Jejuno and Ileum Miscellaneous - The Gastrointestinal Atlas

This is the case of a 63-year-old man, who presents with severe bleeding from the digestive system, the upper endoscopy was negative as well as the colonoscopy, a second colonoscopy is repeated, which was also negative, an enteroscopy is performed, finding this image after the triangle. Treitz, had a history of splenectomy at 18 years without further information and bleeding from the digestive tract 15 years earlier due to duodenal ulcer and had no follow up with any doctor in that period,

Las várices ectópicas (VE) en yeyuno son alteraciones vasculares infrecuentes, asociadas en mayor medida a la hipertensión portal. Cuando se presenta sin esta asociación son aún menos frecuentes.

Fue intervenido quirúrgicamente encontrando múltiples varices extraluminares cuales fueron ligadas con seda

Video Endoscopic Sequence 2 of 4.

Várices del Yeyuno

Fue intervenido quirúrgicamente encontrando múltiples varices extraluminares cuales fueron ligadas con seda.

Se define como sangrado intestinal oscuro al sangrado que persiste o recurre sin obvia etiología luego de practicar endoscopia digestiva alta y colonoscopia y puede ser oscuro evidente o manifiesto cuando el paciente y el clínico evidencian el sangrado u oscuro oculto que no es precisable y los exámenes paraclínicos lo determinan

Video Endoscopic Sequence 3 of 4.

Várices del Yeyuno

Video Endoscopic Sequence 4 of 4.

Várices del Yeyuno

En la cirugía se ligaron al menos un metro de intestino con múltiples varices extraluminales

Para agrandar la imagen presionar sobre ella

Video Endoscopic Sequence 1 of 2.

Diverticulosis of the terminal ileum

Diverticulosis of the terminal ileum is very rare.

This is the case of an 84 year-old-male, who was hospitalized due to bleeding of lower digestive tract because of a diverticular disease, colonoscopy is performed in search of the exact site of bleeding, finding multiple diverticula throughout the entire colon, the terminal ileum, shows several diverticulae.

Download the video clips by clicking on the endoscopic
images, if you wish to observe in full screen, wait to be
downloaded complete then press Alt and Enter for
Windows media, Real Player Ctrl and 3.
Configure the windows media in repeat is optimal.
All endoscopic images shown in this Atlas contain
video clips. We recommend seeing the video clips in full
screen mode.

Video Endoscopic Sequence 2 of 2.

Colonoscopy of diverticulosis of the terminal ileum

Except for Meckel’s diverticulum, diverticulosis of the small intestine is very rare. If present, most of diverticulosis of the small intestine is located in the duodenum and jejunum. Diverticulosis of the ileum is extremely rare; only a few case reports are present in the English literature.

Video Endoscopic Sequence 1 of 9.

Ileal Neobladder Substitution (ileal bladder)

Radical cystectomy remains one of the most effective methods of control of invasive bladder cancer. The construction of an ileal conduit remains a tried and tested method of urinary diversion.

Removal of the bladder (cystectomy) necessitates reconstruction of the lower urinary tract. Bladder cancer is the most common reason for cystectomy.

However, the same principles apply to patients who undergo pelvic exenteration for other malignancies, or who require cystectomy for non-malignant conditions such as birth defects, trauma, or neurologic disorders.

Video Endoscopic Sequence 2 of 9.

This image shows one of the uretero-enteric anastomosis.

Ureterosigmoidostomy was the first widely used surgical technique for urinary diversion, providing an effective diversion that relied upon the anal sphincter for continence.

However, deterioration of renal function over time, metabolic complications, and the increased risk for the development of secondary malignancies limited its usefulness.

Subsequent surgical advances in reconstructive techniques have led to major improvements in both functional outcomes and quality of life.

Video Endoscopic Sequence 3 of 9.

A close up of the uretero-enteric anastomosis.

Ureterosigmoidostomy was the first widely used surgical approach for urinary diversion after cystectomy. The ureters were implanted into the sigmoid colon and the anal sphincters were relied upon to provide continence.

Approximately 50 years of experience with this approach defined a series of complications that guided subsequent surgical progress:

Gradual deterioration of renal function, secondary both to chronic urinary tract infection, which was a result of mixing of the urinary and fecal streams, and to obstruction of the ureterointestinal anastomosis
Hyperchloremic acidosis, as a result of resorption of excreted urinary products by the bowel mucosa
Development of secondary cancers in the sigmoid colon near the site of ureteral implantation.

Video Endoscopic Sequence 4 of 9.

Videoendoscopy of uretero-enteric anastomosis

The most commonly used bowel segments for continent urinary diversion are either ileum or a combination of terminal ileum and ascending colon. Ensuring that all continent diversions store and empty urine at low pressures is paramount.

High storage and voiding pressures ultimately cause high-pressure reflux nephropathy and may result in renal failure; therefore, all bowel segments used for continent diversion, with the exception of their use in a ureterosigmoidostomy procedure, initially are detubularized.

The bowel segments then are refashioned in a more spherical shape, which increases capacity and decreases luminal pressure by a magnitude of 3- to 4-times lower than the original segmental pressure.

Video Endoscopic Sequence 5 of 9.

This image displays the two uretero-enteric anastomosis

Orthotopic diversion (ortho meaning correct, topic meaning of a place) is a term that describes the reconstructed pouch anastomosed to the native urethra. Neobladder is a term used synonymously with orthotopic diversion.

The continence mechanism in an orthotopic diversion is the native urethral rhabdosphincter. Continent diversion may be further categorized into 3 types,

(1) orthotopic or neobladder diversion,

(2) continent catheterizable diversion, and

(3) ureterosigmoidostomy.

Video Endoscopic Sequence 6 of 9.

Videoendoscopy of uretero-enteric anastomosis

Video Endoscopic Sequence 7 of 9.

Again the two uretero-enteric anastomosis

Video Endoscopic Sequence 8 of 9.

Urostomy pouch

Video Endoscopic Sequence 9 of 9.

Urostomy pouch

After having Radical Cystectomy, where the bladder is removed, it is necessary to have a mean of collecting the urine from the stoma that was created; the urine containing body waste must be brought to the out side, the stoma, and disposed of. If we did not ware a Urostomy pouch.

Video Endoscopic Sequence 1 of 6.

Adenocarcinoma of the terminal ileum

This is the case of a man aged 72, who had been with recurrent enterorragias in two previous colonoscopies in another clinic that was not conclusive.

Video Endoscopic Sequence 2 of 6.

Blood remains, seen in retroflexion maneuver at ascending colon.

Video Endoscopic Sequence 3 of 6.

Incompetency of the ileocecal valve

In retroflexion the ileocecal valve is open and part of the terminal ileum is observed.

Video Endoscopic Sequence 4 of 6.

Ulcerated area and narrowness is observed, biopsies confirmed adenocarcinoma of the terminal ileum.

Video Endoscopic Sequence 5 of 6.

Adenocarcinoma of the terminal ileum.

Video Endoscopic Sequence 6 of 6.

Adenocarcinoma of the terminal ileum.

Video Endoscopic Sequence 1 of 7.

Enteroscopy Adenocarcinoma of the Treitz angle

A 65-year-old female who had already undergone two endoscopies of the upper digestive system in other clinics was referred to us, for evaluation, as important data had weight loss of more than 25 pounds and incoerctable vomiting. She underwent a computerized axial tomography finding the stomach and duodenum extremely dilated which gave us the suspicion of a distal obstruction of the duodenum, an enteroscopy was performed finding the mass of these images and videos.