Clinical Endoscopy

Congenital Jejunal Diverticular Bleeding in a Young Adult: Ji-Yung Lee, Jae-Young Jang, Min-Je Kim, Tae-In Lee, Jung-Wook Kim, Young-Woon Chang; Clin Endosc 2017;50(5):495-499. Published online June 14, 2017; DOI: https://doi.org/10.5946/ce.2016.154

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Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel’s diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel’s diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding (OOGIB). This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel’s diverticulum after surgical resection.

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Diverticular hemorrhage of terminal ileum successfully treated by ultra-selective transcatheter arterial embolization using triaxial system: a case report
Yuki Yaginuma, Kenichi Utano, Yuka Utano, Daiki Nemoto, Masato Aizawa, Hajime Matsuida, Noriyuki Isohata, Shungo Endo, Kazutomo Togashi
Clinical Journal of Gastroenterology.2021; 14(2): 517. CrossRef
Small bowel bleeding
Stefania Chetcuti Zammit, Reena Sidhu
Current Opinion in Gastroenterology.2018; 34(3): 165. CrossRef
Diagnosis of Meckel’s Diverticulum Using Colon Capsule Endoscopy for Small Bowel Investigation
Lidia Ciobanu, Oliviu Pascu, Marcel Tanțău
Clinical Endoscopy.2018; 51(4): 395. CrossRef

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Successful Removal of a Screw Nail in the Jejunum Using Double-Balloon Enteroscopy: Dong Ju Kim, Myoung Ki Sim, Sang Wook Lee, Tae Hee Lee; Clin Endosc 2015;48(5):444-446. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.444

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The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion

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Balloon-Assisted Enteroscopy for Retrieval of Small Intestinal Foreign Bodies: A KASID Multicenter Study
Jeongseok Kim, Beom Jae Lee, Nam Seok Ham, Eun Hye Oh, Kee Don Choi, Byong Duk Ye, Jeong-Sik Byeon, Chang Soo Eun, Jin Su Kim, Dong-Hoon Yang
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Foreign Body Penetration through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct
Najib Nassani, Elie El-Charabaty, Patricia Nasr, Iskandar Barakat, Sherif Andrawes
ACG Case Reports Journal.2017; 4(1): e12. CrossRef

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Polypoid Arteriovenous Malformation Presenting with Jejunojejunal Intussusceptions in an Adult: Doo-Ho Lim, Ji Yong Ahn, Myeongsook Seo, Ji Hyun Yun, Tae Hyung Kim, Hwoon-Yong Jung, Jin-Ho Kim, Young Soo Park; Clin Endosc 2014;47(6):575-578. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.575

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Jejunal polypoid arteriovenous malformations (AVMs) and jejunojejunal intussusceptions are both rare. Here, we present the case of a 61-year-old woman who suffered intermittent episodes of abdominal pain over the course of 13 years. A computed tomography scan of her abdomen and pelvis revealed a distal jejunojejunal intussusception. A suspected low density mass was observed at the tip of the intussusception. Treatment comprised laparoscopic small bowel resection with end-to-end jejunostomy. The final diagnosis was a polypoid AVM measuring 5×3.5×3 cm. We suggest that polypoid AVM should be considered as a differential diagnosis in patients presenting with small intestinal neoplasms.

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Arteriovenous malformation that caused prolapse of the colon and was treated surgically in an infant: a case report
Miori Kido, Kiyokuni Nakamura, Tsuyoshi Kuwahara, Yoshitomo Yasui, Hideaki Okajima, Nozomu Kurose, Miyuki Kohno
Surgical Case Reports.2020;[Epub] CrossRef
Colonic Polypoid Arteriovenous Malformation Causing Symptomatic Anemia
Allison Rzepczynski, Jason Kramer, Shriram Jakate, Lin Cheng, Ajaypal Singh
ACG Case Reports Journal.2019; 6(10): e00241. CrossRef
Arteriovenous malformation in the sigmoid colon of a patient with Cowden disease treated with laparoscopy: a case report
Koichi Inukai, Nobuhiro Takashima, Shiro Fujihata, Hirotaka Miyai, Minoru Yamamoto, Kenji Kobayashi, Moritsugu Tanaka, Tetsushi Hayakawa
BMC Surgery.2018;[Epub] CrossRef
Unusual Giant Arteriovenous Malformation in Jejunum: A Case Report
DongJa Kim, JaIl Goo
Journal of the Korean Association of Pediatric Surgeons.2017; 23(2): 52. CrossRef

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Giant Brunner's Gland Adenoma of the Proximal Jejunum Presenting as Iron Deficiency Anemia and Mimicking Intussusceptions: Chan Soo So, Hyun Joo Jang, Yun Sun Choi, Dong Hee Koh, Min Ho Choi, Sea Hyub Kae, Sun Jung Min, Jin Lee; Clin Endosc 2013;46(1):102-105. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.102

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Brunner's gland adenoma is a rare benign proliferative lesion developing most commonly in the posterior wall of the duodenum. It is usually small in size and asymptomatic. Depending on its size or location, however, the clinical manifestations of this tumor may be variable from nonspecific symptoms to gastrointestinal bleeding or obstruction. Brunner's gland adenoma in the proximal jejunum is extremely rare. We report a very rare case of giant Brunner's gland adenoma developing in the proximal jejunum which presented as iron deficiency anemia and mimicked intussusceptions on radiologic studies.

Citations

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Brunner’s gland hamartomas: Not always benign
Manar Shmais, Ahmad Mousawi, Fadi Mourad, Ala I. Sharara
Arab Journal of Gastroenterology.2024; 25(1): 70. CrossRef
Duodenal Epithelial Polyps: A Clinicopathologic Review
Katrina Collins, Saverio Ligato
Archives of Pathology & Laboratory Medicine.2019; 143(3): 370. CrossRef
Giant Brunneroma Originating from Pylorus Imitating Duodenopancreatic Malignancy
N Yilmaz
Nigerian Journal of Clinical Practice.2019; 22(9): 1298. CrossRef
Giant Brunner’s gland adenoma with intestinal obstruction arising from duodenal bulb, resected by ESD : A Case report
Ayako Ochiai, Shigetaka Tounou, Hiroyuki Fukazawa, Yousuke Muraki, Tomoki Michita
Progress of Digestive Endoscopy.2016; 88(1): 118. CrossRef
A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection
Pyung Kang Park, Woo-Cho Chung, Kyoung Yong Lee, Sung Hak Lee, Jae Jung Jang, Seungchul Suh
Kosin Medical Journal.2015; 30(2): 171. CrossRef
Brunner’s gland adenoma: A rare case report
Şehmus ÖLMEZ, Bünyamin SARITAŞ, Süleyman SAYAR, İbrahim ARAS
Endoskopi Gastrointestinal.2015; 23(1): 22. CrossRef
Brunner’s gland hamartoma of the duodenum
J Sedano, R Swamy, K Jain, S Gupta
The Annals of The Royal College of Surgeons of England.2015; 97(5): e70. CrossRef
Some observations on pyloric gland adenoma: an uncommon and long ignored entity!
Michael Vieth, Elizabeth Anne Montgomery
Journal of Clinical Pathology.2014; 67(10): 883. CrossRef
Successful Endoscopic Resection of Large Pedunculated Brunner's Gland Hamartoma Causing Gastrointestinal Bleeding Arising from the Pylorus
Yunho Jung, Il Kwun Chung, Tae Hoon Lee, Young Sin Cho, Yeong Geol Jo, Sang Heum Park, Hyundeuk Cho, Sun Joo Kim
Case Reports in Gastroenterology.2013; 7(2): 304. CrossRef

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Heterotopic Pancreas of the Jejunum Identified by Capsule Endoscopy: Si Eun Kong, M.D., Chang Nyol Paik, M.D., Eun Jung Kim, M.D., Hyung Jin Kim, M.D.*, Ji Han Jung, M.D.^†, Woo Chul Chung, M.D., Kang Moon Lee, M.D. and Jin Mo Yang, M.D.; Korean J Gastrointest Endosc 2011;42(4):259-262. Published online April 28, 2011

Abstract PDF: Heterotopic pancreas is an uncommon condition that commonly occurs in the gastrointestinal tract such as the stomach and small bowel. It is defined as the presence of pancreatic tissue outside its usual location and lacking anatomical and vascular continuity with the pancreas. A heterotopic pancreas is usually found incidentally and is mostly silent; however, it rarely causes abdominal pain, weight loss, bleeding, or ileus. A 49-year-old male presented with intermittent abdominal pain for 4 weeks. We report a case with submucosal features of a jejunal heterotopic pancreas with the aid of capsule endoscopy and a histological confirmation through a single port laparoscopic segmental jejunectomy. (Korean J Gastrointest Endosc 2011;42:259-262)

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A Case of a Jejunal Dieulafoy's Lesion Mimicking a Submucosal Tumor: Hae Won Jeong, M.D., Jin Yong Kim, M.D., Sang Jung Kim, M.D., Tae Hoon Jang, M.D., Won Seok Choi, M.D. and Ji In Lee, M.D.; Korean J Gastrointest Endosc 2008;37(6):438-442. Published online December 30, 2008

Abstract PDF: Dieulafoy's lesion is a rare cause of severe gastrointestinal bleeding. In most cases, Dieulafoy's lesion is typically found in the stomach within 6 cm from the gastroesophageal junction, but the presence of lesions has also been described throughout the gastrointestinal tract. A jejunal Dieulafoy's lesion is extremely rare, and only a few cases have been reported in the Korean population. We experienced a case of a jejunal dieulafoy's lesion mimicking a submucosal tumor that presented with massive gastrointestinal bleeding. The lesion was diagnosed by the use of double balloon enteroscopy and was then confirmed by a pathological examination of the surgical specimen. (Korean J Gastrointest Endosc 2008;37:438-442)

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A Case of Endoscopically Treated Jejunal Bleeding from Polyarteritis Nodosa: Hyeok Choon Kwon, M.D., Jeong Woo Choi, M.D., Seung Jun Choi, M.D., Seung Il Woo, M.D., Joo Sung Sun, M.D.*, Je Hwan Won, M.D.*, Chang Hee Suh, M.D.^†, Kee Myung Lee, M.D., Ki Baik Hahm, M.D. and Jin Hong Kim, M.D.; Korean J Gastrointest Endosc 2006;32(1):48-52. Published online January 30, 2006

Abstract PDF: Polyarteritis nodosa is a necrotizing vasculitis of the small and medium-sized arteries of multiple organ systems. The common symptoms of gastrointestinal involvement are abdominal pain, nausea, and vomiting. However, the symptoms at presentation are sometimes non-specific and vague. The well-known complications of gastrointestinal involvement are mucosal ulceration, bowel infarction, perforation, cholecystitis and hepatitis. We describe a case of a 6-year-old male with jejunal bleeding who was diagnosed with polyarteritis nodosa by angiography. After controlling the systemic symptoms with immunosuppressants and steroids, jejunal bleeding occurred. The jejunal bleeding was treated endoscopically with a hemoclip and increasing the immunosuppressant dose. Generally, massive gastrointestinal bleeding in a patient with polyarteritis nodosa is treated surgically. In this case, the jejunal bleeding was controlled with an endoscope because the bleeding site was located within reach of the endoscope, and systemic symptoms subsided with medication. There is no report of gastrointestinal bleeding from the polyarteritis nodosa in a child in Korea. Therefore, we report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2006;32:48⁣52)

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A Case of Polyarteritis Nodosa Involving Entire Gastrointestinal Tract: Won Young Cho, M.D., Tae Hun Lee, M.D., Jae Hoon Yang, M.D., Hyun Gun Kim, M.D.,; Korean J Gastrointest Endosc 2004;28(2):86-91. Published online March 1, 2004

Abstract PDF: Polyarteritis nodosa is a systemic vasculitis that affects mainly small and medium-sized muscular arteries. About half of the cases, it involves gastrointestinal tract, mainly jejunum and ileum. Major clinical manifestations are bleeding, ulcer, infection, necrosis, atrophy and stricture. Gastrointestinal involvement suggests a poor prognosis. We have experienced one case of polyarteritis nodosa involving entire gastrointestinal tract that showed various endoscopic features and confirmed by renal biopsy. (Korean J Gastrointest Endosc 2004;28:86⁣91)

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A Case of Massive Bleeding from Jejunal Stromal Tumor: Jae Won Yang, M.D., Hyun Soo Kim, M.D., Yeun Jong Choi, M.D., Jung Min Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):214-219. Published online April 30, 2003

Abstract PDF: Gastrointestinal stromal tumors (GISTs) are uncommon tumors that originate from primitive mesenchymal cells. Because GISTs develop throughout the gastrointestinal tract, they present variable heterogenous clinical manifestations such as gastrointestinal bleeding. We report a case of massive gastrointestinal bleeding from jejunal stromal tumor mimicking arteriovenous malformation. (Korean J Gastrointest Endosc 2003;26:214⁣219)

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70세 남자, 식욕부진과 구토: Korean J Gastrointest Endosc 2000;20(5):357-358. Published online November 30, 1999

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증례 : 식도 위장관 ; 결핵성 임파선염을 동반하고 상하부 장관을 광범위하게 침범한 장결핵 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intestinal Tuberculosis Extensively Involving the Upper and Lower Intestinal Tract , Accompanied by Tuberculous Lymphadenitis ): Korean J Gastrointest Endosc 1998;18(3):408-415. Published online November 30, 1997

Abstract PDF: The prevalence of intestinal tuberculosis has been markedly decreased with the development of anti-tuberculous chemotherapy, preventive medicine, vaccinations, early detection and treatment of pulmonary tuberculosis, and improved eeonomic conditions. Nowadays, intestinal tuberculosis is a disease that should be differentiated from the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, Behcet's disease, and colon cancer and amebic colitis. This disease also has a new clinical significance in that it has an increased infection rate and unfavorable outcomes in patients infected by HIV or in those who undergo organ transplantation or receive immunosuppressive agents. Tuberculosis of the duodenum was a rare disease and was not reported in the last decade. Moreover Intestinal tuberculosis extensively involving the small bowel including the duodenum and colon was very rarely reported in the various relateid literature. Recently we experienced a case of advanced intestinal tuberculosis involving the duodenum, jejunum, ileum, and colon accompanied by tuberculous cervical and abdominal lymphadenopathies, in a 49-year-old woman who manifested profound general weakness, diarrhea, and marked weight loss. She was diagnosed pathologically by upper gastrointestinal endoscopy, colonoscopy, and fine needle aspiration cytology as well as by roentgenologic examination. The patient was given antituberculous medication which resulted in dramatic clinical improvement. In this report, we present this case with review of the related literature. (Korean J Gastrointest Endosc 18: 408-414, 1998)

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증례 : 식도 위장관 ; 비전형적 부위인 위전정부 ( 2예 ) 와 위공장문합술후 공장 부위 ( 1예 ) 에서 관찰된 Dieulafoy 양 병변 ( Case Reports : Esophagus , Stomach & Intestine ; Dieulafoy - like Lesions of Nontraditional Locations in Gastric Antrum and Jejunum ): Korean J Gastrointest Endosc 1996;16(3):475-481. Published online November 30, 1995

Abstract PDF: Dieulafoy's lesion is a rare distinetive arterial malformation that can cause massive gastrointestinal henorrhage. Although in most cases the lesion is encountered in the proximal stomach within 6 cm of the gastroesophageal junction, similar lesions have been described in the antrum, duodenum, jejunum, colon, and rectum. We report 3 unusually located Dieulafoy-like lesion, two gastric antrum and one jejunum in patient who had gastrojejunostomy for pancreatic caneer. After a year follow up there was no bleeding episode in patient after endoscopic treatment. (Korean J Gastrointest Endosc 16: 475~479, 1996)

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증례 : 소장 내시경으로 진단된 공장 평활근 육종 출혈 1예 ( Case Reports : A Case of Bleeding from Jejunal Leiomyosarcoma Diagnosed with Small Bowel Enteroscopy ): Korean J Gastrointest Endosc 1995;15(3):539-544. Published online November 30, 1994

Abstract PDF: In the evaluation of the source of occult bleeding, it is mandatory that the small bowel be investigated. But, the small bowel is the area where endoscopic approach is most difficult. The endoscopic evaluation of the small intestine has rapidly evolved over the last 10 years and now includes many of the diagnostic and therapeutic capabilities of standard endoscopic procedures. Various techniques have been developed, including fiberoptic sonde enteroscopy, retrograde ileoscopy, intraoperative enteroscopy, "push" enteroscopy using a pediatric colonoscope, and video enterocopy. Therefore, the small bowel enteroscope has shown great promise in the evaluation of obscure or persistent gastrointestinal bleeding. We have experienced a case of bleeding from jejunal leiomyosarcoma, which diagnosed with small bowel enteroscopy. So we report the case with a brief review of literature.

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공장에 발생한 혈관이형성증 1예 ( A Case of Angiodysplasia in the Jejunum ): Korean J Gastrointest Endosc 1993;13(1):91-94. Published online November 30, 1992

Abstract PDF: Angiodysplasia of the small bowel is an uncommon disorder in Korea, and is often found to be the cause of unexplained gastrointestinal bleeding. A 53-year-old male patient visited an emergeney room because of repeated melena and dizziness, He underwent selective superior mesenteric arterial angiography which revealed abnormal clusters of small arteries and early opacification of veins draining a segment of lower jejunum. An exploratory laparotomy was performed under the impression of angiodysplasia. An ulceration on the lower jejunum was found, and was resected. Subsequent jejunojejunostomy was performed. Histology of the resected specimen showed an irregularly dilated vessels in mucosa and submucosa.

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