Small intestinal intussusceptions due to the placement of a percutaneous endoscopic jejunostomy tube

http://dx.doi.org/10.1136/bcr.07.2010.3169 AuthorPercutaneous endoscopic jejunostomy (PEJ) has been developed and is considered to be a better method than percutaneous endoscopic gastrostomy for preventing the occurrence of aspiration pneumonia. However, the incidence of other complications associated with this procedure is less clear. We herein report a rare case with a small intestinal intussusception due to a PEJ placement. In this case, a radiologic examination with gastrografin was useful to detect the typical findings of a small intestinal intussusception, a beak-like filling defect, and identify the location of the lesion. An endoscopic examination that was carefully performed with a thin scope was effective to observe the ischaemic change of the small intestine and immediately determine the indication for surgical treatment. This case highlights the necessity to carefully manage patients with a PEJ placement, considering the risk of small intestinal intussusceptions when the patient complains of symptoms that are suspicious for an intestinal obstruction

【幹細胞を用いた消化器再生医療の展望】 消化管の再生を支える幹細胞システムはどのようになっているか

雑誌掲載版腸管幹細胞は、すべての腸管上皮細胞、すなわち吸収上皮細胞と3つの分泌型上皮(杯細胞、腸管内分泌細胞、パネート細胞)に分化する多能性と自己複製能を有する細胞であり、その存在部位については2つの候補が同定されている。一つは長い細胞周期をもつ+4LRCs、もう一つは多能性をもつLgr5陽性の陰窩底部細胞である。いずれか一方、もしくは両者が幹細胞の機能を担っていると考えられる。また、腸管細胞の再生・分化にはWnt,Notch,BMP,PTEN/PI3Kなどの多数のシグナル伝達系が関与している。すなわち、Wntシグナリングは幹細胞や前駆細胞の形質維持、分泌型上皮の運命決定、細胞の遊走・配列に中心的な役割をもち、Notchシグナリングは増殖途中の分泌型上皮の分化・成熟を制御している。また、BMPシグナリングやPTEN/PI3Kシグナリングは、Wntシグナリングと協調して幹細胞の増殖や数的な制御に携わるとともに、間質細胞との連携や陰窩の分枝などにかかわっていると考えられる

Collagenous colitis appeared after 6-year administration of lansoprazole

Author http://link.springer.com/article/10.1007/s12328-009-0126-4Collagenous colitis (CC) is one of the causes of undefined watery diarrhea, which is histologically accompanied by thickening of the subepithelial collagen layer. CC associated with lansoprazole normally occurs within several weeks after initial administration, but no case presenting after long-term administration of lansoprazole has yet been reported. A 77-year-old male with 6-year history of administration of lansoprazole complained of watery diarrhea and weight loss. Colonoscopy revealed disappearance of vascular networks and red spots in the sigmoid colon. Biopsy specimen showed erosion and collagen bands thickened, so the patient was diagnosed as CC. After lansoprazole discontinuation, the watery diarrhea disappeared and histological abnormalities improved

Atypical tumour-like involvement of the colon in Henoch-Schönlein purpura successfully treated with the administration of factor XIII

http://dx.doi.org/10.1136/bcr.08.2010.3251 AuthorHenoch-Schönlein purpura (HSP) is a type of systemic vasculitis of the small vessels, which frequently involves the skin, kidney and gastrointestinal tract. While the typical intestinal features of HSP include diffuse mucosal redness, small ring-like petechiae and haemorrhagic erosions, tumour-like lesions are rarely observed. The current study presents a rare case of HSP with an intestinal tumour-like lesion in the caecum. The intestinal lesion caused fresh melaena, and was completely resolved with the administration of factor XIII as described in previously reported cases. It is important to immediately undergo proper treatment for improving tumour-like lesions which may cause severe complications, such as excessive haemorrhage and stricture

Atypical tumour-like involvement of the colon in secondary systemic amyloidosis which vanished after 1 month of observation

http://dx.doi.org/10.1136/bcr.01.2011.3775 AuthorAmyloidosis occurs as a result of the extracellular deposition of protein fibrils in organs and tissues, thus causing mild to severe pathophysiological changes. The gastrointestinal tract is a common site of amyloid deposition. While intestinal amyloidosis frequently results in polypoid lesions, ulcerations, nodules and petechial mucosal haemorrhage, tumour-like lesions are rarely developed and infrequently diagnosed before the resection because of the difficulty in differentiating them from colon cancer. The authors herein reported a case of intestinal amyloid A amyloidosis with a complication of a tumour-like lesion endoscopically resembling a malignant lesion, which was completely diminished after 1 month of observation with bowel rest. Such conservative treatment is a feasible option to cure intestinal tumour-like lesions in patients with intestinal amyloidosis when no neoplastic change is histologically detected, possibly decreasing the need for surgery of the fragile mucosa