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Irritable Bowel Syndrome
Published in Nicole M. Farmer, Andres Victor Ardisson Korat, Cooking for Health and Disease Prevention, 2022
Small intestinal bacterial overgrowth (SIBO) is one of the exciting but still somewhat controversial areas of IBS research. In general, it is thought that the bacteria of the gut microbiome belong, primarily, in the colon (large intestine) with a transition zone in the terminal ileum. For the most part, there shouldn’t be a large population of bacteria in the small intestine. This is because the high acidity of the stomach as well as the effects of digestive enzymes and bile retard the colonization of bacteria introduced to the small intestine via our food and, whatever does make it past these defenses, are swept down to the colon via the migrating motor complex (peristalsis). Finally, an intact ileocecal valve prevents bacteria from moving upwards from the colon to the small intestine. However, when these defenses break down, colonic bacteria can proliferate in the small intestine, and this can often cause problems. This is known as SIBO.
Laparoscopic Ileocecal Resection
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Long-term consequences and physiological changes should be kept in view in surgeries for benign disease. As mentioned earlier, the terminal ileum is a distinct and fairly important area for nutrient absorption, and its loss may lead to deficiency of fat soluble vitamins and vitamin B12. However, physiological adaptation of the remaining bowels generally compensates the loss after a certain period of time. Possibilities of gall stones increases in patients with an absent terminal ileum due to a disturbance in the bile acid pool. Oxalate urinary stones are formed more frequently in patients with a loss of the terminal ileum because the colon gets a greater quantity of free oxalate to absorb. Loss of the ileocecal valve and the initial part of colon may lead to diarrhea, or at least increased stool frequency, in some patients. Similarly, loss of the ileocecal valve allows the colonic flora to populate the distal small bowel, which may lead to possible disturbances in digestive function.
Anatomy
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Reza Mirnezami, Alex H. Mirnezami
The ileocaecal valve is a rudimentary structure consisting of two horizontal folds of mucous membrane that project around the orifice of the terminal ileum. The caecum receives its arterial blood supply from the ileocolic artery via anterior and posterior caecal branches (Figure 1.2). Veins drain into corresponding branches of the superior mesenteric vein. Lymphatic drainage is to local paracolic nodes and ultimately to the superior mesenteric lymph node basin. Autonomic nerve supply is provided by the superior mesenteric plexus via sympathetic and parasympathetic nerve fibres.
Protective Effects of Hydrogen-Rich Saline on Experimental Intestinal Volvulus in Rats
Published in Journal of Investigative Surgery, 2022
Hayrunnisa Oral, Zafer Türkyılmaz, Ramazan Karabulut, Cem Kaya, Duygu Dayanır, Cengiz Karakaya, Kaan Sonmez
While under anesthesia, all animals were fixed in the supine position on the operating table. A midline abdominal incision was performed on the rats in Groups 3, 4, and 5. The small intestines and ileocecal valve were exteriorized from the abdominal cavity. The experimental model was then created by rotating a 5 cm ileal loop 2 cm proximal to the cecum 360° clockwise and fixing it by 4/0 polyglactin (Ethicon, US) to prevent disruption of the volvulus. The cessation of small intestinal vessel pulsations and the change in intestinal color were observed. After creation of the volvulus, the intestines were placed back into their anatomical positions in order to prevent environmental interference (such as light, humidity, hypothermia). After a 2-hours-long ischemia period induced by volvulus, the abdominal cavity was relaparotomized (Figure 2), and reperfusion was achieved by opening the fixation suture and reduction of the volvulus in all study groups.
Preoperative Anti-TNF Therapy is Associated with a Shorter Length of Resected Bowel in Patients Undergoing Ileocolic Resection for Crohn’s Disease
Published in Journal of Investigative Surgery, 2022
Yuhua Huang, Danhua Yao, Feilong Guo, Zhiyuan Zhou, Yousheng Li
We found that the mean length of resected ileocolic segment of bowel was 26 cm in this study, and patients with preoperative anti-TNF therapy had 10 cm shorter length of bowel being resected than those without (19.4 ± 8.4 vs. 29.7 ± 10.0 cm). Similarly, a population-based study showed a median length of 40 cm of resected intestine in CD patients undergoing surgery, with the length of intestine resected cumulatively rising to 64 cm in a 15-year follow-up period [9]. Although the estimated incidence of SBS resulting from repeated operations in CD patients is not high, range from 4.3% to 8.5% as literatures reported [13, 27], the effect of bowel resection cannot be ignored. A scoring system, the Lémann index, measuring fully the cumulative digestive tract damage of CD indicated that the irreversible surgical resection was the maximum level of intestinal damage [28, 29]. What’s more, in our study population, all patients lost the ileocecal valve because of ileocolic resection. Nevertheless, ileocecal valve plays critically important roles, such as maintaining a normal transit of the luminal contents and preventing reflux of colonic contents into small bowel [30]. As a result, when managing CD patients requiring surgery, the potential disabling consequences of surgical intervention should be taken into consideration, which include multiple nutrition and vitamin deficiencies, bile salt diarrhea and small bowel bacteria overgrowth, even in the absence of SBS.
How dyspepsia led to the diagnosis of Morbus Crohn
Published in Acta Clinica Belgica, 2020
A. Maertens, D. Persyn, W. Van Moerkercke
The pathology report concluded a focal active and chronic gastritis with presence of a few granulomas (Figures 3 and 4). The result of a CMV staining was negative. Helicobacter pylori microorganisms were absent in the glandular lumina. In conclusion, this was highly suggestive but not diagnostic for Crohn’s disease. According to the guidelines we performed an ileocolonoscopy as the first line procedure to rule out or establish the diagnosis of underlying IBD, revealing a normal ileocaecal valve and colon, but an aphthous terminal ileum (Figure 5). The pathology report showed the presence of a granuloma in the underlying lamina propria, concordant with a slightly active, mildly chronic terminal ileitis typical of Crohn’s disease. The clinical IBD pathway was started, which included a full laboratory analysis, chest x-ray, tuberculosis screening, thiopurine methyltransferase polymorphism testing, vaccination schedule, small bowel MR enterography and dermatological check-up. The initial therapy consisted of oral budesonide and her symptoms improved markedly. After budesonide we started biological therapy with Ustekinumab (human IgG1k monoclonal antibody that binds with specificity to the p40 protein subunit used by both the interleukin (IL)-12 and IL-23 cytokines).