Concept: Ileocecal valve
To explore whether patients with a defective ileocecal valve (ICV)/cecal distension reflex have small intestinal bacterial overgrowth.
INTRODUCTION: Although both appendiceal tumor and intestinal endometriosis have been reported as rare causes of abdominal pain, the coexistence of appendiceal mucinous neoplasm and ileal endometriosis has not previously been reported. CASE PRESENTATION: A 41-year-old Japanese woman presented with a positive fecal occult blood test and a 3-year history of menstruation-related lower abdominal pain. A colonoscopy demonstrated extrinsic compression of the cecum, suggesting a mass arising from the appendix or adjacent structures. Abdominal imaging showed a 6-cm cystic mass with intraluminal thick fluids originating from the appendix. At ileocecal resection for an appendiceal tumor, a 2-cm mass in the terminal ileum was incidentally found, which was included in the surgical specimen. Microscopic examination confirmed a diagnosis of a mucinous neoplasm of the appendix with endometriosis of the terminal ileum. CONCLUSIONS: To avoid urgent surgery for subsequent serious events associated with disease progression, appendiceal tumor and intestinal endometriosis should be ruled out in patients with chronic abdominal pain.
A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative for ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn’s disease (CD).
Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed.
Contaminated pork is a significant source of foodborne Salmonella infections. Pork is contaminated at the slaughterhouse; however, the mechanisms driving Salmonella contamination of carcasses are still poorly understood. The aim of this study was to investigate whether the amount of Salmonella carried by slaughtered pigs in their guts has an influence on carcass contamination. On that account, we tested whether the number of carcasses contaminated during a slaughter day was associated with the prevalence of highly contaminated pigs (HCP: Salmonella caecal loads ≥3log/g), or with the prevalence of pigs that simply carry Salmonella spp. in their guts. Three hundred and six pigs were sampled in a slaughterhouse from Central Italy. Salmonella loads in the caecum and on the carcass of each pig were estimated by the most probable number (MPN) technique. The overall prevalence of Salmonella was 34.64% and 7.19% for the caeca and carcasses, respectively. S. Derby and S. 4, (Bonardi et al., 2003),12:i:- were the most frequently isolated serovars. The prevalence of HCP was 11.44%. We found a higher number of contaminated carcasses on days of high prevalence of HCP than on days of low prevalence of HCP (p=0.0011). Conversely, carcass contamination did not vary with the prevalence of pigs that simply carried Salmonella spp. in their guts (p=0.7970). Therefore, the prevalence of HCP, but not the prevalence of pigs carrying Salmonella spp., was related to carcass contamination. Taken together, these findings suggest that reduction of Salmonella loads in the guts of slaughtered pigs would result in fewer contaminated carcasses, and consequently, help to minimise the risk of human infection due to the consumption of contaminated pork.
Anomalies of the appendix are extremely rare, and a horseshoe appendix is even rarer. A literature search has revealed only five reported cases. In this report, we present a case of a horseshoe appendix.A 78-year-old man was referred for further examination following a positive fecal occult blood test. A mass in his ascending colon was detected on colonoscopy, while computed tomography showed that it was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected. We diagnosed ascending colon cancer prior to laparoscopic ileocecal resection. Macroscopic findings showed that the appendix connected to the back side of the mass, while microscopic findings showed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon, where a type 1 tumor was observed on the orifice. We eventually diagnosed the patient with tubulovillous adenoma and a horseshoe appendix.A horseshoe appendix communicates with the colon at both ends and is supplied by a single fan-shaped mesentery. Cases are classified by the disposal of the mesentery and the location of the orifice. Anatomical anomalies should be considered despite the rarity of horseshoe appendices.
Serial transverse enteroplasty facilitates weaning from parenteral support in selected patients with short bowel syndrome, although repeated procedure is frequently required. Our aim was to evaluate the outcome of a series of patients after serial transverse enteroplasty and define predictors of repeated serial transverse enteroplasty and weaning off parenteral support.
Background and study aims: Endoscopic submucosal dissection (ESD) is performed for treatment of various gastrointestinal lesions; however, the cecum in proximity to the appendiceal orifice remains a challenging area. We reviewed our experience with cecal ESD near the appendiceal orifice in order to clarify whether this procedure is a safe and effective therapeutic option. Patients and methods: We retrospectively reviewed ESD for lesions within approximately 12 mm of the appendiceal orifice at Kobe University Hospital and an affiliated hospital between January 2003 and December 2014. Lesions were classified as: Type 0, proximity to the appendiceal orifice but does not reach it; Type 1, reaches border of the appendix, but does not enter orifice; Type 2, enters orifice, and transition to normal appendiceal mucosa is discernible on inspection of the appendiceal lumen; and Type 3, enters orifice deeply and tumor edge cannot be observed. ESD was not performed for Type 3 lesions unless appendectomy was performed prior to ESD. Results: A total of 76 lesions satisfied the inclusion criteria (47 Type 0 lesions, 20 Type 1, 6 Type 2, and 3 Type 3). En bloc resection was achieved in 72 lesions (94.7 %). Median specimen size was 49 mm (range 15 - 114 mm), and median tumor size was 35.5 mm (10 - 110 mm). One patient experienced postoperative bleeding, which was treated by endoscopic hemostasis. Another patient who experienced intraoperative perforation and was treated by clip closure later developed appendicitis; he underwent emergency ileocecal surgical resection. Another patient experienced postoperative appendicitis and recovered with antibiotic treatment. Conclusions: ESD in close proximity to the appendiceal orifice seems safe and effective.
A 41-year-old man presented with abdominal fullness in late August 2012. Abdominal CT showed ileus caused by stenosis of the ileum and an enlargement of the ileocecal lymph nodes. Colonoscopy showed a steep elevated protruding tumor in the cecum, with multiple ulcerative lesions on top. A pathological analysis of the lesions confirmed chronic inflammatory infiltration and epithelioid granuloma. The findings of a tuberculin skin test and QuantiFERON-TB-Gold test were positive. As a result, we treated the patient for tuberculosis of the cecum. After 4 months of treatment, colonoscopy confirmed the disappearance of the tumor. In conclusion, intestinal tuberculosis should be considered in the differential diagnosis when protruding lesions appear in the cecum.
This investigation was designed to determine the effects of low-dose electron beam irradiation on the survival of Mycobacterium avium ssp. paratuberculosis in tissue samples collected at necropsy from clinically affected cows. Mycobacterium avium ssp. paratuberculosis was isolated from the ileum and ileocecal valve of one cow and from the ileum of another cow irradiated at 4.0 kGy, but was not isolated from the ileum, ileocecal valve, or mesenteric lymph node of 11 other cows irradiated at 4 kGy.