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Posttraumatic intestinal stenosis presenting as a perforation: report of a case.

A 78-year-old woman was admitted to the hospital after falling into a ditch approximately 1 m deep and sustaining a blunt abdominal trauma with a left femur fracture. On the tenth day after admission, symptoms of a small bowel obstruction occurred. A nasogastric tube was inserted, and the symptoms thus improved. She sometimes complained of abdominal pain during the 12 months after the fall, but recovered with conservative management. The next year, she was readmitted to the hospital for a pin extraction of the left femur bone. During this admission, 15 months since her admission after her fall, she again complained of abdominal pain. Abdominal pain increased with a muscular defense, and abdominal X-rays revealed free air. She was referred to our hospital with a diagnosis of perforative peritonitis, and emergency surgery was performed. Upon laparotomy, circumferential stenoses of the small bowel were recognized in the proximal segments about 40cm, 80cm, and 100cm from the ileocecal region. In addition, a perforation and prominent dilatation of the bowel segment was observed just proximal to the stenosis about 100cm from the ileocecal region. She underwent a small intestinal resection at two sites. There were no findings of an intestinal specific ulcer, such as Crohn's disease, intestinal tuberculosis, or malignancy, based on the results of a histopathological examination.

Abdominal Injuries↗

Constitutional trisomy 8 mosaicism with myelodysplastic syndrome complicated by intestinal Behcet disease and antithrombin III deficiency.

Trisomy 8 is the most common acquired chromosomal abnormality associated with myeloid malignancy. As a constitutional trisomy 8 mosaicism (T8M), it exhibits an extremely variable phenotype. In addition, Behcet disease (BD) has been reported as an unusual complication of myelodysplastic syndrome (MDS). To our knowledge, 12 case reports of various hematologic malignancies in patients with T8M and 18 case reports of MDS with acquired trisomy 8 complicated by BD have been published to date. We report a case of constitutional T8M with MDS complicated by intestinal BD and antithrombin III deficiency.

Antithrombin III Deficiency↗

Specificity of the BT-PABA test for the diagnosis of exocrine pancreatic insufficiency in the dog.

Exocrine pancreatic insufficiency in the dog has been assessed by the oral administration of the synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA), a specific substrate for pancreatic chymotrypsin. The subsequent assay of PABA in either the plasma or the urine clearly differentiated control animals from those with exocrine pancreatic insufficiency (EPI), the results being unaffected by combination of this pancreatic function with a xylose absorption test. Possible interference with the specificity of the peptide test for the diagnosis of EPI was examined in six animals with small intestinal disease. In a group of four animals, with features resembling chronic tropical sprue in man, the results were comparable to those of the control group. In the fifth case, however, the results were indistinguishable from those of the EPI group, the estimation of sodium PABA absorption and the assay of proteolytic activity in the duodenal juice demonstrating that this was due to defective hydrolysis of the peptide. In the sixth case, diffuse intestinal lymphosarcoma and a marked villous atrophy were associated with an apparent reduction in the absorption of sodium PABA. However, although the plasma PABA concentrations following oral BT-PABA were subnormal, they were distinctly higher than those of the EPI group. These findings suggest that small intestinal abnormalities do not affect PABA absorption sufficiently to interfere with the specificity of the peptide test for the detection of severe EPI in the dog. This insufficiency may occasionally be secondary to small intestinal disease.

4-Aminobenzoic Acid↗

Small bowel bacterial overgrowth is not seen in healthy adults but is in disabled older adults.

BACKGROUND/AIMS: Small bowel bacterial overgrowth (SBBO) is defined as an abnormal increase in the number of bacteria in the small intestine, and may be occult in older adults. The aim of this study was to determine whether small bowel bacterial overgrowth (SBBO) is found in healthy older people as a concomitant of normal aging or is seen only in disabled or frail older people, excluding patients with intestinal disease and those who had undergone upper intestinal or gastric surgery. METHODOLOGY: Forty-one relatively healthy older people, aged 74.6 +/- 1.7 (mean +/- SE) years, who engage in regular exercise, and 42 variously disabled older people, average age 78.8 +/- 1.1 years, who commute to a day-care center participated in this study. SBBO was determined by a breath hydrogen (H2) test after ingestion of 50g of glucose solution dissolved in 200mL of water. Physical activity was judged from the number of steps walked per day as measured by a pedometer. Food intake was assessed by an interview. RESULTS: No SBBO-positive subject was seen among the healthy, while 11 (25.6%) of the disabled older adults were positive. The number of steps/day taken by the disabled subjects was extremely low, only 22.3% of that of the healthy (P<0.001). No significant difference was seen between the groups in food intake. The mean age of the SBBO-positive patients was relatively high, 81.5 +/- 2.2 years, and 5 (45.4%) of them were underweight, with a BMI<18.5. CONCLUSIONS: Our results and previous studies indicate that SBBO is seen only in patients with intestinal disease and disabled or frail older people.

Age Factors↗

Intestinal cytomegalovirus disease in immunocompromised patients may be ruled out by search for cytomegalovirus DNA in stool samples.

Cytomegalovirus (CMV) PCR from stool specimens was adopted as a diagnostic tool for patients with suspected CMV colitis. After being established, the method was evaluated in 17 AIDS patients and 19 other immunocompromised patients by comparison of PCR results with clinical, histological, and microbiological or virological data. CMV PCR was positive in 4 symptomatic patients with proven CMV colitis and negative in 15 of 16 patients without characteristic histopathology. Neither CMV immunoglobulin G seropositivity nor intestinal symptoms alone were significantly associated with positive PCR results, but severe active systemic CMV infection may lead to a positive PCR. Absence of CMV DNA in stool samples may prove useful in ruling out CMV related colitis.

Acquired Immunodeficiency Syndrome↗

Localized and disseminated forms of neuronal intestinal dysplasia mimicking Hirschsprung's disease.

Neuronal intestinal dysplasia is characterized by structural changes consisting of hyperplasia of the myenteric plexus, an increase of the acetyl cholinesterase activity and the formation of giant ganglia. The condition gives rise to signs and symptoms similar to Hirschsprung's disease. Neuronal intestinal dysplasia can occur as a clinical entity itself in a localized or disseminated form. It may also accompany Hirschsprung's disease either as a localized defect or as a disseminated disorder of the entire intestinal tract. In localized forms, resection of the entire diseased segment is curative. Disseminated forms often have a fetal outcome despite ileostomy and colectomy. It is conceivable that differences in the severity of symptoms depend upon the development or absence of sympathetic innervation.

Diagnosis, Differential↗

Celiac disease.

Celiac disease is a chronic intestinal disease caused by intolerance to gluten. It is characterized by immune-mediated enteropathy, associated with maldigestion and malabsorption of most nutrients and vitamins. In predisposed individuals, the ingestion of gluten-containing food such as wheat and rye induces a flat jejunal mucosa with infiltration of lymphocytes. The main symptoms are: stomach pain, gas, and bloating, diarrhea, weight loss, anemia, edema, bone or joint pain. Prevalence for clinically overt celiac disease varies from 1:270 in Finland to 1:5000 in North America. Since celiac disease can be asymptomatic, most subjects are not diagnosed or they can present with atypical symptoms. Furthermore, severe inflammation of the small bowel can be present without any gastrointestinal symptoms. The diagnosis should be made early since celiac disease causes growth retardation in untreated children and atypical symptoms like infertility or neurological symptoms. Diagnosis requires endoscopy with jejunal biopsy. In addition, tissue-transglutaminase antibodies are important to confirm the diagnosis since there are other diseases which can mimic celiac disease. The exact cause of celiac disease is unknown but is thought to be primarily immune mediated (tissue-transglutaminase autoantigen); often the disease is inherited. Management consists in life long withdrawal of dietary gluten, which leads to significant clinical and histological improvement. However, complete normalization of histology can take years.

Adult↗

Cytokine-induced alteration of the epithelial barrier to food antigens in disease.

The alteration of the intestinal epithelial barrier is often a consequence of various intestinal diseases but may also be the starting point of these diseases. Undigested food antigens are transported across the intestinal epithelium by a transcytotic mechanism, including a processing within the enterocytes, and leading to the passage of intact proteins, peptides, and amino acids to the underlying mucosa. Inflammation and infection lead to the upregulation of the transport and processing of food proteins; for example, IFN gamma increases the rate of transcytosis and alters, like TNF alpha, the tight junction permeability. Infection of gastric digestive epithelia with Helicobacter pylori also increases the antigenic load transmitted to the underlying immune system by inhibiting the enterocytic lysosomal degradation of proteins. In allergic diseases, such as cow's milk allergy, TNF alpha may be involved in the intestinal dysfunction and the associated enteropathy.

Animals↗

[Intestinal parasitic diseases in an urban environment in Sahel. A study in a district of Niamey, Niger].

Health and environment in Niamey, a capital in Sahel, are particularly linked owing to population growth, promiscuity and large pollution induced by human and animal excreta. One district, located in the centre of the town, was surveyed for drinking water quality (ammoniac and bacterial count) and use, as well as for the prevalence of parasites through both a random sample (fixed tools with methiolate-iodine-formaldehyde) and a systematic one (scotch-test). Water consumption was 16.5 litres/day/man from fresh water supplies (87%) and private wells (13%). Ammoniac measures were low in the wells but high in running water (pool and river). It was the same for faecal coliform bacteria. These results give evidence of biotope faecal pollution. The random sample (322 persons, male/female sex ratio 0,85, average age 20,6 years) showed a 42.1% parasitic prevalence. Amoeba was the most frequent parasite (53.6%); and Giardia (14.9%) was the most frequent pathogenic parasite. In the second sample (161 children under 10 years), 24.2% were carriers of oxyuris. This large intestinal parasitism, without any change in connection with previous data in Niger, points to an important fecal contamination of the people more by the way of "dirty hands" than consumption of drinking water. The parasites observed have a short biological cycle, not necessitating long-term maturation in the environment. Those whose ova or larvae must complete their cycle outside have no possibility of surviving in Sahel, thanks to the beneficial effect of sunlight (heat and ultraviolet light). The inhabitants of this district seem to have adapted to intestinal parasitism. But the occurrence of malnutrition linked to a new drought could lead rapidly to a very serious adverse result.

Adaptation, Physiological↗

[Intestinal parasitic diseases of school children in the Republic of Niger].

Coprologic surveys realized in schoolchildren in a few western areas of the Republic of Niger provided the following results. Concerning protozoa, the prevalence of amebiasis-infestation is strong in all the studies areas, giardiasis is more frequent in dry areas. As for the helminths, Hymenolepsis nana is met everywhere, the prevalence of ancylostomiasis decreases gradually from the south to the north and the endemic area of Schistosoma mansoni is limited to the extreme south of the country. The other helminthiasis are rare.

Adolescent↗

[Inflammatory disease of intestine in the child].

We review 28 patients with IBD (14 UC and 14 CD) diagnosed in a period of eight years (1982-1990). The age at the onset of symptoms was similar in both groups (8.1-8.7 years), but the delay in diagnosis was significantly higher in CD (16.2 months). Fever, growth retardation and oral and perianal lesions were more frequent in CD. Articular, mucocutaneous and hepatic were the more usual extraintestinal manifestations. All of them were more frequent in CD. The same comment can be made with respect to the abnormal laboratory test results. Colonoscopy including histological studies was the useful diagnostic method. An increase of the incidence of IBD it has been observed.

Child↗

Studies in intestinal parasitic disease agents in stools of people in a rural area of Nigeria.

A summary of 300 villagers who reported at the Parasitology Laboratory of the School of Medical Laboratory Technology (S.M.L.T) Vom, Plateau State, Nigeria was carried out for the presence of parasites' cysts, eggs, or larva. Of the 300 faecal samples examined using the light microscope after formal-ether centrifugation, 127 (42.3%) harboured one or more parasites. The parasites identified and their prevalent rates were: Entamoeba coli (19.0%) Necator americanus (17.0%); Entamoeba histolytica (4.7%); Schistosoma mansoni (3.0%); Giardia lamblia (2.3%); Trichuris trichuria (1.7%); Trichomonas hominis (1.0%); Ascaris lumbricoides (0.7%); Hymenolepsis nana (0.3%) Endolimax nana o. 3%); stercoralis (0.23%), and Iodamoeba butschlii (0.3%). The overall infection was 22.7% for the males and 19.7% for the females. Incidence was highest in villagers aged between 21 and 40 years.

Adolescent↗

Thromboangiitis obliterans (Buerger's disease) with intestinal involvement--a case report.

Thromboangiitis obliterans (TAO) or Buerger's disease is a nonatherosclerotic vascular disease of unknown etiology that occurs almost exclusively in young male tobacco users. The involvement of the medium-sized and small arteries and veins leads to ischemic complaints and trophic changes in the limbs. The authors report a case of Buerger's disease in a 29-year-old man, a heavy smoker, affecting the lower limbs and mesenteric vessels.

Adult↗