BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been establi...BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been established.CASE SUMMARY We reported three patients with jejunal varices at the site of choledochojejun-ostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023.We reviewed all patient records,clinical presentation,endoscopic findings and treatment,outcomes and follow-up.Three patients who underwent pancre-aticoduodenectomy with a Whipple anastomosis were examined using conven-tional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop.Varices with stigmata of recent hemorrhage or active he-morrhage were observed around the choledochojejunostomy site in all three patients.Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients.The bleeding ceased and patency was observed for 26 and 2 months in two patients.In one patient with multiorgan failure and internal environment disturbance,rebleeding occurred 1 month after endoscopic sclerotherapy,and despite a second endoscopic sclero-therapy,repeated episodes of bleeding and multiorgan failure resulted in eventual death.CONCLUSION We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoac-rylate injection can be an easy,effective,safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal je...BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.展开更多
Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very diff...Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very difficult to treat.Pharma-cotherapy,endoscopic methods,transcatheter embolization of veins supplying the jejunal afferent loop,portal venous stenting,and surgical procedures can be used for the treatment of jejunal variceal bleeding.Nevertheless,the optimal mana-gement strategy has not yet been established,which is due to the lack of ran-domized controlled trials involving a large cohort of patients necessary for their development.展开更多
BACKGROUND Sarcomatoid carcinoma(SCA)of the jejunum is a rare and aggressive neoplasm affecting the smooth muscle cells of the jejunum.This study presents a recent case of jejunal SCA,detailing its diagnosis and treat...BACKGROUND Sarcomatoid carcinoma(SCA)of the jejunum is a rare and aggressive neoplasm affecting the smooth muscle cells of the jejunum.This study presents a recent case of jejunal SCA,detailing its diagnosis and treatment,thereby providing a reference for clinical practice.CASE SUMMARY A 65-year-old male presented to Yichang Central People's Hospital with a chief complaint of hemorrhoids.A computed tomography(CT)scan incidentally revealed multiple abnormal signals in the liver.Subsequent positron emission tomography/CT at Wuhan Union Hospital indicated malignant tumor progression,with a primary duodenal tumor and multiple metastases in the upper left abdomen.Intraoperatively,a large tumor was identified on the omentum.Histopathological and immunohistochemical analyses of the resected specimen confirmed the diagnosis of jejunal SCA.The patient received a combination therapy of sintilimab,nanoparticle albumin-bound paclitaxel,and anlotinib.Follow-up imaging demonstrated significant reduction of hepatic and peritoneal lesions.The patient has remained stable for over one year postoperatively.CONCLUSION This case suggests that chemotherapy,immunotherapy,plus targeted therapy may represent an optimal treatment for intestinal SCA,meriting further investigation.展开更多
BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymph...BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.展开更多
BACKGROUND In patients with obscure gastrointestinal bleeding,re-examination with standard upper endoscopes by experienced physicians will identify culprit lesions in a substantial proportion of patients.A common prac...BACKGROUND In patients with obscure gastrointestinal bleeding,re-examination with standard upper endoscopes by experienced physicians will identify culprit lesions in a substantial proportion of patients.A common practice is to insert an adult-sized forward-viewing endoscope into the second part of the duodenum.When the endoscope tip enters after the papilla,which is a marker for the descending part of the duodenum,it is difficult to endoscopically judge how far the duodenum has been traversed beyond the second part.CASE SUMMARY We experienced three cases of proximal jejunal masses that were diagnosed by standard upper gastrointestinal endoscopy and confirmed with surgery.The patients visited the hospital with a history of melena;during the initial upper gastrointestinal endoscopy and colonoscopy,the bleeding site was not confirmed.Upper gastrointestinal bleeding was suspected;thus,according to guidelines,upper endoscopy was performed again.A hemorrhagic mass was discovered in the small intestine.The lesion of the first patient was thought to be located in the duodenum when considering the general insertion depth of a typical upper gastrointestinal endoscope;however,during surgery,it was confirmed that it was in the jejunum.After the first case,lesions in the second and third patients were detected at the jejunum by inserting the standard upper endoscope as deep as possible.CONCLUSION The deep insertion of standard endoscopes is useful for the diagnosis of obscure gastrointestinal bleeding.展开更多
BACKGROUND Esophageal replacement(ER)with gastric pull-up(GPU)or jejunal interposition(JI)used to be the standard treatment for long-gap esophageal atresia(LGEA).Changes of the ER grafts on a macro-and microscopic lev...BACKGROUND Esophageal replacement(ER)with gastric pull-up(GPU)or jejunal interposition(JI)used to be the standard treatment for long-gap esophageal atresia(LGEA).Changes of the ER grafts on a macro-and microscopic level however,are unknown.AIM To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.METHODS A cohort study was conducted including all LGEA patients≥16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands.Patients underwent clinical assessment,contrast study and endoscopy with biopsy.Data was collected prospectively.Group differences between JI and GPU patients,and associations between different outcome measures were assessed using the Fisher’s exact test for bivariate variables and the Mann-Whitney U-test for continuous variables.Differences with a P-value<0.05 were considered statistically significant.RESULTS Nine GPU patients and eleven JI patients were included.Median age at follow-up was 21.5 years and 24.4 years,respectively.Reflux was reported in six GPU patients(67%)vs four JI patients(36%)(P=0.37).Dysphagia symptoms were reported in 64%of JI patients,compared to 22%of GPU patients(P=0.09).Contrast studies showed dilatation of the jejunal graft in six patients(55%)and graft lengthening in four of these six patients.Endoscopy revealed columnar-lined esophagus in three GPU patients(33%)and intestinal metaplasia was histologically confirmed in two patients(22%).No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia.Three GPU patients(33%)experienced severe feeding problems vs none in the JI group.The median body mass index of JI patients was 20.9 kg/m^(2) vs 19.5 kg/m^(2) in GPU patients(P=0.08).CONCLUSION The majority of GPU patients had reflux and intestinal metaplasia in 22%.The majority of JI patients had dysphagia and a dilated graft.Follow-up after ER for LGEA is essential.展开更多
Children on exclusive jejunal feeding may be at risk of iron deficiency due to the feeds bypassing the duodenum,which is the primary site for iron absorption.We describe the biochemical and hematological features of s...Children on exclusive jejunal feeding may be at risk of iron deficiency due to the feeds bypassing the duodenum,which is the primary site for iron absorption.We describe the biochemical and hematological features of six children on exclusive jejunal feeding who did not receive iron supplementation.At a mean(standard deviation)period of 11(6.5)mo after commencing jejunal feeds,there was a significant reduction in both serum iron(18.5 g/L vs 9.8 g/L,P=0.01)and transferrin saturation levels(23.1%vs 13.7%,P=0.02),suggesting iron deficiency.However,there was no significant change in ferritin,hemoglobin and mean corpuscular volume levels post-commencement of jejunal feeds.This may be the result of small bowel adaptation in response to early iron deficiency.Larger and longer term prospective studies are required to investigate if children on jejunal feeds are at risk of developing iron deficiency.展开更多
AIM： To study whether early postoperative enteral nutrition reduces the incidence of complications and/or improves nutritional status following duodenohernipancre atectomy （DHP）. METHODS： We studied 39 patients wh...AIM： To study whether early postoperative enteral nutrition reduces the incidence of complications and/or improves nutritional status following duodenohernipancre atectomy （DHP）. METHODS： We studied 39 patients who underwent DHP for a peri-ampullary mass. Twenty-three patients received total parental nutrition and then started to have an oral intake of nutrition between postoperative day （POD） 7 and 14 [late postoperative enteral nutrition （LPEN） group]. Sixteen patients started to have enteral feeding through a jejunostomy catheter the day after the operation [early postoperative enteral nutrition （EPEN） group]. The incidence of complications and laboratory data at the early postoperative stage were studied in comparison between LPEN and EPEN groups. RESULTS： Serum levels of albumin and total protein in the EPEN group were significantly higher than those in the LPEN group. The loss of body mass index was significantly suppressed in the EPEN group as compared to the LPEN group. The lymphocyte count decreased immediately after the operation was restored significantly faster in the EPEN group than in the LPEN group. The EPEN group showed significantly fewer incidences of postoperative pancreatic fistulas, as well as a significantly shorter length of hospitalization than the LPEN group. There were no significant differences in the incidences of other postoperative complications between the two groups, such as delayed gastric emptying, surgical site infection, cholangitis, and small bowel obstruction.CONCLUSION： EPEN is a safe and beneficiaopportunity for patients who have undergone DHP for a peri-ampullary mass.展开更多
AIM: To investigate whether electroacupuncture(EA) at ST25 affects jejunal motility in vivo and if so, whether a sympathetic pathway is involved.METHODS: Jejunal motility was assessed using a manometric balloon placed...AIM: To investigate whether electroacupuncture(EA) at ST25 affects jejunal motility in vivo and if so, whether a sympathetic pathway is involved.METHODS: Jejunal motility was assessed using a manometric balloon placed in the jejunum approximately about 3-5 cm away from the suspensory ligament of the duodenum in anesthetized animals. The effects of EA at ST25 were measured in male Sprague-Dawley rats, some of which were treated with propranolol or clenbuterol(EA intensities: 1, 3, 5, 7, and 9 m A), and in male transient receptor potential vanilloid-1(TRPV1)(capsaicin receptor) knockout mice(EA intensities: 1, 2, and 4 m A).RESULTS: Anesthetized rats exhibited three types of fasting jejunal motor patterns(types A, B, and C), and only type C rats responded to EA stimulation. In type C rats, EA at ST25 significantly suppressed the motor activity of the jejunum in an intensity-dependent manner. The inhibitory effect of EA was weakened by propranolol(β adrenoceptor antagonist) and disappeared with clenbuterol(β adrenoceptor agonist) induced inhibition of motility, suggesting that the effect of EA on motility is mediated via a sympathetic pathway. Compared with wild-type mice, EA at ST25 was less effective in TRPV1 knockout mice, suggesting that this multi-modal sensor channel participates in the mechanism. CONCLUSION: EA at ST25 was found to inhibit jejunal motility in an intensity-dependent manner, via a mechanism in which sympathetic nerves and TRPV1 receptors play an important role.展开更多
AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted ...AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted by two independent researchers on Pub Med,EMBASE,the Cochrane Library,Google Scholar,and other English literature databases,as well as the Chinese Academic Journal,Chinese Biomedical Literature Database,and other Chinese literature databases using "Gastrostomy","Roux-en-Y",and "Interposition" as keywords.Data extraction and verification were performed on the literature included in this study.Rev Man 5.2 software was used for data processing.A fixed-effects model was applied in the absence of heterogeneity between studies.A random effects model was applied in the presence of heterogeneity between studies.RESULTS:Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study.Among them,357 received jejunal interposition reconstruction after total gastrostomy,and 405 received Roux-en-Y anastomosis.Compared with Roux-en-Y anastomosis,jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome(OR = 0.18,95%CI:0.10-0.31;P < 0.001),increased the prognostic nutritional index [weighted mean difference(WMD) = 6.02,95%CI:1.82-10.22;P < 0.001],and improved the degree of postoperative weight loss [WMD = 2.47,95%CI:-3.19-(-1.75);P < 0.001].However,there is no statistically significant difference in operative time,hospital stay,or incidence of reflux esophagitis.CONCLUSION:Compared with Roux-en-Y anastomosis,patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improvedlife quality.展开更多
Pancreato-enteric reconstruction after pancreatoduodenectomy (PD) is still a source of debate because of the high incidence of complications. Among the various types of pancreato-jejunostomies we don't know yet wh...Pancreato-enteric reconstruction after pancreatoduodenectomy (PD) is still a source of debate because of the high incidence of complications. Among the various types of pancreato-jejunostomies we don't know yet which is the best in terms of anastomotic failure and related complications rates. Wirsung-jejunal duct-to-mucosa anastomosis (WJ) and 'dunking' pancreato-jejunal anastomosis (DPJ) are the two most used ones worldwide but conflicting results are reported. To determine which is the safer anastomosis and to define when an anastomosis should be preferred, we retrospectively reviewed two groups of patients who underwent WJ or DPJ. METHODS:Twenty-three patients underwent PD with WJ (n=17) with dilated (WJD) (n=9) or not-dilated Wirsung's duct (WJND) (n=8) or with a DPJ (n=6) over a 3-year period at a single institution. RESULTS: The complications rate was high in all groups of patients (33.3% in WJD, 37.5% in WJND and 66.7% in DPJ). A pancreatic fistula developed in one patient in each group (11. 1% in WJD, 12. 5% in WJND and 16. 7% in DPJ). All these patients were managed conservatively. Anastomotic disruption took place in the WJ patients especially in the WJND group (n=2) compared to the WJD (n=1) (25% vs 11.1%) or DPJ groups (0%) : these three patients required a re-operation. Overall, the anastomotic defects were higher in patients who underwent WJND (37.5%), compared to WJD (22.2%) and to DPJ (16.7%). However, no statistical differences were found among the groups. Delayed gastric emptying (DGE) and total parenteral nutrition (TPN) along with anastomotic defects were responsible for a prolonged hospital stay. CONCLUSIONS:Our results were not able to demonstrate any statistical difference between the two different techniques in preventing anastomotic failure. WJ can represent a valid choice in case of a dilated duct and a firm, fibrotic enlarged gland that could not be properly invaginated in a small jejunal loop. DGE may occur in those patients who experienced an anastomotic failure and required a TPN regimen with a prolonged hospital stay.展开更多
AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY).
We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray.Contrast studies demonstrated small bowel d...We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray.Contrast studies demonstrated small bowel diverticulosis.At laparotomy, the gall bladder was normal with no stones and no abnormal communication with small bowel - excluding the possibility of a gallstone ileus. Analysis of the stone revealed a composition of bile pigments and calcium oxalate.This was a rare case of small bowel obstruction due to enterolith formation - made distinctive by calcification (previously unreported in the proximal small bowel).展开更多
Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is,therefore,elusive. The presence of a structural abnor- mality in the great majority of the adult case...Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is,therefore,elusive. The presence of a structural abnor- mality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointes- tinal lipoma constitutes an infrequent clinical entity. The present report describes a case of jejunojejunal intus- susception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography scan could not rule out malignancy. Explor- atory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental intestinal resection.展开更多
A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a cle...A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy identified the bleeding site in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.展开更多
AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastro...AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.展开更多
Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical an...Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies,while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions,intestinal diverticulum,and/or tumors. Here,we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography(MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum,longer corresponding mesentery with a narrower insertion,and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus,and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.展开更多
Intussusception is rare in adults. We describe a 62-year-old man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdo...Intussusception is rare in adults. We describe a 62-year-old man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdominal pain. Plain abdominal radiography showed some intestinal gas and fluid levels. Abdominal CT scan demonstrated a target sign suggesting bowel intussusception. Jejunography using a naso-jejunal tube showed an oval-shaped mass about 15 mm in diameter with a smooth surface in the jejunum, which suggested a submucosal tumor (SMT), and edematous mucosa around the mass. Partial jejunal resection was carried out and the resected oval-shaped tumor, 14 mm×11 mm in size, was found to be covered with normal jejunal mucosa. The tumor was histologically diagnosed as type ectopic pancreas according to the classification proposed by Heinrich.Abdominal pain resolved postoperatively.This case reminds us that jejunal ectopic pancreas should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.展开更多
文摘BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been established.CASE SUMMARY We reported three patients with jejunal varices at the site of choledochojejun-ostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023.We reviewed all patient records,clinical presentation,endoscopic findings and treatment,outcomes and follow-up.Three patients who underwent pancre-aticoduodenectomy with a Whipple anastomosis were examined using conven-tional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop.Varices with stigmata of recent hemorrhage or active he-morrhage were observed around the choledochojejunostomy site in all three patients.Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients.The bleeding ceased and patency was observed for 26 and 2 months in two patients.In one patient with multiorgan failure and internal environment disturbance,rebleeding occurred 1 month after endoscopic sclerotherapy,and despite a second endoscopic sclero-therapy,repeated episodes of bleeding and multiorgan failure resulted in eventual death.CONCLUSION We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoac-rylate injection can be an easy,effective,safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
基金Supported by the Natural Science Foundation of China,No.82070856the Science and Technology Development Plan of Shandong Medical and Health Science,No.202102040075+1 种基金Scientific Research Plan of Weifang Health Commission,No.WFWSJK-2022-010 and No.WFWSJK-2022-008Weifang Science and Technology Development Plan,No.2021YX071 and No.2021YX070.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM)is often accompanied by impaired glucose utilization in the brain,leading to oxidative stress,neuronal cell injury and inflammation.Previous studies have shown that duodenal jejunal bypass(DJB)surgery significantly improves brain glucose metabolism in T2DM rats,the role and the metabolism of DJB in improving brain oxidative stress and inflammation condition in T2DM rats remain unclear.AIM To investigate the role and metabolism of DJB in improving hypothalamic oxidative stress and inflammation condition in T2DM rats.METHODS A T2DM rat model was induced via a high-glucose and high-fat diet,combined with a low-dose streptozotocin injection.T2DM rats were divided into DJB operation and Sham operation groups.DJB surgical intervention was carried out on T2DM rats.The differential expression of hypothalamic proteins was analyzed using quantitative proteomics analysis.Proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of T2DM rats were analyzed by flow cytometry,quantitative real-time PCR,Western blotting,and immunofluorescence.RESULTS Quantitative proteomics analysis showed significant differences in proteins related to oxidative stress,inflammation,and neuronal injury in the hypothalamus of rats with T2DM-DJB after DJB surgery,compared to the T2DM-Sham groups of rats.Oxidative stress-related proteins(glucagon-like peptide 1 receptor,Nrf2,and HO-1)were significantly increased(P<0.05)in the hypothalamus of rats with T2DM after DJB surgery.DJB surgery significantly reduced(P<0.05)hypothalamic inflammation in T2DM rats by inhibiting the activation of NF-κB and decreasing the expression of interleukin(IL)-1βand IL-6.DJB surgery significantly reduced(P<0.05)the expression of factors related to neuronal injury(glial fibrillary acidic protein and Caspase-3)in the hypothalamus of T2DM rats and upregulated(P<0.05)the expression of neuroprotective factors(C-fos,Ki67,Bcl-2,and BDNF),thereby reducing hypothalamic injury in T2DM rats.CONCLUSION DJB surgery improve oxidative stress and inflammation in the hypothalamus of T2DM rats and reduce neuronal cell injury by activating the glucagon-like peptide 1 receptor-mediated Nrf2/HO-1 signaling pathway.
文摘Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very difficult to treat.Pharma-cotherapy,endoscopic methods,transcatheter embolization of veins supplying the jejunal afferent loop,portal venous stenting,and surgical procedures can be used for the treatment of jejunal variceal bleeding.Nevertheless,the optimal mana-gement strategy has not yet been established,which is due to the lack of ran-domized controlled trials involving a large cohort of patients necessary for their development.
文摘BACKGROUND Sarcomatoid carcinoma(SCA)of the jejunum is a rare and aggressive neoplasm affecting the smooth muscle cells of the jejunum.This study presents a recent case of jejunal SCA,detailing its diagnosis and treatment,thereby providing a reference for clinical practice.CASE SUMMARY A 65-year-old male presented to Yichang Central People's Hospital with a chief complaint of hemorrhoids.A computed tomography(CT)scan incidentally revealed multiple abnormal signals in the liver.Subsequent positron emission tomography/CT at Wuhan Union Hospital indicated malignant tumor progression,with a primary duodenal tumor and multiple metastases in the upper left abdomen.Intraoperatively,a large tumor was identified on the omentum.Histopathological and immunohistochemical analyses of the resected specimen confirmed the diagnosis of jejunal SCA.The patient received a combination therapy of sintilimab,nanoparticle albumin-bound paclitaxel,and anlotinib.Follow-up imaging demonstrated significant reduction of hepatic and peritoneal lesions.The patient has remained stable for over one year postoperatively.CONCLUSION This case suggests that chemotherapy,immunotherapy,plus targeted therapy may represent an optimal treatment for intestinal SCA,meriting further investigation.
文摘BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.
文摘BACKGROUND In patients with obscure gastrointestinal bleeding,re-examination with standard upper endoscopes by experienced physicians will identify culprit lesions in a substantial proportion of patients.A common practice is to insert an adult-sized forward-viewing endoscope into the second part of the duodenum.When the endoscope tip enters after the papilla,which is a marker for the descending part of the duodenum,it is difficult to endoscopically judge how far the duodenum has been traversed beyond the second part.CASE SUMMARY We experienced three cases of proximal jejunal masses that were diagnosed by standard upper gastrointestinal endoscopy and confirmed with surgery.The patients visited the hospital with a history of melena;during the initial upper gastrointestinal endoscopy and colonoscopy,the bleeding site was not confirmed.Upper gastrointestinal bleeding was suspected;thus,according to guidelines,upper endoscopy was performed again.A hemorrhagic mass was discovered in the small intestine.The lesion of the first patient was thought to be located in the duodenum when considering the general insertion depth of a typical upper gastrointestinal endoscope;however,during surgery,it was confirmed that it was in the jejunum.After the first case,lesions in the second and third patients were detected at the jejunum by inserting the standard upper endoscope as deep as possible.CONCLUSION The deep insertion of standard endoscopes is useful for the diagnosis of obscure gastrointestinal bleeding.
文摘BACKGROUND Esophageal replacement(ER)with gastric pull-up(GPU)or jejunal interposition(JI)used to be the standard treatment for long-gap esophageal atresia(LGEA).Changes of the ER grafts on a macro-and microscopic level however,are unknown.AIM To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.METHODS A cohort study was conducted including all LGEA patients≥16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands.Patients underwent clinical assessment,contrast study and endoscopy with biopsy.Data was collected prospectively.Group differences between JI and GPU patients,and associations between different outcome measures were assessed using the Fisher’s exact test for bivariate variables and the Mann-Whitney U-test for continuous variables.Differences with a P-value<0.05 were considered statistically significant.RESULTS Nine GPU patients and eleven JI patients were included.Median age at follow-up was 21.5 years and 24.4 years,respectively.Reflux was reported in six GPU patients(67%)vs four JI patients(36%)(P=0.37).Dysphagia symptoms were reported in 64%of JI patients,compared to 22%of GPU patients(P=0.09).Contrast studies showed dilatation of the jejunal graft in six patients(55%)and graft lengthening in four of these six patients.Endoscopy revealed columnar-lined esophagus in three GPU patients(33%)and intestinal metaplasia was histologically confirmed in two patients(22%).No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia.Three GPU patients(33%)experienced severe feeding problems vs none in the JI group.The median body mass index of JI patients was 20.9 kg/m^(2) vs 19.5 kg/m^(2) in GPU patients(P=0.08).CONCLUSION The majority of GPU patients had reflux and intestinal metaplasia in 22%.The majority of JI patients had dysphagia and a dilated graft.Follow-up after ER for LGEA is essential.
文摘Children on exclusive jejunal feeding may be at risk of iron deficiency due to the feeds bypassing the duodenum,which is the primary site for iron absorption.We describe the biochemical and hematological features of six children on exclusive jejunal feeding who did not receive iron supplementation.At a mean(standard deviation)period of 11(6.5)mo after commencing jejunal feeds,there was a significant reduction in both serum iron(18.5 g/L vs 9.8 g/L,P=0.01)and transferrin saturation levels(23.1%vs 13.7%,P=0.02),suggesting iron deficiency.However,there was no significant change in ferritin,hemoglobin and mean corpuscular volume levels post-commencement of jejunal feeds.This may be the result of small bowel adaptation in response to early iron deficiency.Larger and longer term prospective studies are required to investigate if children on jejunal feeds are at risk of developing iron deficiency.
文摘AIM： To study whether early postoperative enteral nutrition reduces the incidence of complications and/or improves nutritional status following duodenohernipancre atectomy （DHP）. METHODS： We studied 39 patients who underwent DHP for a peri-ampullary mass. Twenty-three patients received total parental nutrition and then started to have an oral intake of nutrition between postoperative day （POD） 7 and 14 [late postoperative enteral nutrition （LPEN） group]. Sixteen patients started to have enteral feeding through a jejunostomy catheter the day after the operation [early postoperative enteral nutrition （EPEN） group]. The incidence of complications and laboratory data at the early postoperative stage were studied in comparison between LPEN and EPEN groups. RESULTS： Serum levels of albumin and total protein in the EPEN group were significantly higher than those in the LPEN group. The loss of body mass index was significantly suppressed in the EPEN group as compared to the LPEN group. The lymphocyte count decreased immediately after the operation was restored significantly faster in the EPEN group than in the LPEN group. The EPEN group showed significantly fewer incidences of postoperative pancreatic fistulas, as well as a significantly shorter length of hospitalization than the LPEN group. There were no significant differences in the incidences of other postoperative complications between the two groups, such as delayed gastric emptying, surgical site infection, cholangitis, and small bowel obstruction.CONCLUSION： EPEN is a safe and beneficiaopportunity for patients who have undergone DHP for a peri-ampullary mass.
基金Supported by The National Key Basic Research Program(973 Program)No.2011CB505206+3 种基金the National Natural Science Foundation of ChinaNo.81202744No.81373749 and No.81574071Jiangsu Provincial Qinglan Project Sci-tech Innovation Team
文摘AIM: To investigate whether electroacupuncture(EA) at ST25 affects jejunal motility in vivo and if so, whether a sympathetic pathway is involved.METHODS: Jejunal motility was assessed using a manometric balloon placed in the jejunum approximately about 3-5 cm away from the suspensory ligament of the duodenum in anesthetized animals. The effects of EA at ST25 were measured in male Sprague-Dawley rats, some of which were treated with propranolol or clenbuterol(EA intensities: 1, 3, 5, 7, and 9 m A), and in male transient receptor potential vanilloid-1(TRPV1)(capsaicin receptor) knockout mice(EA intensities: 1, 2, and 4 m A).RESULTS: Anesthetized rats exhibited three types of fasting jejunal motor patterns(types A, B, and C), and only type C rats responded to EA stimulation. In type C rats, EA at ST25 significantly suppressed the motor activity of the jejunum in an intensity-dependent manner. The inhibitory effect of EA was weakened by propranolol(β adrenoceptor antagonist) and disappeared with clenbuterol(β adrenoceptor agonist) induced inhibition of motility, suggesting that the effect of EA on motility is mediated via a sympathetic pathway. Compared with wild-type mice, EA at ST25 was less effective in TRPV1 knockout mice, suggesting that this multi-modal sensor channel participates in the mechanism. CONCLUSION: EA at ST25 was found to inhibit jejunal motility in an intensity-dependent manner, via a mechanism in which sympathetic nerves and TRPV1 receptors play an important role.
基金Supported by National Basic Research Program of China grant(to Zhu B),No.2011CB505201National Natural Science Foundation of China No.81130063 and No.81173345(to Zhu B and Gao X)
文摘AIM: To investigate the effect and mechanism of acupuncture at heterotopic acupoints on jejunal motility, particularly in pathological conditions.
文摘AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted by two independent researchers on Pub Med,EMBASE,the Cochrane Library,Google Scholar,and other English literature databases,as well as the Chinese Academic Journal,Chinese Biomedical Literature Database,and other Chinese literature databases using "Gastrostomy","Roux-en-Y",and "Interposition" as keywords.Data extraction and verification were performed on the literature included in this study.Rev Man 5.2 software was used for data processing.A fixed-effects model was applied in the absence of heterogeneity between studies.A random effects model was applied in the presence of heterogeneity between studies.RESULTS:Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study.Among them,357 received jejunal interposition reconstruction after total gastrostomy,and 405 received Roux-en-Y anastomosis.Compared with Roux-en-Y anastomosis,jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome(OR = 0.18,95%CI:0.10-0.31;P < 0.001),increased the prognostic nutritional index [weighted mean difference(WMD) = 6.02,95%CI:1.82-10.22;P < 0.001],and improved the degree of postoperative weight loss [WMD = 2.47,95%CI:-3.19-(-1.75);P < 0.001].However,there is no statistically significant difference in operative time,hospital stay,or incidence of reflux esophagitis.CONCLUSION:Compared with Roux-en-Y anastomosis,patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improvedlife quality.
文摘Pancreato-enteric reconstruction after pancreatoduodenectomy (PD) is still a source of debate because of the high incidence of complications. Among the various types of pancreato-jejunostomies we don't know yet which is the best in terms of anastomotic failure and related complications rates. Wirsung-jejunal duct-to-mucosa anastomosis (WJ) and 'dunking' pancreato-jejunal anastomosis (DPJ) are the two most used ones worldwide but conflicting results are reported. To determine which is the safer anastomosis and to define when an anastomosis should be preferred, we retrospectively reviewed two groups of patients who underwent WJ or DPJ. METHODS:Twenty-three patients underwent PD with WJ (n=17) with dilated (WJD) (n=9) or not-dilated Wirsung's duct (WJND) (n=8) or with a DPJ (n=6) over a 3-year period at a single institution. RESULTS: The complications rate was high in all groups of patients (33.3% in WJD, 37.5% in WJND and 66.7% in DPJ). A pancreatic fistula developed in one patient in each group (11. 1% in WJD, 12. 5% in WJND and 16. 7% in DPJ). All these patients were managed conservatively. Anastomotic disruption took place in the WJ patients especially in the WJND group (n=2) compared to the WJD (n=1) (25% vs 11.1%) or DPJ groups (0%) : these three patients required a re-operation. Overall, the anastomotic defects were higher in patients who underwent WJND (37.5%), compared to WJD (22.2%) and to DPJ (16.7%). However, no statistical differences were found among the groups. Delayed gastric emptying (DGE) and total parenteral nutrition (TPN) along with anastomotic defects were responsible for a prolonged hospital stay. CONCLUSIONS:Our results were not able to demonstrate any statistical difference between the two different techniques in preventing anastomotic failure. WJ can represent a valid choice in case of a dilated duct and a firm, fibrotic enlarged gland that could not be properly invaginated in a small jejunal loop. DGE may occur in those patients who experienced an anastomotic failure and required a TPN regimen with a prolonged hospital stay.
文摘AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY).
文摘We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray.Contrast studies demonstrated small bowel diverticulosis.At laparotomy, the gall bladder was normal with no stones and no abnormal communication with small bowel - excluding the possibility of a gallstone ileus. Analysis of the stone revealed a composition of bile pigments and calcium oxalate.This was a rare case of small bowel obstruction due to enterolith formation - made distinctive by calcification (previously unreported in the proximal small bowel).
文摘Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is,therefore,elusive. The presence of a structural abnor- mality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointes- tinal lipoma constitutes an infrequent clinical entity. The present report describes a case of jejunojejunal intus- susception in an adult with a history of severe episodes of hematochezia and colicky upper abdominal pain. The diagnosis was suspected preoperatively but computed tomography scan could not rule out malignancy. Explor- atory laparotomy revealed jejunojejunal intussusception secondary to a lipoma which was successfully treated with segmental intestinal resection.
文摘A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy identified the bleeding site in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.
基金Supported by Department of Gastroenterology and Hepatology,Chang Gung Memorial Hospital
文摘AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.
基金Supported by National Natural Science Foundation of China,No.81372364 and No.81000189General Financial Grant from the China Postdoctoral Science Foundation,No.2014M552695
文摘Small bowel volvulus,which is torsion of the small bowel and its mesentery,is a medical emergency,and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies,while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions,intestinal diverticulum,and/or tumors. Here,we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography(MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum,longer corresponding mesentery with a narrower insertion,and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus,and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.
文摘Intussusception is rare in adults. We describe a 62-year-old man with jejunal ectopic pancreas that led to jejunojejunal intussusception and ileus. The patient was admitted to our hospital because of intermittent abdominal pain. Plain abdominal radiography showed some intestinal gas and fluid levels. Abdominal CT scan demonstrated a target sign suggesting bowel intussusception. Jejunography using a naso-jejunal tube showed an oval-shaped mass about 15 mm in diameter with a smooth surface in the jejunum, which suggested a submucosal tumor (SMT), and edematous mucosa around the mass. Partial jejunal resection was carried out and the resected oval-shaped tumor, 14 mm×11 mm in size, was found to be covered with normal jejunal mucosa. The tumor was histologically diagnosed as type ectopic pancreas according to the classification proposed by Heinrich.Abdominal pain resolved postoperatively.This case reminds us that jejunal ectopic pancreas should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.
