Loops Of Small Intestine Research Articles

An unusual case of small-bowel obstruction: Broad ligament hernia.

Broad ligament hernias (BLHs) are rare internal hernias that can lead to serious complications if left untreated. In this case report, we present the case of a BLH in a female patient and discuss its clinical presentation, diagnosis and management. A 40-year-old woman presented with subacute intestinal obstruction symptoms, including the inability to pass flatus and faeces and recurrent bilious vomiting. A computed tomography (CT) scan confirmed small-bowel obstruction adjacent to the uterus within the left broad ligament. Diagnostic laparoscopy revealed a loop of obstructed small intestine within the broad ligament, which was released and found to be healthy. The defect between the broad and infundibulopelvic ligaments was closed with sutures. The patient had an uneventful recovery and was asymptomatic at a 6-month follow-up. BLHs can be congenital or acquired, with acquired defects often resulting from previous surgeries or pregnancy-related causes. The clinical presentation typically involves the symptoms of bowel obstruction, and a CT scan is the diagnostic modality of choice, showing characteristic findings such as closed-loop obstruction and bowel dilation. Laparoscopic management offers the advantages of faster recovery and less morbidity. Closure of the defect using nonabsorbable sutures is the standard surgical approach, although a wide opening of the defect has also been described. Recurrence is a possibility, particularly if absorbable sutures are used for closure. This case report highlights the importance of early diagnosis and intervention in BLHs to prevent the complications and emphasises the role of laparoscopy in their management.

A clinical case of acute intestinal obstruction as a result of dislocation of the esophageal self-expanding nitinol stent

INTRODUCTION: Covered esophageal self-expanding stents are often used to palliate dysphagia in patients with unresectable esophageal and gastric cardia cancer. Migration of an esophageal stent is a common occurrence in these patients. One of rare complications that can be caused by stent dislocation is intestinal obstruction. The article describes a case of intestinal obstruction in result of migration of a fully covered nitinol esophageal stent. Patient K., 53 years old, was admitted to hospital in a severe condition with complaints of vomiting, abdominal pain and stool retention that had persisted for four days. The patient refused esophagogastroduodenoscopy. A plain abdominal X-ray did not reveal any free gas. In the mesogastrium, numerous pneumatized loops of small intestine with horizontal fluid levels were identified. For life indications, the patient, after preoperative preparation was taken to the emergency operating room; resection of the terminal part of small intestine was performed with placement of an ileostomy and gastrostomy. Taking into account difficulties of diagnosis (refusal of esophagogastroduodenoscopy by the patient and low informative value of X-ray examination), severity of the patient’s condition (due to a malignant neoplasm and intestinal obstruction), anatomical peculiarities (location of the esophageal stent 30 cm from the ileocecal angle, which would complicate potential application of enteroenteroanastomosis), the chosen tactics was to refuse application of enteroenteroanastomosis and exteriorize ileostomy and gastrostomy. CONCLUSION: Acute intestinal obstruction is a threatening complication of migration of an esophageal stent. Patients with placed esophageal stents require careful monitoring, use of a sparing diet and additional methods of stent fixation, which will help reduce the frequency of stent migration and associated complications.

Acute complicated jejunum diverticulitis: a case report with a short literature review.

Jejunal diverticulosis is a rare condition. Most of the time, it is asymptomatic; but it can cause severe complications such as intestinal perforation, mechanical occlusion, and hemorrhage. A patient aged 78 years, with a history of biological aortic valve prosthesis, atrial fibrillation, type 2 diabetes mellitus, and chronic obstructive pulmonary disease, presented in the emergency department for acute abdominal pain in the lower abdominal floor, nausea, and inappetence. Abdominal computed tomography revealed an inflammatory block in the hypogastrium, agglutinated small intestinal loops, fecal stasis, and air inclusions. Pulled mesentery and associated internal hernia are suspected. Exploratory laparotomy was performed, revealing an inflammatory block in the hypogastrium, whose dissection revealed inner purulent collection and the appearance of jejunal diverticulitis, a diagnosis confirmed by histopathological examination. Segmental resection of the jejunum with double-layer terminal-terminal enteroenteric anastomosis, lavage, and drainage was performed. The evolution was favorable. Based on our brief review, the diagnosis of complicated jejunal diverticulosis is difficult and sometimes not accurately established, even by high-resolution imaging techniques, with diagnostic laparotomy being necessary for these situations. Surgical treatment should be considered before severe complications develop.

Cases with Recurrent Hospitalization due to Unexplained Ileus: Paraduodenal Hernia

Internal hernia is one of the rare causes of surgical pathologies in the abdomen.Paraduodenal hernia (PDH) is the most frequent subtype of internal hernia. There are no specific clinical and laboratory findings for diagnosis. This situation may cause delays in diagnosis and adverse clinical outcomes in patients. Computed Tomography (CT) is an imaging method that can help in the diagnosis of internal hernia. A case report of our two patients who were followed up in the clinic, who had been hospitalized with similar complaints in the past and operated for paraduodenal hernia (PDH) has been prepared. Internal herniation is one of the pre-diagnoses that should be kept in mind, especially in the history of unexplained and recurrent hospitalization in patients with abdominal pain and signs of intestinal obstruction. Observation of hernia sac on CT and observing small intestinal loops trapped in it are the only objective findings that can help us in the diagnosis of internal herniation.

Anaesthetic management in adult reindeer (Rangifer tarandus tarandus) undergoing exploratory laparotomy for jejuno‐jejunal intussusception surgery resection

AbstractA 2‐year‐old, male reindeer (Rangifer tarandus tarandus) presented for further investigations and treatment of acute colic signs. On clinical investigations, an ultrasonographic abdominal exam revealed multiple hypomotile, dilated and fluid‐filled small intestinal loops. Based on clinical findings and increased signs of abdominal pain, small intestine obstruction was suspected, and an exploratory laparotomy was performed. The animal was premedicated with medetomidine (0.003 mg/kg) and butorphanol (0.05 mg/kg) intravenously. General anaesthesia was induced with ketamine (2 mg/kg intravenously) and propofol (3 mg/kg intravenously), and maintained with isoflurane in oxygen. Additional analgesia was provided with methadone (0.1 mg/kg intravenously) and ketamine (0.5 mg/kg intravenously). A jejuno‐jejunal intussusception requiring resection of approximately 6 inches (15 cm) was identified and jejuno‐jejuno anastomosis was performed. Fluid resuscitation was administered for treatment of hypotension during general anaesthesia. Recovery from anaesthesia was uneventful. Nevertheless, the deer was euthanased 5 days later due to clinical deterioration.

Preliminary study to evaluate the use of fast abdominal ultrasonography of horses with colic in first opinion ambulatory practice

SummaryBackgroundColic is the commonest emergency in first opinion equine practice. Early referral is important for horses requiring surgery. Fast localised abdominal ultrasonography of horses (FLASH) is frequently used as a diagnostic tool in the investigation of colic at referral hospitals, but its use in first opinion practice has not been evaluated.ObjectiveTo assess the value of FLASH scanning in the primary assessment of horses with colic in the field, using a portable wireless ultrasound system.Study designProspective study (2018–2021).MethodsAny horse examined for colic as an emergency in a first opinion ambulatory practice was eligible for inclusion in the study. A FLASH examination was performed using a wireless handheld ultrasound scanner, with the images displayed on a smartphone or tablet. The findings on FLASH scans and the outcome of the case (recovered, referred for surgery or euthanised without referral) were recorded.ResultsIn total, 135 equids with acute colic were evaluated. Of the 135 horses, 49 (36%) had an abnormal finding on FLASH scanning, including distended loops of small intestine (n = 34), thickened small intestinal walls (n = 23) and/or distension of the stomach (n = 7). Reduced small intestinal motility was recorded in 52 animals (38%). Follow‐up information was available in all animals: 50 (37%) were euthanised due to clinical deterioration and the owners' decision not to undertake surgery; 85/135 (63%) survived, including 5/85 (6%) that underwent surgery and 80/85 (94%) that resolved with medical management.Main limitationsSmall number of cases. Lack of results of post‐mortem examination of horses that were euthanised. Potential selection bias.ConclusionThe FLASH technique can be valuable in the primary assessment of horses with colic in first opinion ambulatory practice. Further evaluation with more cases is required.

Comparison of transrectal and transabdominal transducers for use in fast localized abdominal sonography of horses presenting with colic.

Abdominal ultrasonography is valuable in the diagnosis of equine colic. Fast localized abdominal sonography of horses (FLASH) enables practitioners with limited experience to perform ultrasonography in emergency settings. However, many practitioners only possess rectal format linear array transducers (RFLT). The hypotheses are: (a) A low frequency curvilinear transducer (LFCT) and RFLT will detect free abdominal fluid and abnormal small intestinal loops with similar frequency during FLASH, and (b) there will be a difference between the transducers for detection of gastric abnormalities and nephrosplenic entrapment. The objective is to compare transcutaneous abdominal ultrasonographic detection of abnormalities in horses presenting with colic using a LFCT and RFLT. Twenty-four horses requiring FLASH for investigation of colic were enrolled. Horses that were too painful to undergo transcutaneous abdominal ultrasonographic examination were excluded. A single investigator performed FLASH on all horses using a RFLT, while one of three other clinicians simultaneously performed FLASH using a LFCT. Comparison of abnormal findings between the two transducers was performed using Chi square, Fisher's exact or Wilcoxon tests. The incidence of identification of abnormal findings was similar between the two transducers for all comparisons except the visibility of the left kidney and stomach (kidney LFCT 81.25% vs. RFLT 22.92%, stomach LFCT 87.5% vs. RFLT 62.5%). While there are limitations to using a RFLT to identify nephrosplenic entrapment of the colon and detection of the stomach, it reliably detects other common abnormalities, including peritoneal effusion, lesions of the small intestine, and changes to the wall of the large colon and cecum.

Amyand’s Hernia in an Infant: A Case Report and Review of Literature

Introduction: Inguinal hernia is a common surgical disease among a pediatric population with patent processus vaginalis being the major risk factor. Omentum and small intestine loops are the oftenencountered hernia sac contents, however in a rare instance (1% of cases), a vermiform appendix is found in the sac, and it is referred as Amyand’s hernia (AH). The appendix can be normal, inflamed, strangulated, or perforated. Case presentation: 7-week-old male baby with 2-week history of right groin swelling, excessive crying and restlessness. He was clinically stable with irreducible right inguinoscrotal swelling. An ultrasonography confirmed a 1.5 cm abdominal wall defect with bowels in the sac. A clinical diagnosis of incarcerated inguinal hernia was made, and the patient was prepared for surgery. A standard herniotomy incision was done, hernia sac was found and opened and appendix and cecum were found. The contents were reduced, the sac was ligated and transected, and the incision was closed in layers. The post-operative follow ups were uneventful. Discussion: AH is a rare condition, with estimated prevalence of 0.19% to 1.7% and 0.1% occurrence of appendicitis. The clinical presentations of AH include painful groin swelling, inguino-scrotal erythema, tenderness, and features of obstructed or strangulated inguinal hernia. Diagnosis is often made during surgery as it is exceedingly difficult to diagnose it pre-operatively as it resembles inguinal hernia, and it can mimic testicular torsion or inflammation in case of erythema and tenderness. The surgical approach depends on the status of appendix, and it can be reduction of appendix or appendectomy if inflamed. Conclusions: Although rare, an index of suspicion should be kept in all inguinal hernia repairs. The appendix should be preserved if normal as with emergence of novel surgical technologies, the appendix can be of significant use especially for the children.

Claudius Amyand’s Hernia in Children: About Two Cases in the Pediatric Surgery Unit in the General Surgery Department at Ignace Deen Chu

Acute intussusception is a rare manifestation in adults, most often of malignant tumoral origin occurring on a small intestine loop. Its presence in a pregnant woman with a complication such as peritonitis by ileal perforation is an extremely rare case. We report a clinical case concerning a 32-year-old woman, amenorrhoeic for 24 weeks, referred to the general and visceral surgery department of the Ignace Deen National Hospital for acute intestinal obstruction in pregnancy in whom, after performing an X-ray of the abdomen without preparation which revealed mixed hydro-aeric levels and a biological assessment, she was taken to the block, at the celiotomy purulent liquid flowed out and the exploration revealed a pudding of ileo-coeco-colic intussusception whose disinvagination revealed three ileal perforations with respective diameters of 1.5cm, 2cm and 3cm located respectively 10cm, 30cm and 50cm from the ileocecal junction with pre-perforation zones. We performed a resection removing the perforations followed by an end-to-side ascending ileocecal anastomosis. The post-operative course was marred by complications such as evisceration, disembowelment and the birth of a full-term stillborn.

Acute Intestinal Intussusception Complicated By Peritonitis by Ileal Perforation in Pregnancy Apropos of a Case in the General and Visceral Surgery Department of the Ignace Deen National Hospital

Acute intussusception is a rare manifestation in adults, most often of malignant tumoral origin occurring on a small intestine loop. Its presence in a pregnant woman with a complication such as peritonitis by ileal perforation is an extremely rare case. We report a clinical case concerning a 32-year-old woman, amenorrhoeic for 24 weeks, referred to the general and visceral surgery department of the Ignace Deen National Hospital for acute intestinal obstruction in pregnancy in whom, after performing an X-ray of the abdomen without preparation which revealed mixed hydro-aeric levels and a biological assessment, she was taken to the block, at the celiotomy purulent liquid flowed out and the exploration revealed a pudding of ileo-coeco-colic intussusception whose disinvagination revealed three ileal perforations with respective diameters of 1.5cm, 2cm and 3cm located respectively 10cm, 30cm and 50cm from the ileocecal junction with pre-perforation zones. We performed a resection removing the perforations followed by an end-to-side ascending ileocecal anastomosis. The post-operative course was marred by complications such as evisceration, disembowelment and the birth of a full-term stillborn.

The role of minimally invasive technologies in the diagnosis and treatment of adhezive intestinal obstruction

One of the serious intra-abdominal complications after surgery is intestinal obstruction of adhesion origin (IOAO). Mortality during postoperative intestinal obstruction is 16.2–52.5 %. Aim of the study – laparoscopic diagnosis of IOAO in the early postoperative period and optimization of adhesiolysis.Material and methods. In the early postoperative period 70 patients with IOAO of upper gastrointestinal tract were examined and treated; laparoscopic operation was performed to 46 patients (the main group), an open method (laparotomy) – to 24 patients (the control group).Results and discussion. It was revealed that upper-middle and lower-middle incision laparotomies are more likely to cause intestinal obstruction. The sensitivity of preoperative ultrasound diagnosis of movable visceroparietal adhesions of small intestinal loops is 94.6 %, and the sensitivity of laparoscopic diagnosis is 99.2 %. When using minimally invasive technology, the frequency of intraoperative (4 (8.7 %) and 8 (33.3 %), respectively, p < 0.05) and postoperative complications (5 (10.9 %) and 13 (54.1 %), p < 0.05), mortality (0 and 4 (16.6 %), p < 0.05) and length of stay in hospital (5.7 (3–8) and 14.3 (10–17) days, p < 0,05) was less compared to laparotomy.Conclusions. Using of laparoscopic adhesiolysis and anti-adhesion barrier is appropriate in patients with I-II grade adhesion process. In cases where technical difficulties arise during laparoscopic adhesiolysis, it is more pathogenetically justified to separate adhesions by passing through a mini-laparotomy incision. If this is not possible, it is advisable to perform complex anti-adhesion measures, including conversion to laparotomy and systemic enzymotherapy after adhesiolysis.

Primary sclerosing encapsulating peritonitis: a case report

BackgroundSclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge.Case presentationA 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved.ConclusionSclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.

CURRENT PERSPECTIVES ON OPERATION MINIGASTROSHUNTING

Minigastric bypass is a relatively new bariatric operation that is an effective method for reducing body weight and controlling comorbidities. In minigastric bypass, a thin, narrow tube similar to the gastric sleeve in longitudinal gastric resection is excised from the stomach and a single anastomosis is placed between this sleeve and a loop of small intestine. About two metres of the small intestine is disconnected from digestion.

Chylolymphatic Cyst - Presenting as Acute Intestinal Obstruction – A Case Report

Chylolymphatic cyst is one of the rare variants of mesenteric cysts. These cysts are present within mesentery and contain chylous or lymphatic fluid. Chylolymphatic cysts are rare in paediatric age group. We present a case of a four years old boy who presented with features of acute intestinal obstruction. CECT abdomen revealed a hypodense cystic mass in the peritoneal cavity. Exploratory laparotomy of the abdomen revealed a solitary cyst measuring 10.7 cm x 9.4 cm x 10.5 cm which was adherent to the loops of small intestine and right kidney. Complete excision of cyst along with resection of the adjacent gut and end to end anastomosis was done. Histopathology of the excised cyst was suggestive of chylolymphatic cyst. It has been highlighted that chylolymphatic cyst can be a rare cause of intestinal obstruction in children.

Obturator hernia cause of ileus – modern diagnosis and surgical approach

Introduction: The obturator hernia (OH), which is considered relatively rare, is actually the most common of all hernias types of the pelvic floor. It represents 0.073% of all external hernias. Frequency is greater in older women between the 7th and 9th decades. The male: female ratio is 1:6. It mainly presents with symptoms of small bowel obstruction and accounts for 0.2-1.6% of all causes of ileus. Other concomitant complaints are pain in the thigh radiating to the knee (a symptom of Howship-Romberg) or swelling in the inguinal region with abdominal pain. Case Report: We present an 83 -year -old woman who was admitted to the Surgery department of the Military Medical Academy – Sofia with complaints of abdominal pain, vomiting and stop of defecation for several days. From the tests done, ileus of small intestinal origin was established. The diagnosis of incarcerated, obturator hernia was made after a contrast-enhanced CT scan of the abdomen and pelvis. The patient underwent emergency surgery, during which the incarcerated, small intestinal loop was released, retrograde debarasage of the small intestine and plastic of the obturator channel with its own tissues was done. Conclusions: Small bowel obstruction caused by incarceration in obturator hernia is one of the rare causes of intestinal obstruction in surgery, but on the other hand is a common manifestation in this type of hernia and one of the main causes of its detection. The combination of operative technique for the treatment of ileus condition and the plastic of the obturator channel produces good postoperative results.

Effect of ceftriaxone on intestinal transit time.

Ceftriaxone reduces gallbladder and ileal contractility. Many studies have shown that ceftriaxone causes biliary sludge and pseudolithiasis. However, its effect on intestinal transit time has not been investigated. This study aimed to investigate the effect of ceftriaxone on intestinal transit time. Sixteen rats were examined in two groups: The study group (group A, n= 8) was administered with 100 mg/kg ceftriaxone intramuscularly for 7days. The control group (group B, n= 8) was administered with intramuscular distilled water for 7days. On the seventh day, a mixture of 2ml barium and saline was given orally to both groups. Barium transit was evaluated using serial digital X-ray images. The stomach was full and the transition into the small intestine loop was observed in all rats at 45 min in both groups. At the 2nd hour, colonic transition was observed in two rats in group A (2/8, 25%) and in seven rats in group B (7/8, 87.5%). At the 4th hour, five (62.5%) rats in group A had transverse colonic transition, and all rats in group B (8/8, 100%) had transverse and/or left colonic transition. At the 6th hour, no rat in group A had rectal transition, and all rats in group B (8/8, 100%) had complete passage of colonic contrast material. Ceftriaxone significantly prolongs the small intestine transit time, large intestine transit time, and total intestinal transit times.

Diagnostic value of clinical investigation of children with adhesive intestinal obstruction

Early diagnosis and objective determination of the presence and degree of intestinal obstruction is important for practicing surgeons. The abdominal X-ray examination, the contrast passage examination, and in some cases computer tomography are used for clinical confirmation of this pathological condition. The purpose - to reveal the diagnostic value of clinical investigation methods in children with adhesive intestinal obstruction. Materials and methods. We followed up 89 children with adhesive intestinal obstruction. All the children, in addition to a complete clinical physical examination during hospitalization, had the clinical investigation in order to verify the diagnosis: X-ray examination and ultrasound examination of the abdominal organs. Results. According to our data, the main signs of intestinal obstruction at the X-ray examination of the abdominal cavity were the absence of gas in the large intestine (66; 74.2%), hydroaeric levels or Kloiber’s cups (58; 65.2%) and dilation of small intestine loops ≥3 cm (37; 41.6%); at the ultrasound of the abdominal organs - dilation of the small intestine loops ≥3 cm (70; 78.7%) and an ineffective peristalsis (33; 37.1%). Conclusions. Rapid diagnosis of the surgical disaster in children with suspected adhesive intestinal obstruction and important information is provided by X-ray examination and ultrasound examination of abdominal organs. Ultrasound diagnosis of abdominal organs in patients with peritoneal adhesions is non-invasive and sufficiently informative for multiple monitoring of the disease and the effectiveness of treatment without negative impact on the patient. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all the institutions mentioned in the work. Informed consent was obtained from parents (or guardians). No conflict of interests was declared by the authors.

Characterizing the Contributions of Various Clostridium perfringens Enterotoxin Properties to In Vivo and In Vitro Permeability Effects.

ABSTRACTClostridium perfringens enterotoxin (CPE) is thought to cause lethal enterotoxemia when absorbed from the intestinal lumen into the circulation. CPE action sequentially involves receptor-binding, oligomerization into a prepore, and pore formation. To explore the mechanistic basis by which CPE alters permeability, this study tested the permeability effects of several recombinant CPE (rCPE) species: rCPE and rCPEC186A (which form pores), rC-CPE and rCPED48A (which bind to receptors but cannot oligomerize), rCPEC186A/F91C (which binds and oligomerizes without pore formation), and rCPEY306A/L315A (which has poor receptor-binding ability). On Caco-2 cells, i) only rCPE and rCPEC186A were cytotoxic; ii) rCPE and rCPEC186A affected transepithelial resistance (TEER) and 4 kDa fluorescent dextran (FD4) transit more quickly than binding-capable, but noncytotoxic, rCPE variants; whereas iii) rCPEY306A/L315A did not affect TEER or FD4 transit. Using mouse intestinal loops, rCPE (but not noncytotoxic rC-CPE, rCPED48A or rCPEY306A/L315A) was lethal and caused intestinal histologic damage within 4 h. After 2 h of treatment, rCPE was more strongly absorbed into the serum than those noncytotoxic rCPE species but by 4 h rC-CPE and rCPED48A became absorbed similarly as rCPE, while rCPEY306A/L315A absorption remained low. This increased rC-CPE and rCPED48A absorption from 2 to 4 h did not involve a general intestinal permeability increase because Evans Blue absorption from the intestines did not increase between 2 and 4 h of treatment with rC-CPE or rCPED48A. Collectively, these results indicate that CPE receptor binding is sufficient to slowly affect permeability, but CPE-induced cytotoxicity is necessary for rapid permeability changes and lethality.IMPORTANCE Clostridium perfringens enterotoxin (CPE) causes lethal enterotoxemia when absorbed from the intestines into the bloodstream. Testing recombinant CPE (rCPE) or rCPE variants impaired for various specific steps in CPE action showed that full CPE-induced cytotoxicity causes rapid Caco-2 monolayer permeability alterations, as well as enterotoxemic lethality and rapid CPE absorption in mouse small intestinal loops. However, receptor binding-capable, but noncytotoxic, rCPE variants did cause slow-developing in vitro and in vivo permeability effects. Absorption of binding-capable, noncytotoxic rCPE variants from the intestines did not correlate with general intestinal permeability alterations, suggesting that CPE binding can induce its own uptake. These findings highlight the importance of binding and, especially, cytotoxicity for CPE absorption during enterotoxemia and may assist development of permeability-altering rCPE variants for translational purposes.

Painful Abdominal Mass Showing Internal Hernia on CT scan

We report a case of a left para-duodenal internal hernia in order to describe the role of a CT scan in its diagnosis. It was a 19-year-old boy with no known personal medical history. He was received at “The stars clinic’’ in Bamako (Mali) on 01/15/2020 for an abdominal CT scan for the assessment of diffuse abdominal pain on mass on palpation. The CT scan revealed agglutination of the small intestinal loops with its mesentery and its mesenteric vessels in the left paramedian location without complications. Faced with this semiological CT scan, the diagnosis of a left para-duodenal internal hernia was retained. Surgical management confirmed this diagnosis. Since the clinical diagnosis of an internal hernia is often unrecognized, cross-sectional imaging methods with multiplanar reformatting, in particular CT scan, remain essential in the management of this pathology.

Ex-Vivo Evaluation of "First Tip Closing" Radiofrequency Vessel Sealing Devices for Swine Small Intestinal Transection.

Simple SummaryThe study observed the burst pressure (BP), number of activations, and histological evaluation of ex vivo swine small intestinal loops transected by stapler, a single fulcrum radiofrequency vessel sealing (RFVS—Ligasure Atlas) device, and the newly-invented jaws RFVS (Caiman). Caiman5, Caiman Maryland, Caiman12, Ligasure Atlas, and Stapler were employed as experimental groups, with Stapler serving as the control group. Caiman5, Caiman12, and the stapler needed just one activation to complete the seal. The Caiman5 and Caiman Maryland groups had considerably lower mean blood pressures than the Stapler group. The RFVS Caiman12 and Ligasure Atlas generated mean BP results that were comparable to the Stapler and did not vary. Caiman12 and Ligasure Atlas generate equivalent mechanical capabilities as well as stapled intestinal closure, while Caiman12 requires just one activation to complete the transection.This study compared burst pressure (BP), number of activations, and histological assessment of ex vivo swine small intestine loops transected by stapler, a single fulcrum radiofrequency vessel sealing (RFVS) device, and the newly-developed jaws RFVS. Fifty (n = 50) 20 cm long jejunal loops were randomly assigned to be transected with RFVS devices and linear stapler (Caiman5, Caiman Maryland, Caiman12, Ligasure Atlas, and Stapler group as control respectively). Caiman5, Caiman12 and stapler required only one activation to complete the sealing. The mean BP in Caiman5 and Caiman Maryland groups were significantly lower (p < 0.05) than the S group as control and the other RFVS devices studied. RFVS Caiman12 and Ligasure Atlas produced mean BP values that were close to the Control and did not differ between them. The lumen was totally closed in the Caiman12 and Ligasure Atlas groups. The findings of this investigation were promising; we discovered that Caiman12 and Ligasure Atlas produce comparable mechanical capabilities as well as stapled intestinal closure, however Caiman12 need a single activation to complete the transection.