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Weichen Wang - One of the best experts on this subject based on the ideXlab platform.

  • pancreatic heterotopia in the gastric antrum
    Archives of Pathology & Laboratory Medicine, 2004
    Co-Authors: Vishal S Chandan, Weichen Wang
    Abstract:

    17-year-old adolescent boy presented with a history of epigastric pain for the past 10 to 12 weeks. He had no significant family or personal medical history. The results of a physical examination were nonrevealing, therefore an esophagogastroduodenoscopy was performed. When the endoscope was introduced into the stomach, a 1-cm polypoidal lesion was seen in the gastric antrum. The lesion appeared to be submucosal with an intact submucosa and muscularis propria interface. No lymphadenopathy was seen. This lesion in the gastric antrum was excised and sent for histopathologic examination. On microscopic examination, a well-circumscribed submucosal nodular lesion with overlying benign gastric mucosa was evident (Figure 1). The lesion displayed unremarkable pancreatic lobules with acini, ducts (Figure 2), and islets of Langerhans cells (Figure 3, arrow). No evidence of cellular pleomorphism, necrosis, mitosis, or stromal reaction was present. Heterotopic pancreas is defined as pancreatic tissue outside the boundaries of the pancreas that lacks anatomic and vascular continuity to this organ. Heterotopic pancreas is a relatively infrequent lesion, with an incidence ranging from 0.5% to 13% in autopsy studies. Heterotopic pancreas is usually found in the upper gastrointestinal tract, with more than 90% of the cases involving the stomach, duodenum, jejunum, and Meckel diverticulum. 1 Unusual locations are the colon, spleen, liver, biliary tract, mesentry, skin, lymph nodes, and fallopian tube. The pathogenesis of this lesion is unknown; it is believed to arise during embryonic development of the gastrointestinal tract. The normal pancreas is derived from several evaginations originating from the wall of the primitive duodenum. During embryogenesis, if one or more evaginations remain in the wall of the bowel, then it may be carried away from the remainder of the gland by the developing gastrointestinal tract and may give rise to heterotopic pancreas. 2 The other theory proposes pancreatic metaplasia of endodermal tissues that end up in the submucosa during embryonic life. Pancreatic heterotopia grossly resembles normal pancreatic parenchyma as a submucosal nodule, as an intramural mass, or as a nodular lesion involving the serosa. On gross examination, the color is yellow to yellow-white, and cut section reveals a lobulated appearance. The size

Antonino Apignani - One of the best experts on this subject based on the ideXlab platform.

  • obstructive internal hernia caused by mesodiverticular bands in children two case reports and a review of the literature
    Medicine, 2017
    Co-Authors: Mirko Bertozzi, Berardino Melissa, Elisa Magrini, Giuseppe Di Cara, Susanna Esposito, Antonino Apignani
    Abstract:

    INTRODUCTION The mesodiverticular band (MDB) is an embryologic remnant of the vitelline circulation, which carries the arterial supply to the Meckel diverticulum. In the event of an error of involution, a patent or nonpatent arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This creates a snare-like opening through which bowel loops may herniate and become obstructed. This report describes 2 rare cases of small bowel occlusion owing to an internal hernia caused by a MDB. CASES Case 1 was a 5-year-old boy who presented to our Emergency Department with colicky abdominal pain diffused to all abdominal quadrants. He also had 5 episodes of emesis, the last with bilious vomiting. Case 2, a 12-year-old boy, presented to our Emergency Department complaining of colicky abdominal pain. He had 2 episodes of nonbilious emesis. On physical examination, both children showed distension and tenderness of the abdomen and abdominal x-ray and ultrasound confirmed an occlusive picture without an apparent etiology. In case 1, an urgent laparotomy was performed and the MDB was ligated and cut, whereas in case 2 diagnosis and excision were performed in laparotomy. In both patients, there was a positive clinical evolution. CONCLUSION Although MDB causing internal hernia is very rare, it should be considered in patients with a clinical picture of small bowel obstruction. In these cases, early surgery is important to prevent strangulation and gangrene of the bowel and to avoid dramatic events. Moreover, laparoscopy seems a safe and effective technique in these patients, especially in children with mild abdominal distention without surgical or trauma history, highlighting that further studies on the value of laparoscopy for the treatment of small bowel obstruction in pediatric patients are urgently needed.

Bradley Shapiro - One of the best experts on this subject based on the ideXlab platform.

  • small intestinal intussusception secondary to a submucosal lipoma
    Archives of Pathology & Laboratory Medicine, 2002
    Co-Authors: Yulia Gray, Jhung W Jhung, Bradley Shapiro
    Abstract:

    A woman with a medical history of mastectomy, thyroidectomy, and Hodgkin disease 10 years ago complained of intermittent abdominal pain for 9 to 12 months. Two days before admission, she had worsening of the pain and diminished bowel movements. Abdominal computed tomographic (CT) scan revealed a small bowel intussusception in the lower midabdomen (Figure 1, arrow). There was moderate small intestinal distention. The loops within the intussusception were thickened and presumed to be edematous. The origin of the intussusception was uncertain. The patient underwent an exploratory laparotomy and small bowel resection. The specimen consisted of a small intestinal segment with the intussusceptum telescoping into the intussuscipiens. Mucosa was edematous and hemorrhagic. The leading point was a polypoid mass, which measured 3.5 3 2.0 3 2.0 cm. The mass was firm and rubbery without ulceration. Cut surface revealed a yellowish, solid, homogeneous submucosal nodule (Figure 2), which microscopically was confirmed to be a lipoma. Intussusception is defined as the telescoping of a proximal segment of intestine, termed intussusceptum, into the distal intestinal loop, known as intussuscipiens.1,2 Intussusceptions may be enteroenteric, ileocolic, or colocolic.2 Although intussusception is a common cause of surgical emergencies in infants and children, it occurs relatively rarely in adults. A mechanical cause of intussusception is found in 90% of adults, but can be rarely demonstrated in infancy and early childhood.1 Known causes of intussusception in infants and children include lymphoma, lymphoid polyp, Meckel diverticulum, ectopic pancreas, acute appendicitis, leiomyoma, juvenile polyp, polyposis, enterogenous cyst, and duplication cyst. In 88% of infants and children, no definite cause for intussusception is found.1 Other possible causes include enlarged Peyer patches, viral infections, and trauma. Most cases of intussusception in adults are tumor related, with lipoma as the most common tumor. Other neoplasms include intestinal polyp, adenocarcinoma, leiomyoma, metastatic carcinoma, lymphoma, leiomyosarcoma, and melanoma.1,2 Additional causes include Meckel diverticulum, nonspecific ulcer, and ectopic pancreatic tissue.1

Vishal S Chandan - One of the best experts on this subject based on the ideXlab platform.

  • pancreatic heterotopia in the gastric antrum
    Archives of Pathology & Laboratory Medicine, 2004
    Co-Authors: Vishal S Chandan, Weichen Wang
    Abstract:

    17-year-old adolescent boy presented with a history of epigastric pain for the past 10 to 12 weeks. He had no significant family or personal medical history. The results of a physical examination were nonrevealing, therefore an esophagogastroduodenoscopy was performed. When the endoscope was introduced into the stomach, a 1-cm polypoidal lesion was seen in the gastric antrum. The lesion appeared to be submucosal with an intact submucosa and muscularis propria interface. No lymphadenopathy was seen. This lesion in the gastric antrum was excised and sent for histopathologic examination. On microscopic examination, a well-circumscribed submucosal nodular lesion with overlying benign gastric mucosa was evident (Figure 1). The lesion displayed unremarkable pancreatic lobules with acini, ducts (Figure 2), and islets of Langerhans cells (Figure 3, arrow). No evidence of cellular pleomorphism, necrosis, mitosis, or stromal reaction was present. Heterotopic pancreas is defined as pancreatic tissue outside the boundaries of the pancreas that lacks anatomic and vascular continuity to this organ. Heterotopic pancreas is a relatively infrequent lesion, with an incidence ranging from 0.5% to 13% in autopsy studies. Heterotopic pancreas is usually found in the upper gastrointestinal tract, with more than 90% of the cases involving the stomach, duodenum, jejunum, and Meckel diverticulum. 1 Unusual locations are the colon, spleen, liver, biliary tract, mesentry, skin, lymph nodes, and fallopian tube. The pathogenesis of this lesion is unknown; it is believed to arise during embryonic development of the gastrointestinal tract. The normal pancreas is derived from several evaginations originating from the wall of the primitive duodenum. During embryogenesis, if one or more evaginations remain in the wall of the bowel, then it may be carried away from the remainder of the gland by the developing gastrointestinal tract and may give rise to heterotopic pancreas. 2 The other theory proposes pancreatic metaplasia of endodermal tissues that end up in the submucosa during embryonic life. Pancreatic heterotopia grossly resembles normal pancreatic parenchyma as a submucosal nodule, as an intramural mass, or as a nodular lesion involving the serosa. On gross examination, the color is yellow to yellow-white, and cut section reveals a lobulated appearance. The size

Corsetti, Ralph L. - One of the best experts on this subject based on the ideXlab platform.

  • Peritoneal Encapsulation With Incarcerated Meckel diverticulum Contributing to Small Bowel Obstruction
    'Ochsner Journal', 2019
    Co-Authors: Robbins, Keenan J., Kooperkamp, Hannah Z., Corsetti, Ralph L.
    Abstract:

    Background: Meckel diverticulum is the most common congenital gastrointestinal malformation, but it is rarely symptomatic. Peritoneal encapsulation is a rare abnormality of embryonic development and may present with obstruction, although it too is usually asymptomatic.Case Report: We report the case of an 82-year-old male who presented with symptoms and imaging findings consistent with small bowel obstruction. During laparotomy, a peritoneal encapsulation was observed containing the majority of the small bowel. A Meckel diverticulum was discovered tethered to the small bowel mesentery by a mesodiverticular band, preventing egress from the accessory peritoneal membrane and appearing to be the cause of the obstruction.Conclusion: This patient had 3 rare findings-peritoneal encapsulation, Meckel diverticulum, and a mesodiverticular band- contributing to cause an acute small bowel obstruction. The presence of all of these features in one patient is extremely rare, and we believe this is the first description of such a phenomenon