Thickening Of Small Intestinal Wall Research Articles

An Unusual Occurrence of Immunoproliferative Small Intestinal Disease in Elderly Patient Presenting with Chronic Diarrhea - A Rare Case Report

Immunoproliferative small intestinal disease (IPSID) is a rare type of indolent B-cell lymphoma. It is a variant of extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue. It is commonly seen in older children and young adults in the age group of 10-35 years. It is more common in males with Male: Female ratio of 2.4:1. Duodenum and jejunum are the commonly involved areas in small intestine. Colicky abdominal pain and intermittent diarrhoea are the common symptoms. Here by, we report a rare case in a 74-year-old male patient presented with chief complaints of abdominal pain, diarrhea and weight loss for 3 months. CT scan findings revealed thickening of small intestinal wall and mesenteric lymphadenopathy. Upper gastrointestinal endoscopy findings revealed nodular and ulcerative mucosa in the duodenum. Histopathological examination revealed flattening of mucosa with villous atrophy, destruction of crypts and intraepithelial lymphocytic infiltrate is noted. Interstitium shows dense and diffuse collection of lymphoplasmacytic infiltrate. Immunohistochemistry was done and it showed CD20 positive lymphoid cells. Based on the above findings the case was reported as Immunoproliferative small intestinal disease. Clinicians should suspect IPSID in cases presenting with chronic diarrhea and abdominal pain refractory to treatment. Immunoproliferative small intestinal disease has indolent clinical course and it can be cured with antibiotics in early stages. Late stages have high mortality rate and has poor prognosis. Keywords: IPSID, Alphachain disease, B cell lymphoma, duodenum, villous atrophy, lymphoplasmacytic infiltrate

2522 An Unusual Case of a Colo-enteric Fistula

INTRODUCTION: Entero-enteric fistulas are complications seen in patients with active Crohn's disease or history of extensive intra-abdominal surgeries. Presentations can be non-specific and include disease progression, rectal bleeding, or persistent febrile episodes. Upper and lower gastrointestinal endoscopy are used to diagnose entero-enteric fistulas. Contrast injection along with abdominal radiography can visualize and provide further anatomical details. In the following report, we present the case of a patient with pancreatic adenocarcinoma who presented with rectal bleeding. The diagnosis of colo-enteric fistula was made by fluoroscopy with contrast injection and pathology results. CASE DESCRIPTION/METHODS: A 62-year-old male with PMH of pancreatic adenocarcinoma treated with chemotherapy and whipple procedure complicated by multiple recurrences of liver metastases treated with radiofrequency ablation and excision of abdominal wall implants, who presented with rectal bleeding. On admission, EGD did not identify the source of bleeding, Colonoscopy showed a 4 cm ulcerated pocket at the hepatic flexure. Contrast injected into the pocket revealed a fistulous tract with an extra-colonic segment. Traversing the tract with the colonoscope revealed small bowel tissue. Biopsies of fistulous opening was consistent with necrotic tissue concerning for metastatic implants. DISCUSSION: To the best of our knowledge, most entero-enteric are caused by either active untreated Crohn's disease or as a result of multiple abdominal surgeries. This is a rare case of colo-enteric fistula formation due to metastatic pancreatic cancer. Few case reports show intra-colonic fistula formation due malignancy. Upon literature review, there are case reports of primary lymphoma leading to colo-enteric fistula formation. Diagnosis was difficult to achieve due to non-specific clinical presentation of chronic diarrhea. The fistula was diagnosed by computed tomography enterography (CTE) demonstrated a ileo-ileal fistula and ileo-colonic fistula. Ultrasound (US) showed small intestinal wall thickening and development of a fistula of the sigmoid colon due to malignancy. Although rare, enteric fistula formation due to malignancy should be suspected in patients with GI symptoms and history of metastatic disease.

Prospective evaluation of abdominal ultrasonographic findings in 35 dogs with leptospirosis.

Despite the emergence of new serovars, a detailed and current abdominal ultrasonographic description of dogs with leptospirosis is lacking. The purpose of this prospective, observational, single cohort study was to illustrate abdominal ultrasonographic findings in 35 dogs with confirmed leptospirosis. At least one ultrasonographic abnormality was seen in all of the dogs. Ultrasound renal abnormalities were found in all the dogs and included increased renal cortical echogenicity (100%), increased medullary echogenicity (86%), reduced corticomedullary definition (80%), cortical thickening (74%), renomegaly (60%), pelvic dilation (31%), and medullary band (14%). Hepatic changes were identified in 83% of the dogs, with diffuse hypoechoic parenchyma (71%) and hepatomegaly (60%). Biliary gallbladder abnormalities were found in 60% of the dogs, with biliary sludge (46%), wall thickening (29%), mucocele (26%), and hyperechoic wall (20%). The other most frequently observed abdominal abnormalities were perirenal (60%) and peritoneal (46%) effusions, small intestinal wall thickening (49%), and lymphadenopathy (38%). Two dogs (6%) presented with a small intestinal intussusception. No association was found between serogroups and the presence of ultrasonographic findings. This study is the first to prospectively and exhaustively describe abdominal ultrasonographic findings in dogs with leptospirosis. Our results should prompt clinicians to systematically perform abdominal ultrasounds on dogs with suspected leptospirosis even in the absence of abnormal physical signs. The presence of a gallbladder mucocele could be a warning sign of leptospirosis in dogs.

Sensitivity and Specificity of Ultrasonographic Evaluation of Small Intestine Wall Thickness in the Diagnosis of Inflammatory Bowel Disease in Horses: a Retrospective Study

In horses, inflammatory bowel disease (IBD) usually determines a chronic wasting syndrome (CWS) which is a highly nonspecific clinical syndrome; therefore, diagnosing IBD often represents a challenge. Little is known about the accuracy of abdominal ultrasonography in horses suspected of IBD: previous studies reported abdominal ultrasonography to be useful in the diagnostic approach for IBD in the equine patient but, to the authors' knowledge, no studies assessed its accuracy. The aim of the present study was to assess sensitivity and specificity of ultrasonographic measurement of small intestine wall thickness in the diagnosis of IBD, using rectal biopsy as a reference standard. Thirty-five horses presented for CWS were retrospectively selected among a clinical population. Assessment of sensitivity, specificity, and receiving operator characteristics curve elaboration were made initially for all the patient population and then repeated including only those horses showing ultrasonographic evidence of diffuse small intestinal wall thickening. When all patients were considered, a 5.7 mm cutoff value was the best compromise between sensitivity (36.8%) and specificity (87.5%). When only those patients with diffuse thickening were considered, a 5 mm cutoff value was the best compromise between sensitivity (50%) and specificity (100%). According to the results obtained, ultrasonography appears to be a specific method for the evaluation of small intestinal wall thickness, and it could be useful in the diagnostic protocol of IBD in horses with CWS.

Extensive small intestinal wall thickening in a cat

A two-year-old domestic shorthair cat presented for investigation of a six-month history of intermittent vomiting, weight loss, hyporexia and lethargy. Abdominal ultrasound was performed and revealed extensive small intestinal wall...

Multiple small intestinal pseudodiverticula associated with lymphoma in three horses

Three mature horses presented with progressive weight loss, inappetence, ventral abdominal oedema and lethargy. Two of the animals had intermittent signs of low grade abdominal pain. At presentation, all 3 had hypoalbuminaemia; 2 had hyperfibrinogenaemia and the other had neutrophilia. An oral glucose tolerance test was performed in 2 cases, both of which demonstrated impaired glucose absorption. One pony treated with corticosteroids failed to improve and developed peritonitis and was subjected to euthanasia after 2 weeks. One pony had small intestinal biopsies obtained via a standing flank laparotomy, which revealed a mainly mononuclear cell infiltrate of the mucosa. It failed to respond to treatment with antibiotics and corticosteroids and, after 2 months, developed sternal oedema in addition to the ventral abdominal oedema and peritonitis and was subjected to euthanasia. The remaining pony deteriorated despite symptomatic therapy and was subjected to euthanasia after one week. At post mortem examination, all 3 animals had multifocal lesions of small intestinal wall thickening, mucosal ulceration, pseudodiverticula and enlarged mesenteric lymph nodes. One pony also had a multinodular mass at the root of the mesentery, a mediastinal mass and a lung mass. Histological examination confirmed the presence of lymphoma of the intestinal wall at post mortem examination in each case and immunohistochemistry (including retrospective evaluation of the intestinal biopsies obtained from the pony that underwent a flank laparotomy) indicated that the lymphomas were of T cell origin.

A case of mucosa-associated lymphoid tissue lymphoma forming multiple lymphomatous polyposis in the small intestine

A 50-year old woman suffering from diabetes had a CT scan that revealed a diffuse thickening of small intestinal wall and swollen paraaortic lymph nodes. An esophagogastroduodenoscopy (EGD) confirmed multiple polypoid lesions in the duodenum and small intestine, and conventional histological testing revealed non-specific inflammatory changes. Further examinations including the immunohistochemical profiles of the biopsied specimens led us to diagnose the lesion as a marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type, forming multiple lymphomatous polyposis sequentially spreading from duodenal bulb to terminal ileum. According to Lugano's classification, its staging was clinically diagnosed as stage II. Two courses of a standard CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and predonisolone) regimen with rituximab reduced the lesion and the patient had a almost complete response. A 5-year follow-up EGD and histological examinations detected no recurrence of the disease.