Small Intestinal Bleeding
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
Small intestinal bleeding often poses diagnostic and therapeutic challenges in the care of pediatric patients. This chapter reviews the diagnostic modalities most often used for evaluation, and discusses etiologies of and therapy for small intestinal bleeding in children. Meckel diverticulum is likely to be the most common cause of small intestinal bleeding in children, and is an anomalous remnant of the vitelline duct. Bleeding from Meckel diverticulum is the result of mucosal ulceration due to the secretions of ectopic gastric or pancreatic tissue located in the diverticulum itself. Intestinal duplication cysts arise from the mesenteric border of the bowel, and are typically located in the small intestine, particularly at the terminal ileum. Small intestinal bleeding may occur in children with anastomotic ulcers resulting from previous small bowel resections. Adenomatous polyps and hamartomatous polyps can present with small intestinal bleeding, but frequently the colonic involvement dominates the presentation.
Gastrointestinal disease
Catherine Nelson-Piercy in Handbook of Obstetric Medicine, 2020
Prolonged vomiting may lead to Mallory-Weiss tears of the oesophagus and episodes of haematemesis. Flexible sigmoidoscopy or colonoscopy and mucosal biopsy are safe in pregnancy and may confirm mucosal inflammation and allow histological examination to differentiate ulcerative colitis and Crohn's disease. Irritable bowel syndrome (IBS) is common, and most sufferers encountered in pregnancy will already be aware of their diagnosis. Crohn's disease (CD) affects the terminal ileum alone in 30%, the ileum and colon in 50% and the colon alone in 20% of cases. CD may affect any part of the gastrointestinal tract from the mouth to the anus. Since it is a diagnosis of exclusion, new onset of symptoms in pregnancy are more likely to be attributed to the pregnancy than to IBS. The commonest causes of abdominal pain in pregnancy are constipation, urinary tract infection and uterine contractions.
Three-Dimensional Fluorographic Anatomy
Robert J. Parelli in Principles of Fluoroscopic Image Intensification and Television Systems, 2020
This chapter discusses fluoroscopic anatomy and patient positions for gallbladder, terminal ileum, and knee arthrography. It describes the three methods for fluoroscopic localization techniques. The fluoroscopic localization techniques are parallax method, right-angle method, and radiopaque method. Fluoroscopic spot films may be made of any segment of the small bowel as the loops become opacified. Fluoroscopic views are recorded by a spot-film camera or screen/film spot-film device of each anterior projection and 20° right and left oblique projections. After locating the foreign body, the fluoroscopist closes the diaphragm shutters down to the size of the object to direct the central ray through its center. The radiopaque method requires the use of contrast media to coat the object or localize the site of an obstruction, opaque foreign body, and/or calculus. Fluoroscopic viewing and recording of the ileocecal valve are performed by administering a barium sulfate preparation.
Crohn disease of the small bowel proximal to the terminal ileum: detection by MR‐enteroclysis
Published in Scandinavian Journal of Gastroenterology, 2004
T. Ochsenkühn, K. Herrmann, S. O. Schoenberg, M. F. Reiser, B. Göke, M. Sackmann
Background: Although Crohn disease (CD) can affect the entire alimentary tract, the proportion of patients with small‐bowel inflammation proximal to the terminal ileum is still unclear. Magnetic resonance imaging (MRI) combined with small‐bowel enteroclysis can detect inflammatory lesions of the small bowel. Hence, we applied MR‐enteroclysis to assess the percentage of patients with small‐bowel inflammation proximal to the terminal ileum among patients with CD and abdominal pain. Methods: Twenty‐five consecutive patients with low, active CD of the colon and/or terminal ileum and episodes of abdominal pain were examined by both MR‐enteroclysis and conventional enteroclysis. The findings of MR‐enteroclysis were compared with endoscopic and histological results in the terminal ileum and conventional enteroclysis in the small bowel proximal to the terminal ileum. Results: In 13 of the 25 patients, inflammation of the small bowel proximal to the terminal ileum was shown by MR‐enteroclysis, whereas in only 4 of the 25 patients, signs of inflammation of the small bowel proximal to the terminal ileum were shown by conventional enteroclysis, all of which were demonstrated by MR‐enteroclysis. MR‐enteroclysis confirmed the findings in 22 of 25 patients in whom endoscopy and histology had shown inflammation (16 of 18) or no inflammation (6 of 7) of the terminal ileum. Conclusion: In symptomatic patients with CD even of low activity, inflammation of the small bowel proximal to the terminal ileum is frequent.
The recovery rate at the human terminal ileum of an orally administered non-digestive oligosaccharide (raffinose)
Published in International Journal of Food Sciences and Nutrition, 2009
Sen Shimaya, Tadashi Shimoyama, Shinsaku Fukuda, Masashi Matsuzaka, Ippei Takahashi, Takashi Umeda, Daisuke Chinda, Daisuke Saito, Juichi Sakamoto, Taizo Nagura, Kazuma Danjo, Shigeyuki Nakaji
We clarified how raffinose, one of the non-digestive oligosaccharides, reaches the large intestine. Seven healthy male volunteers were given a test meal containing 10.0 g raffinose. A double-lumen tube was placed in the terminal ileum, and the ileal contents were aspirated through the tube. The amounts of raffinose were orally administered and collected from the terminal ileum and were compared with each other. The result was that the mean±standard error percentage of the amount of ingested raffinose collected in the terminal ileum was 97.1±2.4%. Furthermore, the average times taken for 20%, 40%, 60% and 80% of raffinose to reach the terminal ileum were 2.0±0.6 h, 2.6±0.7 h, 3.6±0.7 h and 4.9±0.7 h, respectively. In conclusion, approximately 100% of ingested raffinose was recovered in the terminal ileum in the present study. This corresponds with the present generally accepted definition of a dietary fibre.
How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy?
Published in Libyan Journal of Medicine, 2014
Ali Riza Koksal, Salih Boga, Huseyin Alkim, Meltem Ergun, Mehmet Bayram, Damlanur Sakiz, Osman Ozdogan, Engin Altinkaya, Canan Alkim
BackgroundTerminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. ObjectiveThis study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. MethodsA total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. ResultsThe terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. ConclusionIn anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated.
Related Knowledge Centers
- Crohn's Disease
- Tuberculosis
- Medicine
- Ileocecal Valve
- Lymphoma
- Cecum
- Small Intestine