Interposição jejunal após gastrectomia total radical por adenocarcinoma gástrico

Realizamos um estudo retrospectivo do tratamento cirúrgico do adenocarcinoma gástrico por uma gastrectomia total radical, com reconstrução do trânsito esofagoduodenal pela interposição de uma alça jejunal pediculada. Revisão de trabalhos nacionais e estrangeiros relacionados ao tratamento do adenocarcinoma gástrico pela gastrectomia total radical. De acordo com a operabilidade relacionada ao paciente e à ressecabilidade, à lesão primária e sua evolução, 126 pacientes foram submetidos à interposição de um segmento de alça jejunal após gastrectomia total radical. Ressecção oncológica total do estômago e sistematizada reconstrução técnica do reservatório gástrico e do trânsito esofagoduodenal. Nossos casos evoluíram de maneira satisfatória, não fugindo daqueles estudados na literatura. Ênfase especial foi dada ao procedimento técnico, mais anatômico e muito mais funcional, restituindo ao operado um neoestômago e um trânsito esôfago-intestinal através do duodeno. A interposição de uma alça jejunal pediculada entre o esôfago terminal e a segunda porção do duodeno age como neo-reservatório gástrico. Evita o refluxo esofágico e direciona o bolo alimentar para o delgado através do duodeno, trânsito anatômico e funcional capaz de proporcionar melhor qualidade de vida ao gastrectomizado total.

Laparoscopic Duodenal-Jejunal Bypass for the Treatment of Duodenal Obstruction Caused by Annular Pancreas: Description of a Surgical Technique

Annular pancreas is a rare congenital anomaly, which is only surgically treated in symptomatic cases. Surgical treatment consists of bypassing the duodenal transit by gastrojejunal or duodenal-jejunal anastomosis. In the absolute majority of published cases, laparotomy is the most widely used access technique. The aim of this article is to report a case of an annular pancreas and describe the technical steps involved in carrying out a laparoscopic duodenal-jejunal anastomosis, for correction of the duodenal obstruction. The patient`s recovery was uneventful; she was discharged on the fourth postoperative day and remained asymptomatic for the 2-year, outpatient follow-up period. Laparoscopic duodenal-jejunal bypass is shown to be feasible and safe, and produce less surgical trauma, when carried out by an experienced surgeon who is duly trained and familiar with the laparoscopic technique.

Glutamine supplementation does not improve protein synthesis rate by the jejunal mucosa of the malnourished rat

It has been demonstrated that glutamine, a conditionally essential amino acid, improves nitrogen balance, acts as a stimulant of protein synthesis, and decreases proteolysis in myopathic children. In contrast, other studies have shown no beneficial effect of glutamine supplementation on burn victims or critically ill patients. Nonetheless, we hypothesized that glutamine supplementation would increase the fractional protein synthesis rate (FSR) in the jejunal mucosa of malnourished male Wistar rats. Thus, the objective of the present study was to test the effect of daily oral glutamine supplementation (0.42 g kg(-1) d(-1) for 14 days) on the FSR of the jejunal mucosa of healthy and malnourished rats. A 4-hour kinetic study with L-[1-(13)C]leucine was subsequently performed, and jejunal biopsies were obtained 1.5 cm from the Treitz angle and analyzed. Malnourished rats showed a 25% weight loss and increased urinary nitrogen excretion. Plasma amino acid concentration did not differ between groups. (13)C enrichment in plasma and jejunal cells was higher in the malnourished groups than in the healthy group. The FSR (percent per hour) was similar for the control and experimental groups (P > .05), with a mean range of 220%/h to 27%/h. Oral glutamine supplementation alone did not induce higher protein incorporation by the jejunal mucosa in malnourished rats, regardless of total food intake or the presence or absence of glutamine supplementation. (C) 2009 Elsevier Inc. All rights reserved.

Assessment and management of dysphagia following pharyngolaryngectomy with free jejunal interposition: A series of eight case studies

The physiological and structural deficits contributing to swallowing complications in the pharyngolaryngectomy patient population are not homogeneous. Consequently, a team approach, involving medical investigations as well as clinical and radiological assessments of swallowing, is necessary to facilitate diagnosis of the underlying impairment and assist the medical/surgical and speech pathology team members in the process of individualizing the management plan for each patient. In the present study, the clinical assessment and management of eight pharyngolaryngectomy patients who presented with a decline in swallowing function unrelated to immediate postsurgical effects or direct effects of radiotherapy are reported. Clinical and radiological investigations revealed a heterogeneous group of factors contributing to their swallowing impairments and disability levels, including difficulty with graft and anastomotic patency and graft motility, impaired lingual coordination, increased bolus transit time, nasal and oral regurgitation, patient distress, and recurrence. Variation between the cases supported the need for differential intervention and management plans for all eight patients. Ratings of perceived swallowing disability, handicap, and well-being/distress levels at initial assessment and again six months following dysphagia intervention revealed a pattern of reduced levels of impairment, functional disability, and overall patient distress levels following informed intervention. The present case study data highlights the key role thorough clinical and radiological investigations play in the process of diagnosing the factors contributing to dysphagia and guiding the management of the resultant swallowing disability in the pharyngolaryngectomy population.

Transient mesenteric ischaemic episodes tracked by continuous jejunal PCO2 monitoring during liquid feeding

Objective: To test the effect of liquid feeds on the responses to splanchnic ischaemia of a continuous rapid response PCO2 sensor inserted in the jejunum. Design: Prospective experimental animal study in a university research laboratory. Subjects: Adult male Wistar rats. Interventions: Adult male Wistar rats (285-425 g) were anaethetised with sodium pentobarbitone 60 mg/ kg i.p. and ventilated with 100 % oxygen and isoflurane via tracheostomy to a PaCO2 of 30-40 mmHg. A sensor was inserted into the mid-jejunum to record PCO2 every second. Distal aortic pressure was transduced. Four control rats received no feeds whilst in another four rats liquid feed was infused into the proximal jejunum at 3 ml/h. In each rat five episodes of splanchnic ischaemia were induced by 2-min elevations of an aortic sling to a mean distal aortic pressure of 30 mmHg. Measurements and main results: PCO2 elevations were always detectable, usually less than a minute from the onset of splanchnic ischaemia in both fed and unfed rats, with no difference in mean times to detectable response. In the fed rats there was a small but significant increase in the time to peak sensor response (196 +/- 16 vs. 180 +/- 12 s) and a trend towards an elevated mean baseline luminal PCO2 (67 +/- 9 vs. 55 +/- 4 mmHg). Conclusions: Brief episodes of splanchnic ischaemia were tracked successfully by a rapid response jejunal continuous PCO2 sensor during the infusion of a proprietary liquid feed preparation despite minor changes in PCO2 response characteristics and a possible elevation in baseline luminal PCO2.

Jejunal perforation caused by abdominal angiostrongyliasis

The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment.

Structural changes in the jejunal mucosa of mice infected with Schistosoma mansoni, fed low or high protein diets

The effects of high and low-protein diets on the structure of the jejunal mucosa were studied in Schistosoma mansoni infected mice (morphology and histomorphometry). Weaning male albino mice were infected with 80 cercariae, fed with high (20%) or low-protein (5%) diets and compared to uninfected controls under the same conditions. Mice were sacrificed 12 weeks after infection. Animals submitted to a low-protein diet showed lower weight curves, mainly when infected. In the jejunal mucosa, finger-like villi were the predominant pattern among uninfected high-protein fed animals, while the infected ones showed leaf-shaped and flattened villi in most cases. Undernourished infected mice had 65.7% leaf-shaped villi. A significant increase in the number of goblet cells was seen in infected mice. A decrease in the number of absorptive cells was detected in undernourished mice, particularly in infected ones.

Acute ulcerative jejunal diverticulitis: case report of an uncommon entity.

Jejunal diverticulosis is a rare entity with variable clinical and anatomical presentations. Its reported incidence varies from 0.05% to 6%. Although there is no consensus on the management of asymptomatic jejunal diverticular disease, some complications are potentially life threatening and require early surgical treatment. We report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory syndrome. Inflammation of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT). As a result of the clinical and biological signs of early peritonitis, an emergency surgical exploration was performed. The first jejunal loop showed clear signs of jejunal diverticulitis. Primary segmental jejunum resection with end-to-end anastomosis was performed. Histopathology report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local peritonitis. The patient made an excellent rapid postoperative recovery. Jejunal diverticulum is rare but may cause serious complications. It should be considered a possible etiology of acute abdomen, especially in elderly patients with unusual symptomatology. Abdominal CT is the diagnostic tool of choice. The best treatment is emergency surgical management.

Diverticulite jejunal: relato de caso

Diverticulite jejunal é doença rara que acomete principalmente os idosos. Os sintomas e sinais clínicos são inespecíficos, fato que dificulta e retarda o diagnóstico. A tomografia computadorizada é muito valiosa na definição do diagnóstico. Neste relato será apresentado um caso de diverticulose jejunal complicada com diverticulite aguda perfurada bloqueada, assim como uma discussão breve sobre diverticulite jejunal e suas complicações.

Prolapso jejunal em gastroenteroanastomose

The autors report a case of jejunal mucosa prolapse after gastroenteroanastomosis, a rare postoperative complication. In the late postcholecistectomy period the patient had persistent vomit. Upper digestive endoscopy (UDE) showed obstruction of the second portion of duodenum, and a gastrojejunal anastomosis was performed. Soon after that, the patient had persistent vomit and upper digestive endoscopy (UDE) showed invagination of the jejunal mucosa. She was reoperated, a Roux Y gastrectomy was performed and the patient had a good evolution. The treatment for this complication is basically surgical, which intends to realieve the obstructive symptomatology.

Influência da icterícia obstrutiva na cicatrização da pele e de anastomose jejunal em ratos

A cicatrização da pele e do intestino podem ser influenciadas pela elevação da bilirrubina. Com o objetivo de avaliar o possível efeito da icterícia obstrutiva sobre a sutura da pele e de anastomose jejunal, foram estudados 32 ratos, divididos em quatro grupos (n=8) e acompanhados em períodos pós-operatórios de sete e 14 dias. Todos os animais foram submetidos a laparotomia e anastomose jejunal. Os grupos 1 e 2 serviram como controle dos grupos 3 e 4, os quais foram submetidos a ligadura do ducto biliopancreático. Os animais dos grupos 1 e 2 mantiveram o mesmo peso corporal durante todo o período de acompanhamento, enquanto os ictéricos apresentaram uma queda ponderal significativa após sete dias (p<0,05). Não houve diferença na resistência da sutura de pele entre os ratos ictéricos e não-ictéricos. Após duas semanas, a icterícia reduziu a resistência anastomótica jejunal (p<0,01). O exame histológico revelou menor grau de desenvolvimento da fibrose cicatricial nas anastomoses dos ratos ictéricos. Conclui-se que a icterícia obstrutiva pode atuar negativamente sobre a cicatrização tissular. Deve-se ressaltar a importância dos fatores associados à icterícia na gênese desse efeito.

Anastomose esôfago-jejunal látero-lateral com grampeador linear cortante complementada por sutura manual

One of the most difficult procedures in digestive-tract surgery is esophago-jejunal anastomosis following total gastrectomy. Cost/benefit analysis of this procedure justifies the use of mechanical staplers, in spite of their high cost. A technical variant of the side-to-side esophago-jejunal anastomosis is presented, which incorporates the use of a cutting linear stapler. Technical maneuvers are easy to perform, the cost of the cutting linear stapler is smaller than the circular ones, the amplitude of the anastomosis is wider and the likelihood of fistulae is smaller when compared to other techniques. The side-to-side esophago-jejunal anastomosis with the cutting linear stapler is always complemented by a manual suture.

Tricobezoar gastro-duodeno-jejunal: abordagem videolaparoscópica

Trichobezoars are gastric concretions of hair that sometimes extend throught the intestine. We report on a patient with trichobezoar managed by videolaparoscopic extraction, and discuss the advantages and disadvantages of this method, that can be the treatment of choice of this conditions.

Perfuração de intestino delgado por doença diverticular jejunal

Small Intestine's diverticulosis is an uncommon pathology of intestine. It's more evident at jejune and can be complicated by intestinal perforation, obstruction or diverticulitis, increasing the mortality. We describe a forty years old female patient that arrived at emergency service complained of diffuse abdominal pain. There aren't signals of peritonitis and the radiological evaluation showed small intestine's distension. Surgical intervention was performed revealing multiples diverticulums at jejune and intestinal perforation. The aim of this article is present a case of Small Intestine's diverticulosis and its complications that had precise intervention resulting in a favorable resolution.

Lipocalina associada à gelatinase de neutrófilos (NGAL) e calprotectina no tecido laminar de equinos após obstrução jejunal, tratados ou não com hidrocortisona

A laminite é uma doença podal grave que acomete os equídeos, sendo responsável por intenso sofrimento. Neste estudo foram pesquisadas a presença de calprotectina por meio da imunoistoquímica, e de lipocalina associada à gelatinase de neutrófilos (NGAL), por zimografia, no tecido laminar do casco de equinos após obstrução intestinal. Os animais foram divididos em quatro grupos: Grupo controle (Gc), contendo sete animais normais, sem procedimento cirúrgico; Grupo Instrumentado (Gi), contendo cinco animais, os quais passaram por todo o procedimento cirúrgico sem sofrerem obstrução intestinal; Grupo Não Tratado (Gnt), contendo quatro equinos submetidos a obstrução intestinal do jejuno por distensão de balão intraluminal, sem tratamento; e Grupo Tratado (Gt), contendo quatro equinos submetidos a obstrução intestinal, e tratados preventivamente com hidrocortisona. Houve imunomarcação de calprotectina em todos os grupos experimentais, com aumento nos equinos do grupo distendido em relação ao Gc. Com relação ao NGAL, houve aumento também do Gnt e do Gi em relação ao Gc. O Gt não diferiu dos demais. Conclui-se que a distensão do intestino delgado pode promover acúmulos de leucócitos nos cascos de equinos e que o NGAL é um método viável para se detectar infiltração neutrofílica em equinos. Novos estudos deverão ser realizados para se verificar possível benefício anti-inflamatório da hidrocortisona no casco de equinos com obstrução intestinal.