Mucosal Diaphragm Research Articles

Diafragma mucoso pré-pilórico cursando com vômitos de repetição em recém-nascido - Relato de caso e Revisão da literatura

OBJECTIVE: To report the case of a newborn with a pre-pyloric mucosal diaphragm with repercussions on weight gain and food acceptance. This is a rare congenital gastrointestinal malformation and corresponds to approximately 1% of all etiologies of gastrointestinal obstruction in newborns. DESCRIPTION: Female NB, started post-feeding vomiting at 4 hours of life. Multiple attempts of oral feeding reintroduction were performed, episodes of post-feeding vomiting and inadequate weight gain were maintained. Imaging exams did not show intestinal obstruction, an upper digestive endoscopy (UDE) was performed on the 19th day of life, which identified and corrected a pre-pyloric mucous diaphragm with transposition of the membrane by the device. Formula was reintroduced, with a gradual increase in supply and satisfactory weight gain. He was discharged at 24 days of life, with total acceptance of the diet and complete remission of the condition. COMMENTS: This study shows that it is important to consider the performance of UDE in cases of prolonged neonatal vomiting, after excluding more prevalent causes, such as APLV and GERD, as it is capable of diagnosing and treating some causes of obstruction of the gastrointestinal tract, such as the diaphragm pre-pyloric mucosa.

DIAFRAGMA MUCOSO PRÉ-PILÓRICO CURSANDO COM VÔMITOS DE REPETIÇÃO EM RECÉM-NASCIDO - RELATO DE CASO E REVISÃO DA LITERATURA

Objective: To report the case of a newborn with a pre-pyloric mucosal diaphragm with repercussions on weight gain and food acceptance. This is a rare congenital gastrointestinal malformation and corresponds to approximately 1% of all etiologies of gastrointestinal obstruction in newborns. Description: Female NB, started post-feeding vomiting at 4 hours of life. Multiple attempts of oral feeding reintroduction were performed, episodes of post-feeding vomiting and inadequate weight gain were maintained. Imaging exams did not show intestinal obstruction, an upper digestive endoscopy (UDE) was performed on the 19th day of life, which identified and corrected a pre-pyloric mucous diaphragm with transposition of the membrane by the device. Formula was reintroduced, with a gradual increase in supply and satisfactory weight gain. He was discharged at 24 days of life, with total acceptance of the diet and complete remission of the condition. Comments: This study shows that it is important to consider the performance of UDE in cases of prolonged neonatal vomiting, after excluding more prevalent causes, such as APLV and GERD, as it is capable of diagnosing and treating some causes of obstruction of the gastrointestinal tract, such as the diaphragm prepyloric mucosa.

Imaging congenital anomalies of the ileum in adults:a pictorial review.

The ileal loops are anatomical location for the majority of congenital anomalies affecting the gastrointestinal tract. These include Meckel's diverticulum, ileal duplication, dysgenesis, atresia, mucosal diaphragm, and malposition of the ileum. Symptomatic lesions that often present with abdominal pain, intestinal obstruction or bleeding are usually diagnosed and treated during infancy and childhood. However, many of these congenital conditions may remain clinically silent and detected incidentally in adults undergoing radiological evaluation for unrelated medical reasons. This article presents the spectrum of the congenital ileal anomalies and their distinct features on small bowel examination and CT of the abdomen.

Imaging of Drug-induced Complications in the Gastrointestinal System.

Drug-induced injury commonly affects the gastrointestinal and hepatobiliary systems because of the mechanisms of absorption and metabolism. In pill esophagitis, injury is frequently related to direct contact with the esophageal mucosa, resulting in small superficial ulcers in the mid esophagus. Nonsteroidal anti-inflammatory drugs can lead to gastrointestinal tract ulcers and small bowel mucosal diaphragms (thin weblike strictures). Injury to the pancreatic and hepatobiliary systems can manifest as pancreatitis, acute or chronic hepatitis, cholestasis, or steatosis and steatohepatitis (which may progress to cirrhosis). Various drugs may also insult the hepatic vasculature, resulting in Budd-Chiari and sinusoidal obstructive syndromes. Focal lesions such as hepatic adenomas may develop after use of oral contraceptives or anabolic steroids. Ultrasonography, computed tomography, and magnetic resonance imaging can aid in diagnosis of drug-induced injuries and often are necessary to exclude other causes.

Systematic review of small bowel diaphragm disease requiring surgery

To perform a systematic review of all cases of small bowel diaphragm disease requiring surgery. Small bowel diaphragm disease is a rare complication of small bowel enteropathy secondary to the use of non-steroidal anti-inflammatory drugs (NSAIDs). The objective was to determine the presenting symptoms, duration of NSAID use, mode of diagnosis and type of surgery associated with cases of small bowel diaphragm disease requiring surgery. A comprehensive search of the world literature between January 1980 and December 2010 was undertaken. The search terms 'diaphragm disease' and 'mucosal diaphragm disease' in combination with the terms 'surgery', 'intestine' or 'small bowel' were used. All cases of small bowel diaphragm disease requiring surgery in adult patients within the the last 30 years were included. Data including age, gender, mode of presentation, NSAID use, mode of diagnosis, form of surgery, affected area of small bowel and mortality were recorded and analysed. There were 55 cases of small bowel diaphragm disease requiring surgery (31F:18M) with a median age of 69 years. NSAID use occurred in 44 cases and the mean duration of NSAID use was 7 years. The most common presentation was with anaemia in combination with obstructive symptoms. The diagnosis was established by a laparotomy in 51% of cases followed by capsule endoscopy in 25% of cases. Operations performed included small bowel resection (56), combined resection and strictureplasty (three), strictureplasty (one) and hemicolectomy (two). There was only one death. Small bowel diaphragm disease presenting as a surgical emergency is likely to become more common due to the increased use of NSAIDs. A history of NSAID use in patients with iron deficiency anaemia or obstructive symptoms should lead to a high index of suspicion for this condition and should be preoperatively investigated.

Plummer–Vinson syndrome successfully treated by endoscopic dilatation

Plummer-Vinson (Paterson-Brown-Kelly) syndrome is uncommon nowadays. Although iron repletion improves its symptoms, endoscopic dilatation of associated esophageal webs is sometimes required. The case is described of a 69-year-old woman with Plummer-Vinson syndrome who was successfully treated by endoscopic bougienage. The patient had a longstanding history of anemia and slowly progressive dysphagia of solid food. Laboratory data on admission showed iron deficiency anemia (red blood cell count 402 x 10(4)/microL, hemoglobin 6.8 g/dL, serum iron 8 microg/dL, and serum ferritin 2.4 ng/mL). Radiographic esophagography revealed two circumferential webs at the level of the cervical esophagus. Upper gastrointestinal endoscopy showed a severe upper esophageal stricture caused by a smooth mucosal diaphragm. The patient was prescribed 40 mg of intravenous iron supplements daily for 30 days; her anemia improved but the dysphagia did not. Endoscopic bougienage was performed with the use of Celestin dilators of serially increasing diameters. The webs were easily disrupted without complications. The patient's dysphagia resolved shortly after the treatment and did not recur. This experience indicates that endoscopic bougienage is safe, effective, and relatively easy to perform in patients with severe esophageal stenosis.

Addisonian pigmentation due to extreme pyloric stenosis by a mucosal diaphragm

Journal Article Addisonian pigmentation due to extreme pyloric stenosis by a mucosal diaphragm Get access Henry B Young Henry B Young Wolverhampton Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 49, Issue 213, July 1961, Pages 104–107, https://doi.org/10.1002/bjs.18004921324 Published: 07 December 2005

A case of partial atresia of the pyloric antrum due to a mucosal diaphragm of doubtful origin.

Journal Article A case of partial atresia of the pyloric antrum due to a mucosal diaphragm of doubtful origin Get access C Patrick Sames C Patrick Sames Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 37, Issue 146, October 1949, Pages 244–246, https://doi.org/10.1002/bjs.18003714620 Published: 06 December 2005

Endoscopic treatment of mucosal diaphragm with enterolith in the jejunum of an adult

An unusual case of jejunal mucosal diaphragm with enterolith causing liver dysfunction and fever in a 36‐year‐old man is reported. The diagnosis of jejunal mucosal diaphragm was made by panendoscopy. Treatment of the jejunal mucosal diaphragm was by dilatation of the diaphragm. The enterolith was removed by panendoscopy.

Congenital Antral Membrane: Case Report

Congenital Antral Membrane: Case Report

Familial occurrence of congenital incomplete prepyloric mucosal diaphragm.

Incomplete prepyloric mucosal diaphragm (IPMD) is an uncommon congenital anomaly that leads to gastric outlet obstruction in infancy and childhood. This report describes the occurrence of IPMD in six children...

Nonsteroidal Anti-Inflammatory Drug-Induced Enteropathy: Case Discussion and Review of the Literature

Nonsteroidal Anti-Inflammatory Drug-Induced Enteropathy: Case Discussion and Review of the Literature

Nonsteroidal antiinflammatory drug-induced colonic stricture

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely prescribed drugs that can result in gastroduodenal ulceration. Adverse effects upon the small and large intestine are now more often recognized. Small intestinal obstruction secondary to both mucosal diaphragms and broad-based stenoses is reported, but colonic strictures appear to be less common. A case of NSAID-induced colonic stricture leading to large bowel obstruction and secondary cecal perforation (previously unreported) is presented. Twelve additional cases of NSAID-induced colonic stricture are reviewed from the literature and its possible pathogenesis is discussed.

Toxicity of the nonsteroidal anti-inflammatory drugs

The nonsteroidal anti-inflammatory drugs continue to be prescribed frequently around the world to palliate the pain and inflammation associated with various medical conditions. These are a heterogenous group of drugs with similar mechanisms of action, yet they are very different chemically and at times possess different potential risks for toxicity. The risk factors for renal dysfunction after therapy with various nonsteroidal anti-inflammatory drugs are reviewed. In addition glomerulopathy and tubular dysfunction are discussed. Further information about nonsteroidal anti-inflammatory drug-induced gastroduodenal erosive disease and who is at risk is presented. Potential methods for preventing mucosal ulcers or treating them once established are discussed. Other recently described nonsteroidal inflammatory drug-induced toxicities, including hepatotoxicity, esophagitis, and the formation of small and large bowel mucosal diaphragms precipitating obstruction are reviewed.

Congenital esophageal obstruction by intraluminal mucosal diaphragm

Congenital intraluminal esophageal diaphragm causing complete obstruction is a rare anomaly. By esophagoscopy, a complete membranous diaphragm was demonstrated, perforated, and excised. In the English language literature, this case represents the first report of an isolated membranous atresia at the lower end of the esophagus. A brief review of the world literature and the classification of membranous atresia of the esophagus is discussed.

Diaphragm disease: pathology of disease of the small intestine induced by non-steroidal anti-inflammatory drugs.

Operative small bowel resection specimens received over a period of 16 years were reviewed to assess whether any intestinal disease could be directly attributed to the use of non-steroidal anti-inflammatory drugs (NSAID). Seven cases of intestinal disease associated with the use of NSAID were identified, all of which occurred in the final six years of the survey, which may reflect the increasing use of these compounds. A spectrum of patterns was found from multiple pathognomonic ileal mucosal diaphragms to broad strictures similar to those seen as a complication of enteric potassium. It seems likely that the formation of diaphragm lesions requires an additional factor, but what is not known as yet is whether the effects of NSAID are local or systemic.

Fiberoptic Upper Intestinal Endoscopy in Infants and Children

Fiberoptic upper intestinal endoscopy has been shown in the last decade to be the most sensitive technique to diagnose upper gastrointestinal disease. Diagnostic endoscopy has been shown to be safe, with a low complication rate of less than 2 per cent, and most of those reported have been minor. Furthermore, therapeutic endoscopy has been used to treat bleeding varices by sclerotherapy, avoiding the need for shunting procedures, which often fall in young children. Dilation of strictures with wire-guided dilators, endoscopic incision of antral mucosal diaphragms, and percutaneous placement of gastrostomy tubes are other ways endoscopy is being used as a means of treatment. Electrocoagulation and photocoagulation of bleeding upper gastrointestinal lesions have not been used.

Successful endoscopic transaction of a partially obstructing antral diaphragm

A 14-yr-old girl presented with long-standing symptoms of partial gastric outlet obstruction due to an antral mucosal diaphragm that had a central aperture of 4–5 mm. The literature of this congenital malformation is reviewed with respect to diagnostic criteria and feasibility of endoscopic transection. The procedure and outcome of this first successful endoscopic transection of a partially obstructing antral diaphragm are reported.

Antral mucosal diaphragms in infants and children.

The antral mucosal diaphragm in infants and children has been reported in the literature in 48 patients. We have encountered antral mucosal diaphragms in 6 children. Only 3 of these 6 patients required surgery. These 6 cases and a review of the published cases suggest that patients fall into two groups: the first group usually requires surgery because of recurrent clinical signs suggesting a partial gastric outlet obstruction. The second group have the diaphragm detected incidentally or have unimpressive clinical findings. This group can be followed without surgery. In all cases, the diagnosis is made by an upper gastrointestinal series, but the need for surgery was determined clinically.

Antral mucosal diaphragms in adults.

A group of 53 patients with the diagnosis of antral mucosal diaphragm is reported. In over 50% of the cases the diaphragm was considered an asymptomatic lesion. In addition, an autopsy study in 29 unselected cases is reported with demonstration of five antral mucosal diaphragms in different forms. On the basis of these findings, it is evident that the antral mucosal diaphragm in the adult is not an acquired lesion secondary to peptic ulcer disease, but may be congenital. In addition, techniques of radiologic evaluation of the diaphragm for significant narrowing of the central aperture using the compressed barium tablet, and for significant gastric outlet obstruction using the "barium burger" examination, are described.