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[Blind loop of the large intestine--bypass enteropathy or diversion colitis?]
1Abteilung für Allgemeine, Abdominal- und Gefässchirurgie, Chirurgische Universitätsklinik Homburg/Saar.
Insights
Patients with long-term digestive issues may have bypass-enteropathy and diversion-colitis due to prior surgeries. Surgical correction of the bowel bypass can fully resolve symptoms and restore normal health.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Context:
- Presents a clinical entity in patients with prior ileo-colic bypass surgery.
- Highlights longstanding diarrhea, bloating, and cramps as key symptoms.
Purpose:
- To describe a functional disorder characterized by bypass-enteropathy and diversion-colitis.
- To emphasize the diagnostic role of radiology in differentiating from Crohn's disease.
- To recommend surgical reintegration for causative treatment.
Summary:
- Investigated three patients with symptoms of bypass-enteropathy and diversion-colitis.
- Identified stenotic anastomosis in two patients with ileo-colic bypass.
- Radiological examination is crucial for diagnosis, as endoscopic and histological findings may mimic Crohn's disease.
Impact:
- Surgical correction leads to complete symptom resolution and normal health.
- Morphological signs of inflammation are reversible post-surgery.
- Bowel function is preserved, allowing for successful treatment even decades after initial surgery.
Abstract:
Investigating three patients with longstanding diarrhoea, severe abdominal bloating and cramps revealed an exclusion of the right hemicolon in all patients and additionally of the terminal ileum in one of them. The anastomosis of the ileo-colic bypass, performed decades ago due to complicated appendicitis, was stenotic in two of them. Because a classical blind-loop-syndrome could not be proven, the functional disorder is described as a clinical entity characterized by signs of bypass-enteropathy and diversion-colitis. The importance of the radiological examination for diagnosis and therapy-planing is emphasized, because endoscopically and histologically Crohn's disease might be suspected. The surgical reintegration of the bowel into the orthograde continuity of the intestinal tract is recommended as the causative treatment. Symptoms disappear completely and patients win normal health even after some decades, because the morphological signs of inflammation are reversible and bowel function is not lost during the exclusion.