (p = 0.045), had higher CRP levels at 2 weeks (p = 0.035), and had less intestinal failure ([30.3 % vs 52.5 %]; p = 0.014) than mild/moderate (Grade 0-2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage had significantly higher mean inflammation score (2.67 [0.94] vs. 1.63 [0.92]; p = <0.001), higher necrosis scores (1.95 [1.28] vs. 1.49 [1.35]; p = 0.037), higher neovascularization (p = 0.01), higher fibroblasts (p = 0.023) and higher lymphocyte percentages up to 48 hours (p < 0.05) following NEC than mild/ moderate hemorrhage group.On multivariable regression, less exposure to antenatal steroids (OR 0.18 [95% CI 0.05-0.58]; p = 0.005), higher inflammation (OR 3.7 [95% CI 2.09-7.32]; p = 0.001), and lymphocyte count on the day of onset/24 hours following NEC (OR 1.06 [95% CI 1.02-1.11]; p = 0.005) were independently associated with a higher odd of severe intestinal hemorrhage. The surgical NEC infants with intestinal hemorrhage were less likely to have antenatal steroid exposure but had higher inflammation grade and lymphocyte counts following NEC onset on multivariable regression modeling.

Diagnostic Accuracy of Fecal Immunochemical Test (FIT) in Bleed-positive and Bleed-negative Colorectal Cancer (CRC) Among a Cohort of 5,090 Subjects who Participated in the Colorectal Neoplasia (CRN) Screening in Brazil.

This study assessed the diagnostic accuracy (DA) of fecal immunochemical test (FIT) ColonView (CV) and guaiac-based fecal occult blood test (HemoccultSENSA) among bleed-positive (history or signs of intestinal bleeding) and bleed-negative participants (no history or signs of intestinal bleeding) (n=5,090) in colorectal neoplasia (CRN) screening in Brazil. The eligible patients for the study (n=506) collected three consecutive stool samples, to be analyzed by both assays (CV, SENSA). Finally, 421/5090 (8.3%) patients returned both samples, which were subjected to final analysis. Receiver operating characteristic (ROC) analysis with different cut-offs was performed to assess the DA. The area under curve (AUC) values for i) visually analyzed (VA) CV for bleed-positive CRC, ii) automatically analyzed (AA) CV for bleed-positive CRC, iii) VA CV for bleed-negative CRC, and iv) AA CV for bleed-negative CRC as endpoints were as follows: i) AUC=0.864, ii) AUC=0.933, iii) AUC=0.836, and iv) AUC=0.892. In roccomp analysis, the differences in AUC values were: between i) and ii) p=0.068; between i) and iii) p=0.497; between i) and iv) p=0.488; between ii) and iii) p=0.0058; between ii) and iv) p=0.229; and between iii) and iv) p=0.138. This is the first investigation where two modes of CV test, VA, and AA, for bleed-positive and bleed-negative CRC patients were used as the endpoint. The AA reading of the CV test showed higher DA in bleed-positive than in bleed-negative CRC patients.

Interleukin-10 Knockout Mice Do Not Reliably Exhibit Macroscopic Inflammation: A Natural History Endoscopic Surveillance Study.

Interleukin (IL)-10 knockout (KO) mice, a model for inflammatory bowel disease (IBD), develop chronic enterocolitis due to an aberrant immune response to enteric antigens. Endoscopy, the gold standard for evaluation of human mucosal health, is not widely available for murine models. To assess the natural history of left-sided colitis in IL-10 KO mice via serial endoscopies. BALB/cJ IL-10 KO mice underwent regular endoscopic assessments from 2 up to 8months of age. Procedures were recorded and blindly evaluated using a 4-component endoscopic score: mucosal wall transparency, intestinal bleeding, focal lesions and perianal lesions (0-3 points each). An endoscopic score ≥ 1 point was considered as the presence of colitis/flare. IL-10 KO mice (N = 40, 9 female) were assessed. Mean age at first endoscopy was 62.5 ± 2.5days; average number of procedures per mouse was 6.0 ± 1.3. A total of 238 endoscopies were conducted every 24.8 ± 8.3days, corresponding to 124.1 ± 45.2days of surveillance per mouse. Thirty-three endoscopies in 24 mice (60%) detected colitis, mean endoscopy score 2.5 ± 1.3 (range: 1-6.3). Nineteen mice (47.5%) had one episode of colitis and 5 (12.5%) had 2-3 episodes. All exhibited complete spontaneous healing on subsequent endoscopies. In this large-scale endoscopic surveillance study of IL-10 KO mice, 40% of mice did not develop endoscopic left-sided colitis. Furthermore, IL-10 KO mice did not exhibit persistent colitis and universally exhibited complete spontaneous healing without treatment. The natural history of colitis in IL-10 KO mice may not be comparable with that of IBD in humans and requires careful consideration.

Treatment of Cutaneous Lesions in a Case of Blue Rubber Bleb Nevus Syndrome

Blue rubber bleb nevus syndrome (BRBNS), sometimes called Bean syndrome, is a rare sporadic congenital vascular disorder characterized by multiple venous malformations in various organ systems, most commonly the skin and gastrointestinal tract. The presence of characteristic skin lesions is often the first suggestion of this diagnosis, though chronic anemia and intestinal bleeding are also commonly present. We report a case of a patient with painful lesions on the plantar surfaces of the feet and a new cutaneous growth on the left labia majora. The plantar lesions were treated with Nd:YAG laser and the lesion on the labia majora was removed with a shave biopsy.

A269 THE MODULATION OF INTESTINAL INFLAMMATION BY PARABACTEROIDES GOLDSTEINII IN MURINE MODELS OF COLITIS

Abstract Background Inflammatory bowel diseases (IBDs), comprised mainly of Crohn’s disease and ulcerative colitis, are characterized by chronic and relapsing intestinal inflammation. Though the etiology of IBDs is not entirely understood, it is thought that an imbalance of the gut microbiota is one contributing factor, making it a potential target for the treatment of IBDs. Purpose This study aims to examine how the potential probiotic Parabacteroides goldsteinii modulates intestinal inflammation in the context of experimental colitis. Method Wild type C57BL/6 mice were divided into three groups. One group was given phosphate-buffered saline (PBS) via oral gavage without any further treatment. The second group was treated with 1% dextran sodium sulfate (DSS) for twelve days induce colitis and given PBS every three days. Finally, the third group was also treated with 1% DSS for twelve days and given P. goldsteinii via oral gavage every three days. Weight loss, stool consistency, and intestinal bleeding were monitored and were used to calculate the Disease Activity Index (DAI) daily. Postmortem, colon length was measured, and inflammation score was evaluated on hematoxylin and eosin-stained samples of the colon and spleen. Finally, interleukin (IL)-6 levels were measured in the colon tissue and the serum by ELISA. Result(s) Colonization was confirmed at day three after gavage by real-time PCR. Preliminary results show that DSS-treated mice lost significantly more weight by day twelve than mice colonized with P. goldsteinii. Additionally, on days eight and twelve, mice colonized with P. goldsteinii had significantly lower DAI scores than mice that received only PBS. Finally, mice colonized with P. goldsteinii had significantly longer colons than those that received only PBS. Conclusion(s) The preliminary data indicates that mice colonized with P. goldsteinii had less severe symptoms of colitis than mice only given PBS. This suggests that P. goldsteinii may attenuate inflammation in mice treated with DSS. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; ICM Disclosure of Interest None Declared

A271 THE MODULATION OF INTESTINAL INFLAMMATION BY PARABACTEROIDES GOLDSTEINII IN EXPERIMENTAL MURINE COLITIS

Abstract Background Inflammatory bowel diseases (IBDs), comprised mainly of Crohn’s disease and ulcerative colitis, are characterized by chronic and relapsing intestinal inflammation. Though the etiology of IBDs is not entirely understood, it is thought that an imbalance of the gut microbiota is one contributing factor, making it a potential target for the treatment of IBDs. Purpose This study aims to examine how the potential probiotic Parabacteroides goldsteinii modulates intestinal inflammation in the context of experimental colitis. Method Wild type C57BL/6 mice were divided into three groups. One group was given phosphate-buffered saline (PBS) via oral gavage without any further treatment. The second group was treated with 1% dextran sodium sulfate (DSS) for twelve days induce colitis and given PBS every three days. Finally, the third group was also treated with 1% DSS for twelve days and given P. goldsteinii via oral gavage every three days. Weight loss, stool consistency, and intestinal bleeding were monitored and were used to calculate the Disease Activity Index (DAI) daily. Postmortem, colon length was measured, and inflammation score was evaluated on hematoxylin and eosin-stained samples of the colon and spleen. Finally, inflammatory cytokine levels were measured in the colon tissue and the serum by multiplex assay. Result(s) Colonization was confirmed at day three after gavage by real-time PCR. Preliminary results show that DSS-treated mice lost significantly more weight by day twelve than mice colonized with P. goldsteinii. Additionally, on days eight and twelve, mice colonized with P. goldsteinii had significantly lower DAI scores than mice that received only PBS. Finally, mice colonized with P. goldsteinii had significantly longer colons than those that received only PBS. Conclusion(s) The preliminary data indicates that mice colonized with P. goldsteinii had less severe symptoms of colitis than mice only given PBS. This suggests that P. goldsteinii may attenuate inflammation in mice treated with DSS. Please acknowledge all funding agencies by checking the applicable boxes below CIHR Disclosure of Interest None Declared

Importance of intraoperative indocyanine green imaging in the management of non-occlusive mesenteric ischemia: a case report

BackgroundNon-obstructive intestinal ischemia (NOMI) is caused by intestinal vascular spasm and has a poor prognosis if not diagnosed and treated early. Indocyanine green (ICG) fluorescence imaging has been reported to be useful for the intraoperative assessment of the extent of intestinal resection required for NOMI. Few reports have described massive intestinal bleeding after conservative management of NOMI. We report a case of NOMI with massive postoperative bleeding from the site of an ICG contrast defect found before the initial surgery.Case presentationA 47-year-old woman with hemodialysis-dependent chronic kidney disease presented complaining of severe abdominal pain. A computed tomography scan showed portal gas and dilation of the small intestine, leading to a diagnosis of NOMI and subsequent emergency surgery. At the time of initial surgery, the contrast effect of ICG was slightly reduced, showing a granular distribution in the ascending colon to cecum (fine grain pattern) and significantly reduced in parts of the terminal ileum except around blood vessels (perivascular pattern). However, there was no obvious gross necrosis of the serosal surface, and the intestinal tract was not resected. The acute postoperative course was uneventful; however, the patient went into shock on the 24th postoperative day due to massive, small intestinal bleeding, and emergency surgery was performed. The bleeding originated from the section of the ileum that had complete loss of ICG contrast effect before the initial surgery. A right hemicolectomy with the terminal ileum resection was performed, and an ileo-transverse anastomosis was performed. The second post-operative course was uneventful.ConclusionsWe report a case of delayed hemorrhage of the ileum shown to have poor blood flow on ICG imaging at the initial surgery. Intraoperative ICG fluorescence imaging is useful in assessing the degree of intestinal ischemia for NOMI. When patients with NOMI are followed up without surgery, complications such as bleeding should be noted.

Intestinal Parasites in School-Aged Children of Rumuodogo, Emohua Local Government Area, Rivers State, Nigeria

Aim: This epidemiological survey was carried out to assess the prevalence of intestinal parasites in School aged Children.&#x0D; Place and Duration of study: The study was carried out in Rumuodogo Community in Emohua Local Government area of Rivers State, Nigeria between the months of March to June 2019.&#x0D; Methodology: Microscopic examination of stool samples from 200 school-aged pupils between the ages 3-18 years was carried out using formol-ether concentration and direct wet mount, and stained iodine. Demographic as well as epidemiological data were obtained using a questionnaire.&#x0D; Results: The finding reveals an overall prevalence of 49.5%. However, there was a significant difference in the parasite prevalence values between the age groups (P = 0.01). The common intestinal parasites identified were Ascaris lumbricoides 19.5%, Ancylostoma duodenale 9.5%, Trichuris spp. 6%, Strongyloides spp. 4.5%, Enterobius spp. 1%, Taenia solium, 1.5%, Taenia saginata 1%, Entamoeba histolytica 4.5%, Giardia lamblia 4% and Schistosoma mansoni 2%. The prevalence of intestinal parasites infections with respect to the available and use of toilet facility revealed that Pit toilet users had the highest prevalence of 62 (56.9%) while no infection was recorded among users of water closet toilet. When age groups were compared, the result showed that age group 3-6 years were significantly more infected than the other age groups (P = 0.01). There was no significant difference between other age groups. The findings however, showed that age groups 6-10 years had the highest prevalence of 55.6%. Maximum of seven children had multiple infections. The male female ration was 62:37 while the percentage for males was 43.2% and 50% for females.&#x0D; Conclusion: Intestinal parasitic infections are associated with reduced development of children manifested by a reduced physical fitness which may result from vitamin deficiencies, inducing intestinal bleeding, and protein energy malnutrition. Therefore, the high prevalence of intestinal parasites recorded in this study calls for an intensified effort in the control of the infections. Regular deworming of children and environmental sanitation should be carried out to further reduce the prevalence.

Convolutional neural network-based segmentation network applied to image recognition of angiodysplasias lesion under capsule endoscopy

Small intestinal vascular malformations (angiodysplasias) are common causes of small intestinal bleeding. While capsule endoscopy has become the primary diagnostic method for angiodysplasia, manual reading of the entire gastrointestinal tract is time-consuming and requires a heavy workload, which affects the accuracy of diagnosis. To evaluate whether artificial intelligence can assist the diagnosis and increase the detection rate of angiodysplasias in the small intestine, achieve automatic disease detection, and shorten the capsule endoscopy (CE) reading time. A convolutional neural network semantic segmentation model with a feature fusion method, which automatically recognizes the category of vascular dysplasia under CE and draws the lesion contour, thus improving the efficiency and accuracy of identifying small intestinal vascular malformation lesions, was proposed. Resnet-50 was used as the skeleton network to design the fusion mechanism, fuse the shallow and depth features, and classify the images at the pixel level to achieve the segmentation and recognition of vascular dysplasia. The training set and test set were constructed and compared with PSPNet, Deeplab3+, and UperNet. The test set constructed in the study achieved satisfactory results, where pixel accuracy was 99%, mean intersection over union was 0.69, negative predictive value was 98.74%, and positive predictive value was 94.27%. The model parameter was 46.38 M, the float calculation was 467.2 G, and the time length to segment and recognize a picture was 0.6 s. Constructing a segmentation network based on deep learning to segment and recognize angiodysplasias lesions is an effective and feasible method for diagnosing angiodysplasias lesions.

Antimicrobial Resistance and Pathogenicity of Aliarcobacter butzleri Isolated from Poultry Meat

Aliarcobacter butzleri (A. butzleri) is an emergent zoonotic food-related pathogen that can be transmitted through the consumption of poultry meat. Data regarding the pathogenicity and resistance of A. butzleri are still scarce, and the presence of virulent MDR strains of this zoonotic pathogen in poultry meat is an issue of particular concern to public health. This study aimed to characterize the pathogenicity and antimicrobial resistance profiles of A. butzleri strains isolated from poultry meat sold at retail markets in São Paulo, Brazil. The minimum inhibitory concentrations of 27 strains were determined using the broth microdilution method. The results showed that 77.7% of the isolates were resistant to clindamycin, 62.9% to florfenicol, 59.2% to nalidixic acid, 11.1% to azithromycin, 7.4% to ciprofloxacin and telithromycin, and 3.7% to erythromycin and tetracycline, although all were susceptible to gentamicin. Moreover, 55.5% of the virulent isolates were also multidrug-resistant (MDR). Three strains were selected for pathogenicity tests in vitro and in vivo. The tested strains expressed weak/moderate biofilm production and showed a diffuse adhesion pattern (3 h) in HeLa cells and toxicity in Vero cells (24 h). Experimental inoculation in 11-week-old chicks induced a transitory inflammatory enteritis. Intestinal hemorrhage and destruction of the intestinal crypts were observed in the rabbit ileal loop test. Considering the fact that Brazil is a major exporter of poultry meat, the data from this study point to the need of improvement of the diagnostic tools, as well as of the adoption of surveillance guidelines and more specific control strategies to ensure food safety, reducing the presence of pathogenic MDR strains in broilers.

Rare giant adrenal cyst in pediatric patient

Giant adrenal cysts represent very rare clinical cases that are normally incidentally discovered and occur extremely rarely among pediatric patients. This case reports a patient who presented with generalized intestinal complaints and GI bleeding. Ultrasound and MRI were performed and identified a giant right retroperitoneal cyst (9.2 cm × 10.5 cm x 11.7 cm). The patient underwent laparoscopic surgery with complete removal of the cyst from the right adrenal gland. Pathologic evaluation confirmed a benign adrenal cyst.

P183 Development of a new simple ultrasound activity score for intestinal Behçet's Disease

Abstract Background Intestinal Behçet's disease (BD) is a relapsing-remitting disease typically associated with punched-out ulcers in the ileocecal region. Optimal monitoring of disease activity is necessary; however, ileocolonoscopy cannot be performed on a regular basis as it is invasive, resource-intensive and causes considerable patient discomfort. Furthermore, there are risks of intestinal bleeding and perforation caused by pretreatment laxatives and air insufflation during the examination. Hence, other follow-up examinations are required. Intestinal ultrasonography (IUS) is a minimally invasive imaging method, but there are no previous reports of comparisons between IUS and endoscopy for intestinal BD. This study aimed to evaluate the usefulness of IUS in assessing the activity of ileocecal ulcers in intestinal BD. Methods This retrospective single-centre study included patients with intestinal BD who underwent colonoscopy and IUS within 2 weeks, from 2007 to 2020. Correlations between the corresponding endoscopic activity using the Sakita–Miwa classification and six IUS variables (bowel wall thickness [BWT], vascularity, bowel wall stratification, intramural and extramural abscesses, fistulas and mesenteric lymphadenopathy) were assessed and used to select the variables that should be included in the new simple score. IUS findings were also compared with biomarker (C-reactive protein [CRP]) concentrations and clinical severity indices (Crohn’s disease activity index and disease activity index for intestinal BD [DAIBD]). Results Seventy-nine IUS examinations from 53 patients were included. Univariate analysis revealed that CRP and DAIBD and the IUS findings BWT, vascularity and bowel wall stratification and intramural and extramural abscesses differed significantly according to endoscopic ulcer activity. Multivariate analysis using a logistic regression model revealed that only BWT and vascularity were statistically different; therefore, a new simple score ([2*BWT] + [5*vascularity]) was constructed. Receiver operating characteristic curve analysis revealed an area under the curve of 0.91 for detecting endoscopic activity, which was superior to those of CRP (0.80; P=0.069), Crohn’s disease activity index (0.69; P=0.002) and DAIBD (0.67; P&amp;lt;0.001). Conclusion A new simple ultrasound activity index for intestinal BD comprising BWT and vascularity was constructed and correlated well with endoscopic disease activity. This is the first report describing the usefulness of IUS for intestinal BD, and we believe the findings will have many implications in clinical practice.

An intelligent intestinal bleeding diagnosis and treatment capsule system based on color recognition.

To our best knowledge, there are no non-invasive and painless means for the diagnosis and treatment of intestinal bleeding as of now, especially the segment of intestine that cannot be reached by endoscopy. We proposed an intelligent intestinal bleeding diagnosis and treatment capsule (IBDTC) system for the first time to diagnose and treat intestinal bleeding with low power consumption, estimated to be about 2.16mW. A hue-saturation-light (HSL) color space method was applied to diagnose bleeding according to H (hue) values of the film dyed by blood. A MEMS-based micro-igniter works as the critical component of the micro-thruster that houses the propellant (74.6% potassium nitrate, 11.9% sulfur, 13.5% charcoal) and the detonating agent (dinitrodiazophenol), to help release drug. Bleeding detection and ignition tests were performed to justify its feasibility and reliability. Results demonstrated that the bleeding diagnosis module of the IBDTC can effectively detect bleeding and the micro-igniter can successfully ignite the propellant. Owing to its simplicity and intelligence, the IBDTC system will pave a way for future accurate treatment of small intestinal bleeding with no injury, no pain, no complicated supporting equipment, no need for in vitro operation and positioning.

Endoscopic research methods for morphofunctional changes in the small intestine

Purpose: to analyze the results of diagnosis and treatment of tumors of the small intestine, which served as a source of small bowel bleeding. Materials and methods: 35 patients were analyzed: men - 19 (59.4%), women - 16 (41.6%) aged 19 to 85 years, with tumors and tumor-like lesions of the jejunum and ileum. The main indication for examination of the small intestine in these patients was the search for a source of bleeding that was not identified by standard diagnostic methods (esophagogastroduodenoscopy and colonoscopy). After analyzing the clinical picture in 5 examined patients with identified tumors of the small intestine, 3 (15.5%) clinical symptoms were manifested by obvious intestinal bleeding characterized by melena or hematochezia, and in 2 (10.5%) patients the course was latent. Conclusion: After analyzing the results of the diagnosis of small intestine tumors complicated by bleeding in young and middle-aged patients, the survey data demonstrate the importance of enteroscopy techniques in patients with iron deficiency anemia and chronic recurrent bleeding

Vascular malformation of ileum

The aim of the study is to observe a patient with vascular malformation of the ileum complicated by recurrent bleeding. Materials and methods: the article presents a clinical case of small intestine bleeding from ileum angiectasia in a 64-year-old patient. At the patient's place of residence, a video capsule endoscopy of the gastrointestinal tract was performed, angiectasia of the ileum was detected, from which fresh blood was received. Upon admission, the patient has iron deficiency anemia, and hematocheesia. In our institution, the patient underwent diagnostic egophagogastroduodenoscopy, video colonoscopy, balloon-assisted enteroscopy (BAE). According to BAE, vascular malformation with a diameter of up to 10 mm is viuzalized in the ileum Results: The patient underwent endoscopic treatment: one endoclypse was applied to the identified vascular malformation. Conclusion: The capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine are enhanced by the availability of modern equipment in medical and preventive institutions, as well as to perform minimally invasive treatment, reducing the rehabilitation time due to the reduction of surgical trauma.

Vascular malformation of ileum

The aim of the study is to observe a patient with vascular malformation of the ileum complicated by recurrent bleeding. Materials and methods: the article presents a clinical case of small intestine bleeding from ileum angiectasia in a 64-year-old patient. At the patient's place of residence, a video capsule endoscopy of the gastrointestinal tract was performed, angiectasia of the ileum was detected, from which fresh blood was received. Upon admission, the patient has iron deficiency anemia, and hematocheesia. In our institution, the patient underwent diagnostic egophagogastroduodenoscopy, video colonoscopy, balloon-assisted enteroscopy (BAE). According to BAE, vascular malformation with a diameter of up to 10 mm is viuzalized in the ileum Results: The patient underwent endoscopic treatment: one endoclypse was applied to the identified vascular malformation. Conclusion: The capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine are enhanced by the availability of modern equipment in medical and preventive institutions, as well as to perform minimally invasive treatment, reducing the rehabilitation time due to the reduction of surgical trauma.

Case report Ileal diverticulitis with covered perforation complicated by pulmonary embolism - case report.

Diverticulitis of the ileum is an inflammatory complication of diverticulosis. It is an uncommon cause of acute abdomen that can have a very serious course, leading, for example, to intestinal perforation or bleeding. Imaging findings are very often negative and the true cause of the condition is only revealed peroperatively. In this case report, we present a case of perforated ileal diverticulitis in a patient with bilateral pulmonary embolism. This was the main reason for conservative management in the first period of time. After resolution of the pulmonary embolism, resection of the affected bowel segment was performed at the time of the next attack.

Hemorrhagic bowel syndrome in dairy cattle: Gross, histological, and microbiological characterization.

Hemorrhagic bowel syndrome (HBS) is a sporadic and fatal disease of predominantly lactating dairy cattle, characterized by segmental hemorrhage and luminal clot formation in the small intestine. Although, Clostridium perfringens and Aspergillus fumigatus have been associated with HBS, the pathogenesis and cause are currently unknown. In this study, 18 naturally occurring cases of HBS (7 necropsied immediately following euthanasia, 11 with 12-48 hour postmortem intervals) were investigated to characterize the pathology and the intestinal microbiome. Hemorrhagic bowel syndrome was characterized by a single small-intestinal, intramucosal hematoma with dissection of the lamina muscularis mucosae. In most cases necropsied immediately after euthanasia (4/7), the intestinal mucosa proximal to the hematoma contained 9 to 14, dispersed, solitary or clustered, erosions or lacerations measuring 4 to 45 mm. In 77% (37/48) of these mucosal lesions, microscopic splitting of the lamina muscularis mucosae comparable to the hematoma was present. These findings suggest the intramucosal hematoma to originate from small mucosal erosions through dissecting hemorrhage within the lamina muscularis mucosae. No invasive fungal growth was observed in any tissue. Bacteriological cultivation and nanopore sequencing showed a polymicrobial population at the hematoma and unaffected intestine, with mostly mild presence of C perfringens at selective culture. Gross and microscopic lesions, as well as the culture and sequencing results, were not in support of involvement of C perfringens or A fumigatus in the pathogenesis of HBS.