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Ileal Dieulafoy lesion arose 15 years after partial small bowel resection for meconium obstruction of the neonate: a case report.

ABSTRACT:

Background

Anastomotic or perianastomotic ulcers present with symptoms such as chronic anaemia and occult bleeding as long-term complications of bowel resection performed in infancy.

Case presentation

Herein, we describe a 15-year-old girl with a history of surgery for meconium obstruction without mucoviscidosis in infancy who was hospitalized with chief complaints of presyncope and convulsions. Seven hours after admission, she developed melena and went into shock. An emergency laparotomy was performed, and a Dieulafoy lesion was detected near the site of ileal anastomosis from the surgery that had been performed during infancy.

Conclusions

Although overt massive lower gastrointestinal bleeding necessitating emergency care is rare in the long term after infant bowel resection, Dieulafoy lesions can cause serious bleeding, requiring rapid life-saving haemostatic procedures.

SUBMITTER: Iwamoto M

PROVIDER: S-EPMC8494758 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeTo investigate the role of endogenous hydrogen sulfide (H(2)S) in partial obstruction-induced dysfunction of the interstitial cells of Cajal (ICC) in mice ileum.Materials and methodsPartial intestinal obstruction was induced surgically in male imprinting control region (ICR) mice. ICC networks were studied by Immunohistochemistry. Electrical activity was recorded by intracellular recording techniques. The expression of ICC phenotype marker c-kit receptor tyrosine kinase (c-kit), membrane binding stem cell factor (mSCF), the endogenous H(2)S biosynthesis enzymes cystathionine-?-synthase (CBS) and cystathionine-?-lyase (CSE) was studied by Western blotting. The expression of tumor necrosis factor-? (TNF-?) mRNA was observed by using real-time polymerase chain reaction.ResultsPartial intestinal obstruction resulted in ICC networks were disrupted above obstruction 14 days after the operation. The slow waves of intestinal smooth muscles in the dilated region were significantly suppressed and their amplitude and frequency were reduced, whilst the resting membrane potentials were depolarized. The expression of c-kit and mSCF was significantly decreased, also suggesting the disruption of the ICC network. The expression of TNF-? was significantly increased in the tunica muscularis of the obstructed intestine. Treatment of cultured intestinal smooth muscle cells with TNF-? caused dramatic down regulation of mSCF. The expression of CBS and CSE was significantly decreased in the tunica muscularis of the obstructed intestine. Intraperitoneal injection (i.p) of DL-propargylglycine, an irreversible inhibitor of CSE, and aminooxyacetic acid, an inhibitor of CBS, elevated the expression of TNF-? mRNA in the tunica muscularis of the ileum. Obstruction-induced over expression of TNF-? was significantly improved by supplementation of NaHS, but not the expressions of mSCF and c-kit.ConclusionsThe down regulation of endogenous H(2)S biosynthesis is related to over expression of TNF-? in obstructed small intestine. TNF-?-mediated mSCF down-regulation is not the only reason of partial intestinal obstruction-induced loss of ICC.