Jejunal Stricture Research Articles

Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy.

We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE). We undertook a retrospective review of CD patients with VCE performed under age 18 between 2003 and 2017 and having received any biologics. We identified patients from our institutional registry. Eligible patients (n = 118) had their first VCE performed after a median of 0.1 years after diagnostic endoscopies at a median age of 12.2 years. The proximal SB disease group (Paris classification L4b inclusive) comprised 70 patients with extensive SB lesions in 81% and deep ulcers in 79%. Patients with Paris L1-3 disease with no findings in VCE or disease restricted to the terminal ileum comprised the control group. At first VCE, levels of albumin (34 g/L vs. 37 g/L) and hemoglobin (117 g/L vs. 127 g/L) were lower in SB patients (p < 0.02). After the first VCE, 68% were introduced to biologics, while 10% already received them. Follow-up VCE was performed after a median of 2.4 years (SB group n = 42; controls n = 21). Proximal SB findings had disappeared in 40% of SB patients, and extensive lesions and deep ulcers had decreased to 26% and 29%, respectively (p = 0.001). In the control group, one had progressed to proximal disease. During the clinical follow-up of a median of 4.7 years, one patient with SB underwent surgery for a jejunal stricture. Proximal SB disease detected through capsule endoscopy abated in most patients with biological medication.

Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction

Background:: Fetal small bowel obstruction (SBO) is a serious condition with high morbidity and mortality rates. Prenatal ultrasound is an important tool for detecting SBO, but the optimal cutoff value for intestinal diameter remains undefined. Objective:: This study aimed to investigate the ultrasonic characteristics of fetal SBO and determine the optimal cutoff value for intestinal diameter to enhance prenatal ultrasound diagnosis. Methods:: We retrospectively analyzed the ultrasonic characteristics and postpartum data of 76 cases diagnosed with SBO. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for dilated intestinal diameter. Results:: Among the 76 cases, 31 displayed the “double bubble sign” on ultrasound, with 20 cases identified as annular pancreas, 6 as duodenal atresia, and 5 as duodenal membranous stenosis. In 45 cases, the lesions were located in the jejunal or ileal segment and exhibited intestinal dilatation above the lesion site, including 27 cases of small bowel atresia, 7 cases of membranous jejunal stenosis, and 11 cases of small bowel volvulus. Out of the 76 cases, 9 showed no abnormalities after birth. ROC curve analysis determined optimal cutoff values of 17.5mm and 10.5mm for predicting “double bubble sign” lesions in the gastric and duodenal widths. For predicting small intestinal dilatation, the optimal cutoff values for dilated width and length of the intestinal tube were 11.5mm and 21.5mm, respectively, with high sensitivity and specificity. Conclusion:: Ultrasonic imaging and changes in intestinal diameter provide valuable information for prenatal diagnosis and management of SBO. Establishing these cutoff values can improve the accuracy of prenatal ultrasound diagnosis for SBO.

Allogeneic bone marrow transplantation for patients with treatment-refractory Crohn's Disease

Background & aimsDurable remissions of Crohn's Disease (CD) have followed myeloablative conditioning therapy and allogeneic marrow transplantation. For patients with treatment-refractory disease, we used reduced-intensity conditioning to minimize toxicity, marrow from donors with low Polygenic Risk Scores for CD as cell sources, and protracted immune suppression to lower the risk of graft-versus-host disease (GVHD). Our aim was to achieve durable CD remissions while minimizing transplant-related complications. MethodsDNA from patients and their HLA-matched unrelated donors was genotyped and Polygenic Risk Scores calculated. Donor marrow was infused following non-myeloablative conditioning. Patient symptoms and endoscopic findings were documented at intervals after transplant. ResultsWe screened 807 patients, 143 of whom met eligibility criteria; 2 patients received allografts. Patient 1 had multiple complications and died at day 332 from respiratory failure. Patient 2 had resolution of CD symptoms until day 178 when CD recurred, associated with persistent host chimerism in both peripheral blood and intestinal mucosa. Withdrawal of immune suppression was followed by dominant donor immune chimerism in peripheral blood and resolution of CD findings. Over time, mucosal T-cells became donor-dominant. At 5 years after allografting, Patient 2 remained off all medications but had mild symptoms related to a jejunal stricture that required stricturoplasty at 6 years. At 8 years, she remains stable off medications. ConclusionsThe kinetics of immunologic chimerism after allogeneic marrow transplantation for CD patients depends on the intensity of the conditioning regimen and the magnitude of immune suppression. One patient achieved durable improvement of her previously refractory CD only after establishing donor immunologic chimerism in intestinal mucosa. Her course provides proof-of-principal for allografting as a potential treatment for refractory CD, but an immunoablative conditioning regimen should be considered for future studies.(ClinicalTrials.gov, NCT01570348)

Delayed Presentation of Malrotation: Case Series and Literature Review.

Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%). The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy. Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively. Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia. Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients.

Jejunal stenosis as a sequela after laparoscopic sleeve gastrectomy for morbid obesity: a case series

Porto-mesenteric venous thrombosis (PMVT) is a rare complication that is encountered in less than 1% of patients following laparoscopic sleeve gastrectomy (LSG). This condition could be conservatively managed in stable patients with no evidence of peritonitis or bowel wall ischemia. Nonetheless, conservative management may be followed by ischemic small bowel stricture, which is poorly reported in the literature. Herein, we present our experience regarding three patients who presented with manifestations of jejunal stricture after initial successful conservative management of PMVT. Retrospective analysis of patients who developed jejunal stenosis as a sequela after LSG. The three included patients had undergone LSG with an uneventful post-operative course. All of them developed PMVT that was conservatively managed mainly by anticoagulation. After they were discharged, all of them returned with manifestations of upper bowel obstruction. Upper gastrointestinal series and abdominal computed tomography confirmed the diagnosis of jejunal stricture. The three patients were explored via laparoscopy, and resection anastomosis of the stenosed segment was performed.Bariatric surgeons should be aware of the association between PMVT, following LSG, and ischemic bowel strictures. That should help in the rapid diagnosis of the rare and difficult entity.

Абдоминальный туберкулез у ребенка раннего возраста (клиническое наблюдение)

Abdominal tuberculosis is a specific tuberculous lesion of the abdominal organs. In children, abdominal tuberculosis is mostly secondary, occurring mainly in the form of mesadenitis and intestinal tuberculosis. In most cases (63–96%), the process is localized in the ileocecal valve. The article presents a case of untimely diagnosed abdominal tuberculosis with lymph node lesions of the peritoneum and intestines in a child with intrathoracic lymph node tuberculosis of all groups during densification and the calcification onset. The examination (computed tomography) revealed a lesion of the ileocecal valve, while histology of biopsy material taken during colonoscopy showed granulomatous colitis of mycobacterial nature. The leading clinical manifestation was malabsorption syndrome with increased protein-energy undernutrition. The disease pattern was the rare localization of a specific lesion — in the small intestine with the development of jejunal stenosis, which led to a significant disorder of enteral nutrition and the development of malabsorption syndrome with severe trophological insufficiency. The decisive factor in determining the cause of the malabsorption syndrome was laparotomy, which was performed in presented signs of acute intestinal obstruction. In our opinion, an indication for diagnostic laparoscopy in children with abdominal tuberculosis should be considered the enteral nutrition disorder and malabsorption syndrome, which cannot be corrected at the therapeutic process stage. KEYWORDS: primary generalized tuberculosis, mycobacterium tuberculosis, intestinal tuberculosis, mesadenitis, malabsorption syndrome, jejunal stenosis, computed tomography, histology. FOR CITATION: Poddubnaya L.V., Dubakova G.F., Geleskul T.S., Shilova E.P., Kolpakova T.A., Osipenko M.F., Nikonov S.D., Drobysheva V.P. Abdominal tuberculosis in a baby (case report). Russian Medical Inquiry. 2023;7(5):337–342 (in Russ.). DOI: 10.32364/2587-6821-2023- 7-5-13.

TUMEURS GRELIQUES QUELLES DIVERSITES HISTOLOGIQUE ?

Primary malignant tumors of the small intestine are rare tumors. They represent 1 to 5% of all tumors of the digestive tract. The multiplicity of histological types associated with the rarity of these tumors. The small intestine is considered as a clinically silent area and this results in a delay in diagnosis and therefore a non-optimal treatment and a severe prognosis. The objective of our work is to report the epidemiological, diagnostic characteristics of patients with small bowel tumors as well as their endoscopic and histological aspects collected in the hepato-gastroenterology department of the Hassan II University Hospital of Fez. Patient and method:We retrospectively analyzed the clinical records of 8 patients with the diagnosis of small bowel malignancies admitted to our training over a period of 11 years. Results: The average age of our patients was 42 years,The sex ratio M/F was 3, the tumor was revealed by an upper GI hemorrhage in 50%(N: 4) followed by abdominal pain in 37%(N: 3) and koening syndrome in 12%(N: 1). The CT scan showed a parietal thickening in all the cases, of which 1 case showed a mass. Double balloon enteroscopy was performed in 8 patients (100%), the endoscopic aspect revealed an ulcerating process in 75% (N: 6), a tumor of sub-mucosal appearance in 12% (N: 1). An ulcerated jejunal stenosis that could not be crossed in 12% (N:1).the biopsy by enteroscopy had allowed to make the diagnosis in 100% of the cases (N: 8).the histological examination had objectified: lymphomas in 37%( N: 3), GIST in 25% cases (N: 2), adenocarcinomas in 25% cases (N: 2) and neuroendocrine tumor in 12% (N: 1). The evolution was unfavorable in all our cases with a median survival rate of 10 months. Conclusion: Small bowel tumors are rare but interesting because of their great histological diversity. The diagnosis is difficult because of the non-specific symptomatology, In our study the couple imaging -enteroscopy had allowed to establish the diagnosis in all our cases, with predominance of the anatomopathological aspect of lymphoma in 37% of the cases.

Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy.

Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have not been documented well. In this paper, we report unusual patients who manifested jejunal limb stricture near the esophageal hiatus without anastomotic stenosis during long-term observation after surgery. From April 2009 until May 2020, we retrospectively reviewed 211 patients underwent LTG following by OEJ for gastric carcinoma and took a standard surveillance program. We aimed to characterize a novel complicated disorder observed in these patients to assist treatment and prevention. Five patients (2.4%) had unusual jejunal limb stricture after LTG and OEJ, occurring at a mean of 10 mo after initial radical LTG. All five patients had disturbed oral intake and marked weight loss, and two had aspiration pneumonia. Various diagnostic modalities and intraoperative findings in each patient revealed an intact anastomosis, bent or tortuous jejunal limb resulting from loose fibrous adhesions on the left crus at the esophageal hiatus and no cancer recurrence. All five patients were successfully treated by reoperation for adhesiolysis, division of the left crus and rearrangement of the jejunal limb. Disturbed passage through the jejunal limb near the hiatus can occur after some types of OEJ following LTG. We speculate that it may result from a short remnant esophagus, excessive mobilization of the jejunal limb that permits bending or tortuosity and adhesions on the left crus at the hiatus. Prevention for this complication is possible during the original LTG procedure.

S3505 A Case of Invasive Gastrointestinal Mold Infection

IntroductionL: Invasive mold infections can be devastating and are mostly seen in patients with hematologic malignancies, profound neutropenia, solid organ or hematopoietic cell transplantation, and poorly controlled diabetes mellitus. Mucormycosis is caused by a group of ubiquitous molds called Mucormycetes and characterized by tissue infarction and necrosis that results from invasion of the vasculature by hyphae. We present a rare case of a patient with invasive gastrointestinal mold infection. Case Description/Methods: A 40-year-old male with chronic inflammatory demyelinating polyneuropathy (CIDP) was admitted for autologous stem cell transplantation (ASCT). Initial hospitalization was complicated by neutropenic fever and C. difficile enteritis treated with Fidaxomicin. He was admitted one month later for nausea, vomiting and push enteroscopy revealed two circumferential deep small bowel ulcerations and a jejunal stricture too distal to be reached. Ulcer biopsies showed granulation tissue and was positive for Cytomegalovirus. He was treated with Valganciclovir and initiated on TPN. One week later, he had a third admission for intractable nausea and vomiting due to a small bowel obstruction. He failed conservative management and underwent diagnostic laparoscopy that revealed five strictures in the distal small bowel which were all resected with two small bowel resections and re-anastomosed. Histopathology of resected jejunum showed necrotizing granulomatous inflammation with aseptated fungal hyphae concerning for Mucormycosis, which was not identified on fungal PCR. He was treated with liposomal Amphotericin B then transitioned to oral Isavuconazole before making a full recovery. (Figure) Discussion: The most common presentation of Mucormycosis is a rhino-orbital-cerebral infection. Gastrointestinal infection is rare in living patients and has been estimated to occur in around 7% of all Mucormycosis cases and carries mortality as high as 85%. Our patient had a history of refractory CIDP and underwent chemotherapy for ASCT that was complicated by development of C. difficile and CMV gastrointestinal infections and small bowel obstruction necessitating endoscopic intervention which led to exploratory laparoscopy for surgical resection and the diagnosis of invasive Mucormycosis. Although invasive GI Mucormycosis is rare, in severely immunocompromised patients with unexplained gastrointestinal symptoms and multiple risk factors as presented in our patient, this infectious organism can be considered in the differential.Figure 1.: (A, B) Circumferential ulcerations seen in the small bowel on push enteroscopy. (C) Mucosal ulceration with underlying necrotizing granulomatous inflammation in the deep muscularis propria/pericolonic adipose tissue with non-septated fungal hyphae present.

Long-term treatment of an ischemic jejunal stricture: Is stenting a viable option?

Video 1Management of jejunal stricture with stenting.

Cetuximab-Induced Small Intestine Stricture in Metastatic Squamous Cell Carcinoma of the Oral Cavity

ABSTRACTCetuximab is an epidermal growth factor receptor (EGFR) inhibitor, which is used to treat patients with metastatic head and neck cancer. Dermatological reactions are the most serious adverse events associated with cetuximab treatment including an acne-like rash, xerosis, and pruritus. Other adverse effects include infections, hypomagnesemia, mucositis, conjunctivitis, nausea, and diarrhea. Mucositis is not only restricted to the oral mucosa, however, can affect any part of the gastrointestinal tract. The duration of treatment-related mucositis has been associated with stricture formation. We describe a case of chronic duodenal and jejunal strictures attributed to cetuximab use.

An uncommon presentation of primary gastro-intestinal non- Hodgkin’s lymphoma (PGINHL) with multiple jejunal strictures in a young patient

Introduction:Primary gasrointesinal non-Hodgkin’s lymphoma (PGINHL) is a heterogeneous complex disease (1).Variations in patients’ characterisics, clinical sages, hisologic sub-types, and treatment options dependlargely on the site of origin (1, 2). In fact, gasrointesinal tract is the mos commonly involved site forprimary NHL occurrence, accounting for nearly 20–40% of all extra-nodal disease (2). It arises from thelymphoid tissues within the wall of small intesine which are more abundant in the ileum (3), being eitherlocalized to a single segment of the small intesine, or multi-centric in 15–20% (3). Clinical presentation isextremely variable with a wide range of presenting symptoms like: non-specifc abdominal pain; anorexiaand weight loss; diarrhea; subacute obsruction; and a palpable abdominal mass (2, 4-6), with an emergencysurgical treatment being required in 11–64 % of cases (4). Herein, authors describe an unusual presentationof a PGI NHL in a young Sudanese patient who suffered from recurrent episodes of subacute small bowelobsruction due to multiple jejunal srictures (simulating Crohn’s disease clinically and radiologically) andfound to have a diffuse large B-cell lymphoma on hisopathological examination of the surgical specimen.

Diagnostic challenge between Crohn's disease and intestinal tuberculosis in chronic diarrhea with ulcerated jejunal stenosis: a case report

Intestinal tuberculosis and Crohn's disease are a diagnostic challenge because of the clinical, radiological and endoscopic similarity. The histological and microbiological findings are positive in less than 50%, which delays the correct treatment, putting the patient at risk. We reported a 34-year-old immunocompetent patient with 4 years of malabsorptive diarrhea, weight loss, nocturnal diaphoresis, abdominal pain and an ulcer with stenosis in the jejunum was found; she mpirical antituberculosis treatment with clinical improvement. Later the culture was positive for M. tuberculosis.

Possibilities of diagnostic and therapeutic balloon-assisted enteroscopy in a multidisciplinary hospital

The aim of investigation: to assess the possibilities of diagnostic and therapeutic BAE in a multidisciplinary hospital.Materials and Methods: The analysis of the findings was carried out in 32 patients who underwent 40 diagnostic and 17 therapeutic procedures. Small bowel ulcers were detected in 6 patients, angioectasias in 5. One patient with subcompensated jejunal stricture in the suprastenotic section was found to have a bezoar foreign body. In 17 patients, tumors of a different nature were identified: carcinoids in 4, gastrointestinal-stromal tumors (GIST) in 6 patients, adenocarcinomas in 7 patients. One patient was diagnosed with varicose veins of the jejunum, complicated by bleeding. In 9 patients, polyps of the jejunum and ileum were identified. Reoperations were planned in 6 patients.Results: When conducting therapeutic balloon-assisted enteroscopy, the following types of endoscopic treatment were used: endoscopic clipping (angiectasia-4 and ulcers-2), argon plasma coagulation was used in 1 case, endoscopic polypectomy was performed in 9 patients, destruction of the bezoar with a diathermic loop and balloon dilatation strictures in one case. Patients who had a pathology that was not subject to endoscopic treatment were operated on.Conclusion: The availability of modern equipment significantly expands the capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine and allows for minimally invasive treatment, shortening the rehabilitation period due to the reduction of surgical trauma.

Digestive involvement in a severe form of Snyder-Robinson syndrome: Possible expansion of the phenotype

Snyder-Robinson syndrome (OMIM #309583) is a rare X-linked condition, caused by mutation in the SMS gene (MIM *300105), characterized by a wide spectrum of clinical signs including developmental delay, epilepsy, asthenic habitus, dysmorphism, osteopenia, and renal or genital anomalies.Here we describe two maternal half-brothers who both presented with severe neurodevelopmental delay, seizures, hearing loss, facial dysmorphism, renal and ophthalmologic anomalies, failure to thrive and premature death. A novel p.(Gly203Asp) variant was found at the hemizygous state in the two boys, and an elevated Spermidine/Spermine ratio confirmed the diagnosis of Snyder-Robinson syndrome. One of the brothers presented with gastrointestinal symptoms, with jejunal stenosis, enteral feeding intolerance, failure to thrive due to a dysfunctional gastrointestinal system, cholestasis and exocrine pancreatic insufficiency. Although more studies will be needed to understand its mechanisms, this observation lends further support to the possibility of severe digestive involvement in Snyder Robinson syndrome.

A Case of Jejunal Stricture and Mesenteric Lymphadenopathy in a Young Man

Question: A 29-year-old man with a past medical history significant only for an open appendectomy for appendicitis as a child presented with complaints of right-sided abdominal flank pain. Upon further interview, he endorsed colicky abdominal pain for approximately 1 year with intermittent nausea, vomiting, and a significant weight loss of 15–20 pounds. He admitted to passing flatus but had not had a bowel movement for 3 days. Physical examination showed a soft, nondistended abdomen with a well-healed surgical scar in the right lower quadrant.

Appearance of fetal intestinal obstruction on fetal MRI.

To retrospectively analyze the imaging findings of fetal intestinal obstruction diagnosed by MRI and compare with postnatal surgery findings. MRI data of 3346 pregnant women were retrospectively analyzed; we found 47 cases of suspected fetal small intestinal obstruction. Twenty-nine underwent postnatal surgery. We identified one case of jejunal obstruction secondary to perforation, five annular pancreas, 10 duodenal stenoses, four jejunal stenoses, five jejunal atresias, two ileal atresias, four intestinal volvulus, and four intestinal malrotations. We further found four cases of duodenal stenosis with intestinal malrotation (two cases also showed volvulus). On fetal MRI, annular pancreas and duodenal obstruction manifested as a "double bubble." Jejunal stenosis appeared as a "triple bubble." Jejunal and ileal atresia mainly manifested as proximal dilatation with high signal on T1WI. Intestinal volvulus showed a sausage-like intestinal distortion and mixed signals on T1WI and DWI sequences. Intestinal malrotations were characterized as abnormal duodenal morphology. We missed two malrotations; one jejunal obstruction was misdiagnosed. Prenatal MRI can accurately determine the degree of intestinal obstruction and help qualitatively diagnose its possible etiology according to changes in MRI signals in multiple sequences, providing guidance for prenatal counseling.

Annular pancreas in two cases after diamond-shaped anastomosis duodenoduodenostomy: case reports

Background: Annular pancreas is an infrequent congenital disorder characterized as a partial or complete pancreatic tissue around the descending part of the duodenum. Prenatal control is essential in the early detection of the annular pancreas. Initial management might increase better prognosis. We report two cases of the annular pancreas in Sanglah General Hospital, Denpasar, Bali in 2016-2019 to describe the clinical characteristics and outcome of different ages in annular pancreas managed by diamond-shaped duodenoduodenostomy.Case Description: The first case was a six days old baby boy with bile stained vomiting every time he breastfed when she was three days old and got worsen. USG fetal showed polyhydramnios with duodenal or jejunal stenosis. Besides, the abdominal X-ray showed double bubble sign and the laboratory findings were in a standard limit. The second case was a nine months old girl with bile-stained vomiting when she was eight months old and got worsen along with the time. She found with severe malnutrition and mild-moderate dehydration. The laboratory examination revealed electrolyte imbalanced, and abdominal X-ray showed double bubble sign. Postoperative to first feed was 1 day in both cases and full feed duration was 5 and 10 days. Length of stay was 16 and 25 days—both of the cases without complication after surgery.Conclusion: Annular pancreas is a rare congenital malformation that manifests primarily by signs related to duodenal obstruction. Earlier identifications will help to ensure that appropriate treatment can be instigated as soon as possible. Treatment by surgical with duodenoduodenostomy procedure is a surgical technique in the treatment of annular pancreas, with the advances in neonatal intensive care, may reduce the postoperative complications and will make a better outcome.

Magnetic compression anastomosis for non-anastomotic stenosis of the proximal jejunum after total gastrectomy with Roux-en-Y reconstruction: a case report

BackgroundPostoperative non-anastomotic stenosis of the proximal jejunum after total gastrectomy with Roux-en-Y reconstruction is a rare complication. If endoscopic balloon dilation proves ineffective, patients need re-operation under general anesthesia and experience a high rate of postoperative complications. Magnetic compression anastomosis is a nonsurgical procedure that can create an anastomosis similar to that obtained through surgery. We report a case in which magnetic compression anastomosis was successfully performed to avoid re-operation for non-anastomotic stenosis of the proximal jejunum after total gastrectomy with Roux-en-Y reconstruction.Case presentationA 70-year-old woman was admitted to our hospital for treatment of non-anastomotic stenosis of the proximal jejunum. Open total gastrectomy and Roux-en-Y reconstruction were performed 2 years previously for advanced gastric cancer at another hospital. She complained of anorexia and obstructed passage of food. No recurrence of gastric cancer was identified. Esophagogastroduodenoscopy showed circumferential membranous stenosis of the jejunum 3 cm distal to the esophago-jejunal anastomosis. Endoscopic balloon dilation was performed three times, but proved ineffective. Magnetic compression anastomosis was planned because the stenosis existed near the esophago-jejunal anastomosis and re-operation was a highly invasive procedure requiring intrathoracic anastomosis. Endoscopic balloon dilation preceded placement of the parent magnet on the anal side of the stenosis. Confirming the improvement of stenosis, the parent magnet was placed on the anal side of the stenosis during esophagogastroduodenoscopy. The parent magnet attached to nylon thread was fixed to the cheek to prevent magnet migration. A week after placing the parent magnet, restenosis was confirmed and the daughter magnet was placed via nylon thread on the oral side of the stenosis. The two magnets were adsorbed in the end-to-end direction across the stenosis. Magnets adsorbed in the end-to-end direction moved to the anal side 11 days after placement. Wide anastomosis was confirmed by esophagogastroduodenoscopy. Endoscopic balloon dilation was regularly performed to prevent restenosis after magnetic compression anastomosis. No complications were observed postoperatively. The patient was able to eat normally and successfully reintegrated into society.ConclusionsMagnetic compression anastomosis could be a feasible procedure to avoid surgery for non-anastomotic stenosis of the proximal jejunum after gastrectomy with Roux-en-Y reconstruction.

Jejunal Stenosis as a Late Complication of Superior Mesenteric Vein Thrombosis: Overview and Case Report

Jejunal Stenosis as a Late Complication of Superior Mesenteric Vein Thrombosis: Overview and Case Report