Partial Resection Of Small Intestine Research Articles

To Evaluate The Efficacy Of Bioresorbable Seprafilm Membrane In Avoiding Abdominal Adhesions

Aim: To evaluate the efficacy of bioresorbable Seprafilm membrane in avoiding abdominal adhesions.
 Material and methods: After obtaining approval from the appropriate institutional review board, this research was conducted within the department of General Surgery. Patients who needed a Hartmann procedure for diverticulitis or rectosigmoid blockage were randomly assigned to receive Seprafilm or to act as a control patient.
 Results: This research covered 100 patients in total. 50 patients were randomly assigned to receive Seprafilm while the other 50 served as controls. There were no significant variations in medical history or preoperative physical examination. At the midline incision, five patients got three Seprafilm membranes, 35 patients received two membranes, and ten patients received one membrane. In 40 patients, additional surgical operations were performed during the Hartmann procedure. In the Seprafilm group, 8 patients had appendectomy, 6 had surgical decompression of the small intestine, 3 had his peritoneal dialysis catheter removed, and 3 had ovarian cyst resection and partial small intestinal resection for unintentional bowel perforation. In the control group, 8 patients had further appendectomy, 6 patients had splenectomy, 3 patients had suturing for an iatrogenic bladder damage, and 3 patients had partial small bowel resection for a mesentery abscess. The median blood loss in the Seprafilm group was 352mL and 420mL in the control group. Postoperative wound healing was abnormal in 18 of the Seprafilm patients and 14 of the control patients. The time between the original operation and the follow-up surgery was not statistically different across groups. The median interval in the Seprafilm group was 6 months (range 2-17) and 4 months in the control group (range 1–31).
 Conclusion: we concluded a decrease in the degree of adhesion development following the application of Seprafilm in Hartmann procedure patients compared to controls.

Liquid levothyroxine improves thyroid control in patients with different hypothyroidism aetiology and variable adherence - case series and review.

It is estimated that hypothyroidism treatment may be either suboptimal or excessive in about 32-45% patients treated with L-thyroxine (LT4). There are multiple possible causes of poor control of hypothyroidism, including narrow LT4 therapeutic index, food and drug interactions, comorbidities, and patient non-adherence. Some of these obstacles could possibly be overcome with the novel liquid LT4 formulation. Liquid LT4 reaches maximum blood concentration about 30 minutes faster than the tablet form. Faster pharmacokinetics might lead to more efficient LT4 absorption, as suggested by a recent real-world study in patients with primary and central hypothyroidism. Liquid LT4 treatment led to increased free thyroxine (FT4) and sex hormone binding globulin (SHBG) with decreased low-density lipoprotein (LDL) cholesterol concentration and substantially improved quality of life for the patients. Herein we present a series of 31 patients with hypothyroidism of different aetiologies treated with the novel liquid LT4 formulation in standard clinical care in light of the latest scientific publications on liquid LT4 formula. We observed normalization of thyroid function tests shortly after introduction of liquid LT4, irrespective of concurrent diseases or concomitant medications that could diminish LT4 absorption. In more detail, the treatment with liquid LT4 managed to normalize thyroid-stimulating hormone (TSH) concentrations in patients without any known causes of LT4 absorption disturbances, as well as in those with malabsorption: with gastric bypass, partial small and large intestine resection, scleroderma, gluten intolerance, celiac disease, atrophic gastritis, and polytherapy. In conclusion, considering many factors disturbing LT4 absorption, hypothyroidism therapy with liquid LT4 seems to be a particularly effective option.

Jejunal Hemolymphangioma in a Patient Presenting with Gastrointestinal Bleeding

Background: Hemolymphangioma is rarely found in the small intestine. There have only been eight reports of hemolymphangiomas arising in the small intestine to date. The first patient was reported by Fang et al. in 2012. A small intestinal hemolymphangioma may lead to anemia and gastro-intestinal bleeding. Case Presentation: We report a case of jejunal hemolymphangioma in a 49-year-old man. The patient presented with melena and anemia. He underwent double balloon enteroscopy (DBE) the antegrade approach, which demonstrated a 3.0 cm segment of jejunum with nearly 75% of the circumferential lesion with blood remnant. The raised soft lesion was in the middle of the jejunum with white patches on the surface of the mucosa. Endoscopic biopsy was not performed to avoid secondary bleeding. The patient underwent laparotomy, and partial small intestine resection was performed. A 5.0cm segment of jejunum was resected with primary anastomosis. The patient had an uneventful postoperative recovery. Macroscopic pathological examination showed a cavernous, soft and compressible tumor. Microscopic examination showed a tumor which was composed of blood and lymphatic vessels mainly located in the submucosa. The definitive histological diagnosis was jejunal hemolymphangioma. During a follow-up of 2 years, there was no further gastrointestinal bleeding. Conclusion: Small intestinal hemolymphangioma is a rare benign tumor of which clinical manifesta-tions are nonspecific and accurate preoperative diagnosis is challenging. Endoscopic biopsy is not rec-ommended for hemolymphangioma of the gastrointestinal tract due to the risk of severe bleeding. Com-plete surgical resection of the hemolymphangioma is considered the most effective treatment for small intestinal hemolymphangioma.

Small İntestine İntussusception Accompanying With Bilateral Adrenal Mass In A 11 Years Old Child With Burkitt Lymphoma

The Gastrointestinal system is one of the most common places for extranodal Non-Hodgkin lymphomas. On the other hand, Non-Hodgkin lymphomas have been seen less in the small intestine. We present here a rare condition in the literature which is a case of bilateral adrenal mass and Burkitt lymphoma with small intestine origin. Eleven years old male patient applied to pediatric emergency service with acute abdomen. In the abdominal USG examination intussusception and bilateral adrenal mass had seen. In a surgical operation, five lesions were seen in the small intestine. Partial small intestine resection was performed. In the pathological examination of the resection material Burkitt Lymphoma with the origin of the small intestine diagnosed to the patient. Prognosis of NHL with the origin of the small intestine, adrenal mass and come with an acute abdomen depends on the histological type and grade. He was started on NHL - BFM95 chemotherapy and had a good clinical response and he was remained in complete remission for two months after completion of chemotherapy. Bilateral adrenal mass remains a rare form of Burkitt lymphoma and care must be taken in ruling out other causes of bilateral adrenal masses.

P382 Application of enhanced recovery after surgery in single-port laparoscopic partial small intestine resection in the treatment of Crohn’s disease

Abstract Background Single-incision laparoscopic surgery (SILS) with enhanced recovery after surgery (ERAS) can reduce operation trauma and accelerate postoperative rehabilitation. This study aims to investigate the safety and feasibility of SILS with ERAS in the treatment of Crohn’s disease. Methods Thirty patients with Crohn’s disease were randomly assigned to receive traditional laparoscopic surgery plus ERAS (n = 20) and SILS plus ERAS (n = 18)，respectively. Comparisons and analysis were made between the two groups in the perioperative conditions. Results There were significant differences in the mean operation time between the two groups (p < 0.01)，There were no significant differences in the intra-operative blood loss, postoperative complications rates, the time to first flatus and treatment cost (p > 0.05). There were significant differences in the postoperative hospital stay between the two groups (p < 0.05). WBC, CRP and PCT in SILS plus ERAS group were lower than those in the control group at the first days and the third days after operation, the differences were statistically significant (p < 0.05). Conclusion SILS plus ERAS can shorten postoperative hospital stay and facilitate bowel function recovery in the treatment of Crohn’s disease. It is worthwhile to mention the nice cosmetic benefits of SILS, the perioperative SILS plus ERAS program is safe and effective and should be popularised in Crohn’s disease.

Characteristics and prognosis of isolated small-bowel Crohn's disease.

Previous studies suggest that Crohn's disease (CD) with both small bowel and colon involvement is more serious than colonic CD. However, clinical features of isolated small-bowel CD have not been fully investigated. In this retrospective case-control study, 89 patients were divided into two groups according to capsule endoscopy, ileocolonoscopy, and enhanced computed tomography results. The case group was isolated small-bowel CD (n = 50) and the control group was CD with both small bowel and colon involvement (n = 39). We collected data of the patients and analyze it. In univariate analysis, isolated small-bowel CD group had higher percentage of stricture, Lewis score, platelet, plateletcrit and lower Harvey-Bradshaw index, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate. In multivariable analysis, it had lower Harvey-Bradshaw index (p = 0.000), which meaned relatively mild symptoms. However, it had higher Lewis score (p = 0.007), which meaned more serious small-bowel inflammation. The Kaplan-Meier survival curve also suggested that isolated small-bowel CD patients were more likely to accept partial small intestinal resection surgery (p = 0.029). Isolated small-bowel CD is easily overlooked for milder clinical symptoms and relatively limited lessions, but severe small-bowel histological injury results in owing worse clinical outcomes. Clinicians should pay more attention to the isolated small-bowel CD and take aggressive intervention during therapy.

Partial small intestinal resection for successful surgical management of refractory protein-losing gastroenteropathy in systemic lupus erythematosus: A case report and literature review: Retraction.

Partial small intestinal resection for successful surgical management of refractory protein-losing gastroenteropathy in systemic lupus erythematosus: A case report and literature review: Retraction.

Diagnosis and treatment of congenital mesenteric hiatal hernia in adults

Objective To investigate the diagnosis and treatment of congenital mesenteric hiatal hernia in aduls. Methods The retrospective cross-sectional study was conducted. The clinical data of 11 adult patients with congenital mesenteric hiatal hernia who were admitted to the First Affiliated Hospital of Henan University from January 1999 to January 2016 were collected. All patients underwent abdominal X-ray and ultrasound examinations. Patients diagnosed as with intestinal obstruction or suspected intra-abdominal hernias underwent abdominal CT examination, and then were finally confirmed during surgery. Patients diagnosed as with mesenteric hiatal hernia received necrotic tissues resection and tissue repair (small intestine resection and anastomosis) if there was necrosis of hernia contents, and closing mesenteric hiatus. Patients without small intestine necrosis received closure of mesenteric hiatus after retraction of the hernia contents. Observation indicators: (1) clinical manifestations, (2) imaging findings, (3) treatment, (4) pathological examination, (5) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to March 2017. Results (1) Clinical manifestations: all 11 patients were acute onset, with incentives of satiation, postprandial exercise and diarrhea. The time from onset to admission was 2.0-30.0 hours, with an average time of 9.8 hours. The main symptoms included abdominal pain, nausea and vomiting, exhaust reduction and other intestinal obstruction performances. Eleven patients received physical examination, and 10 showed abdominal bulge, including 9 with intestinal type. Eleven patients had abdominal tenderness, and 9 combined with rebound tenderness. Abdominal percussion of 11 patients showed hyperresonant without shifting dullness, and active, muted and fading bowel sounds were detected in 1, 3 and 7 patients, respectively. (2) Imaging examination: of 11 patients receiving abdominal X-ray examination, 2 had intestinal loop and 4 had the intestinal obstruction performances such as typical gas-liquid plane. Abdominal ultrasound examination of 11 patients showed no specific findings due to abdominal intestinal gas, and 10 with peritoneal effusion. Of 11 patients, 1 didn′t receive abdominal CT scan due to preoperatively misdiagnose with acute appendicitis and 10 underwent abdominal CT scan. Nine patients were diagnosed with intestinal torsion by abdominal CT scan and then underwent enhanced CT scan, and 8 with small mesenteric vascular torsion and swirling sign were diagnosed with small intestine torsion and partial necrosis of small intestine. (3) Treatment: 1 patient preoperatively misdiagnosed with acute appendicitis was converted to exploratory laparotomy, and 10 patients underwent exploratory laparotomy due to complete intestinal obstruction or progressive increase in symptoms. Intraoperative exploration showed that intestinal mesenteric hiatus and colon mesenteric hiatus were respectively in 8 and 3 patients, and hiatuses were round or oval, with a diameter of 2.0-8.0 cm and an average of 4.4 cm. Hernia contents were small intestine. The partial small intestine in 10 patients were resected and then mesenteric hiatus was closed due to necrosis of the small intestine, with removal length of 110-250 cm and an average of 176 cm, and length of remaining small intestine was 80-230 cm, with an average of 159 cm. The hernia into small intestine in 1 patient without complete necrosis was retracted to abdominal cavity after symptomatic treatment, and closing mesenteric hiatus. Eleven patients were cured and out of hospital after operation, without nosocomial complications. (4) Pathological examination: small intestine ischemic necrosis was detected in 10 patients after partial small intestine resection. (5) Follow-up situations: all patients were followed up for 12-24 months, without malnutrition, short bowel syndrome and other complications. Conclusions Without history of abdominal trauma or surgery, with incentives of the satiation, postprandial exercise and diarrhea, abnormal retroperitoneal small intestine shadow and small intestinal torsion diagnosed by CT scan and absent intestine sign by enhanced CT scan can be helpful to diagnose congenital mesenteric hiatal hernia in adults and small intestinal necrosis. Surgery is the only effective method in the treatment of congenital mesenteric hiatal hernia in adults. Key words: Internal abdominal hernia; Intestinal obstruction; Congenital mesenteric hiatal hernia; Diagnosis

A case of small intestinal endometrioid adenocarcinoma.

Endometriosis generally occurs in the ovary. Intestinal endometriosis is rare. About 1 % of all endometriosis cases become malignant. Malignant transformation of small intestinal endometriosis is very rare. A 55-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and omentectomy for endometriosis 7 years ago presented to her primary care doctor with melena. A tumor was detected in the right lower abdomen by ultrasonography. The doctor referred her to our hospital. Computed tomography demonstrated a lobulated tumor ventral to the right common iliac vessels. Magnetic resonance imaging demonstrated that the tumor had heterogeneous intensity on T2-weighted images. Several small cysts with high intensity were observed caudal to the tumor on T2-weighted images. We performed partial small intestinal resection for the lesion. The tumor was diagnosed as endometrioid adenocarcinoma of the small intestine. She has been relapse-free for 5 years after surgery. Only three cases of malignant transformation of small intestinal endometriosis have been reported previously. It is very rare for long-term survival to be obtained with surgery alone, as in our case. This case report highlights the imaging findings for malignant transformation of intestinal endometriosis.

消化管出血を契機にカプセル内視鏡・バルーン小腸内視鏡で診断された小腸GISTの1例

A 58 years old man was admitted with melena. Gastroscopy and colonoscopy couldn’t determine the source of bleeding. Capsule endoscopy demonstrates a submucosal tumor in jejunum. Single-balloon enteroscopy showed a submucosal tumor with active bleeding. Laparoscopy-assisted partial resection of small intestine was performed. Surgical resected specimens showed submucosal tumor with ulceration. Histopathologically, the tumor cells were spindle-shaped. Immunohistochemically, C-kit was positive so we finally diagnosed with small intestinal gastrointestinal stromal tumor (GIST) . This case suggest that patients with OGIB should be examined both by CE and BE.

腸管切除を要する絞扼性イレウスの予測

虚血により腸管切除を必要とする絞扼性イレウスを術前に予測することを目的とし絞扼性イレウスと診断された36例を対象に，腸管切除，非切除群間で，背景因子，バイタルサイン，血液検査，腹水・拡張腸管内容CT値について比較した．この結果，統計的に有意と判定された拡張腸管内容CT値・CRP値・Alb値の3因子を用いてロジスティック回帰分析を行い，腸管切除を要する絞扼性イレウスの判別式を求めた．本判別式に従えばsensitivityは78.6％，specificityは86.4％，正診率は83.3％であった．次に，別の絞扼性イレウス17例および他院の25例を対象に腸管切除予測と実際の結果を比較した．その結果，sensitivityは各々100，60％，specificityは80，90％，正診率は86.7，72％であった．絞扼性イレウスにおける腸管切除の必要性を予測する上で有用であることが示唆された．

Carcinosarcoma of the ovary successfully treated with paclitaxel and carboplatin therapy: two cases

We present two rare cases of carcinosarcoma of the ovary treated successfully with paclitaxel and carboplatin therapy. Case 1: A 79-year-old Japanese woman was diagnosed with carcinosarcoma of the ovary stage IV. We administered neoadjuvant chemotherapy (paclitaxel 180 mg/m2 and carboplatin AUC 6). After three cycles, she underwent a bilateral salpingo-oophorectomy, hysterectomy and omentectomy as a debulking procedure. She received another three cycles of paclitaxel and carboplatin therapy as adjuvant therapy. She is well without evidence of disease 6 months after the sixth chemotherapy cycle. Case 2: A 74-year-old Japanese woman was diagnosed with carcinosarcoma of the ovary stage IIIc. We performed hysterectomy, bilateral salpingo-oophorectomy, partial resection of small intestine, pelvic lymphadenectomy, omentectomy and low anterior resection of the rectosigmoid colon as the primary debulking surgery. She received six cycles of paclitaxel and carboplatin therapy as adjuvant therapy. She has been recurrence free for 6 years. The standard chemotherapy for ovarian carcinosarcoma is not established, but we think that paclitaxel and carboplatin therapy for progressive ovarian carcinosarcoma as an adjuvant therapy might become a standard chemotherapy if further cases of ovarian carcinosarcoma treated with paclitaxel and carboplatin therapy are reported.

Clinical analysis of 29 cases with neuroendocrine neoplasm in the digestive system

To investigate the diagnosis and treatment of neuroendocrine neoplasm (NEN) in the digestive system. Clinical data of 29 patients with NEN from January 2000 to December 2012 in The First Affiliated Hospital of Dalian Medical University were analyzed retrospectively and the prognosis was evaluated according to the new WHO classification. There were 19 males and 10 females and the average age was 46.5 years. All the patients had no clinical manifestations of carcinoid syndrome, and they all received surgical treatment. Two cases were gastric neuroendocrine carcinoma(NEC), who received radical total gastrectomy and distal gastric resection respectively. Three cases had neoplasm in the duodenum, including 2 NEC and 1 neuroendocrine tumor(NET), and they all underwent Whipple's procedure. Two cases were small intestine NEC, who received partial small intestine resection. Three cases had neoplasm in the appendix, including 1 NEC treated with right hemicolectomy and 2 NET with appendectomy. One case was ascending colon NEC, who received right hemicolectomy. Eighteen cases had neoplasm in the rectum, including 4 NEC treated with low anterior resection and abdominoperineal resection respectively, and 14 cases of NET underwent low anterior resection, local resection, and endoscopic resection respectively. The 1- and 3- year survival rates of 13 NEC cases were 38.4% and 7.7% respectively. The 5-year survival rate of 16 NET cases was 81.3%. NEN of digestive system is located mainly in the rectum and the clinical symptom is unspecific. Radical resection of NEN is the preferred treatment. The prognosis of NEC is poor, and that of NET is better.

Coexistence of multiple gastrointestinal stromal tumors and signet ring cell carcinoma of stomach in a patient with neurofibromatosis type-1: case report

Gastrointestinal stromal tumors are mesenchymal neoplasias which are derived from Cajal's interstitial cells. The most common site of involvement is the stomach. It may be multiple in patients with Neurofibromatosis Type-1, while the small intestine is the most common location. In this case report, we aimed to present a Neurofibromatosis Type-1 patient, showing coexistence of multiple gastrointestinal stromal tumors in the stomach and small intestine with a signet ring cell carcinoma in the stomach. A 74-year-old female patient with poor appetite, vomiting and stomach ache was admitted to the hospital. After detection of a tumoral lesion with an ulcerated surface in stomach during the upper gastrointestinal tract endoscopic examination, the patient underwent surgery. During the operation, multiple nodular lesions were observed in the serosal surfaces of the small intestine and stomach. Gastrectomy and partial small intestine resection specimens were evaluated and the patient was diagnosed as signet ring cell carcinoma in the stomach, and multiple gastrointestinal stromal tumors in the serosal surfaces of both the stomach and small intestine. Resection specimens of patients with GIST need to be evaluated carefully on macroscopic examination, considering the possible presence of a coexistent tumoral lesion.

Pneumatosis cystoides intestinalis: A single center experience

To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI). The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed. Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d. Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.

Complete resection after imatinib treatment of a gastrointestinal stromal tumor of the ileum with peritoneal metastases: Report of a case

A 70-year-old woman with a pelvic tumor had undergone exploratory laparoscopy at another institution, which revealed many peritoneal nodules. Immunohistochemical staining of a biopsy specimen of the peritoneal nodules was positive for KIT. Thus, a gastrointestinal stromal tumor (GIST) was diagnosed and imatinib treatment was begun. After 16 months of this treatment, the tumor size had decreased from 51 x 55 mm to 22 x 17 mm, and surgery was performed. Laparotomy revealed complete regression of the peritoneal lesions. The primary tumor was seen to arise from the small intestine and to loosely adhere to the rectum. We performed partial resection of the small intestine. Imatinib therapy was restarted 1 month postoperatively, and the patient is doing well after 12 months of follow-up. We report this case to show that there is the possibility of curative salvage surgery after long-term imatinib treatment in some patients with peritoneal metastases of a GIST.

Clinical analysis of gastrointestinal stromal tumor: a report of 29 patients

To investigate the clinical manifestations, diagnosis and treatment of gastrointestinal stromal tumor (GIST). Clinicopathological data of 29 cases with GIST from 2003 to 2005 were retrospectively analyzed. The most common clinical manifestations were abdominal pain, distention or discomfort in 16 cases (55.2%), abdominal mass in 9 (31.0%), melena and hematemesis in 5 cases (17.2%). The tumor was located in the stomach in 16 cases, the small intestine in 9, the colorectum in 2, the esophagus in one, and the duodenum in one case. All the cases underwent operation, included total gastrectomy in one case, subtotal gastrectomy in 8, partial gastrectomy in 4, local excision of the tumor in 5 cases, partial small intestine resection in 9 and right colectomy in 2 cases. The resection rate was 100% and no complication and death occurred. The positive rates of CD117(+) and CD34(+) were 93.1% and 51.7% respectively. After follow up from one to 2 years after operation, 2 cases died of tumor recurrence and metastasis, the others survived. Immunohistochemical examinations of CD117 and CD34 are important diagnostic markers. Surgery is the main method of final diagnosis and treatment.

A CASE REPORT OF ISCHEMIC STRICTURE OF THE JEJUNUM WITH PROTEIN -LOSING ENTEROPATHY

An 81-year-old woman was admitted to the hospital because of right upper abdominal pain and melena. Bleeding from the small intestine was suspected as a cause of melena, because we could not detect any bleeding lesion by gastrointestinal fiberscopy and total colonofiberscopy. The patient appeared systemically well, and was treated conservatively. On the 47th day after the onset of symptoms, the patient exhibited symptom of ileus. Barium-meal studies revealed a long stricture about 30cm in length of the jejunum 25cm distal to the Treitz ligament, Angiography from the superior mesenteric artery (SMA) showed obstruction of major branches of SMA. Despite adequate hyperalimentation, the patient presented remarkable hypoalubuminemia. Extravasation was seen in the strictured jejunum by 99mTc-labeled albumin scintigraphy. So, we diagnosed the case as ischemic stricture of the jejunum with protein-losing enteropathy. A partial resection of small intestine was carried out on 99th day after the onset, the resected jejunnum showed firm tubular stricture 33cm in length, with ulceration (UL-II) and fibrosis. These features were strongly suggestive of an ischemic process. It is rare that ischemic stricture of the jejunum causes protein-losing enteropathy. This rare case in which extravasation of protein was successfully demonstrated on imaging procedure is reporoted here.

Intestinal adaptation after extensive small bowel resection: differential changes in growth and insulin-like growth factor system messenger ribonucleic acids in jejunum and ileum.

The distal small bowel exhibits greater adaptive growth than proximal segments after partial small intestine resection. To explore this process, we evaluated adaptive cellularity, intestinal insulin-like growth factor (IGF) system messenger RNA (mRNA) transcripts, and effects of recombinant IGF-I treatment in jejunum and ileum of adult rats. Gastrostomy-fed animals underwent 80% jejuno-ileal resection or intestinal transection and reanastomosis without resection, followed by infusion of human recombinant IGF-I (2.4 mg/kgXday) or vehicle. After 7 days, resected rats demonstrated modest adaptive growth in jejunum and marked cell proliferation in ileum. Resection increased IGF-I mRNA in both jejunum (183%) and ileum (249%) and up-regulated IGFBP-4 mRNA levels in both tissues. IGFBP-3 mRNA fell significantly in ileum after resection. IGF-I infusion modestly increased ileal cellularity after resection, but had no effect in jejunum. IGF-I markedly increased IGFBP-3 mRNA levels in jejunum after both transection and resection. These data confirm that bowel resection induces greater adaptive growth in ileum than jejunum. IGF-I administration modestly increases ileal, but not jejunal, growth after resection. Increased levels of intestinal IGF-I and IGFBP-4 mRNA suggest roles for IGF-I and IGFBP-4 in mediating small bowel adaptation. Higher levels of jejunal IGFBP-3 mRNA may be related to limited jejunal vs. ileal growth after extensive jejuno-ileal resection.

Early Proliferative Events Following Intestinal Resection in the Rat

Summary:Partial resection of the small intestine results in compensatory proliferation and adaptation in the remaining small intestinal mucosa. The molecular mechanisms governing the proliferative response are not known, nor has the timing of events associated with proliferation been adequately defined, particularly during the period just after resection. We designed experiments to characterize early (within 24 h) proliferative events associated with proximal intestinal resection and sought to determine the cell type that first responds to proliferative stimuli. Twenty‐one day old male Sprague‐Dawley rats underwent a 70% proximal intestinal resection or transection (control). Poly(A) RNA was isolated from the distal (ileal) remnants. Northern blots showed a marked induction of the immediate early genes zif‐268, nup‐475, and c‐myc 1–3 h following resection, but not following transection. Immunohistochemical analysis of c‐myc expression in ileal crypt epithelial cells showed a biphasic induction that was most marked 6 h after resection and less prominent 24 h after resection. Immunostaining with 5‐bromodeoxyuridine (5‐BrdU) was restricted to ileal crypt nuclei and was maximal 24 h after resection. All these events were observed in the absence of nutrient intake. Taken together, these data show that a potent nutrient‐independent stimulus for intestinal epithelial cell proliferation occurs within minutes of partial small intestinal resection and that the first targets of this stimulus are crypt epithelial cells in the residual intestine.